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Jarmak posted:That's some impressive levels of selective reading to support a desired narrative, you sure its not an epidemic because of that part that said WorldsStrongestNerd posted:Yes. Deaths are going up because it is infiltrating the white community, and thus is a problem. Please don't be willfully dense.
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Jan 21, 2016 19:54
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My smallish Midwest hometown has been struggling with heroin for the last decade or so. It's predominantly white and middle-to-upper-middle class, so fatal drug overdoses took most people by surprise. Most folks start experimenting with drugs in high school, and I was one of the last groups to go through the school system there before more exotic substances started showing up. When I went there you could get booze, marijuana, and mushrooms (if you were lucky). When my younger brother went through 4 years later, AD/HD medications and opiods were very common and being recreationally used by students. He and around half of the football team were using oxycontin, and when that pipeline dried up most of them made the switch to heroin. The first time my brother overdosed I went to pick him up from the hospital, because my folks were out of town. I knew nothing about the changes that had happened, and I assumed he had tried to chug a whole bottle of liquor or something (because they told me he wasn't breathing when the ambulance showed up). When I found out he had been shooting up heroin I was pretty taken aback. He's been an addict ever since high school, and has been in and out of treatment programs for the better part of the last decade.
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Jan 21, 2016 20:24
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fade5 posted:Oh yeah it's definitely an epidemic, I'm just mocking because the cries of how to deal with this drug epidemic are amazingly different from the old standby of "we have to be tough on drugs/lock them up for years", instead it's more treatment vs harsh punishment. I like the rat park hypothesis that the cure for addiction is not sobriety, but social integration, the latter of which is counterintuitive both on a societal level and an emotional one as well. It can be genuinely difficult emotionally and socially to be around addicts (my mother is a former alcoholic and tobacco user, while I myself have had issues with substance abuse in the past as well), but I agree that isolating people from others only makes turning to addictive behavior a lot more attractive than the alternative of enduring the raw pain of your negative environment alone. The solution is to take the path of most resistance and be a constant ally of addicts through the dirt and muck of their life situation and so they don't feel alone and stigmatized in their struggle instead of just leaving them to bootstrap it through. Teriyaki Koinku fucked around with this message at 20:39 on Jan 21, 2016 |
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Jan 21, 2016 20:36
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I remember the last time we had an opium epidemic.
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Jan 21, 2016 23:59
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I like how it wasn't a problem when it was just the idle rich using it but suddenly became a menace when poors heard about it. I'm still not certain which is the worst situation, to be a 19th century Chinese peasant with easy access to opium and a ~12% chance of addiction, or a 19th century peasant who would be tortured to death if caught with opium and a tooth infection. I'm going with the latter.
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Jan 22, 2016 00:09
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I wouldn't doubt that a lot of it is related to how competitive hospitals can be. Where I work, we assess pain once per shift and ask about their pain every hour. Hcaps surveys also ask how well pain is controlled and hospital reimbursement is based on the surveys.
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Jan 22, 2016 01:11
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pangstrom posted:I have no doubt that opiates are the best option for some chronic pain patients, but I also have no doubt that they're not the best option for a lot of people who are taking that option. And that the pill mill closures are a good thing on the whole, even though things will probably have to get worse before they get better. Opiates are great for end-of-life stuff and (if you can shut the door) acute stuff. Alcohol and I guess nicotine are the only two drugs I have problems stopping, haven't had a drink in 10 years at least. The fact that they are legal just makes it that much more depressing. And I've done quite a few other drugs. And I agree and said the Oxy epidemic was loving evil, I just wish it hadn't led to therefore all opiates are evil. But again, addiction from taking as prescribed is worlds easier to get over than from abuse. If you aren't No Butt Stuff and intentionally abuse them there's no little to no psychological addiction and getting over the physical if you step down your dosage gradually over a few weeks is not that unpleasant (YMMV as always). Baclofen has been found to almost eliminate withdrawal and I can vouch personally that it does. I take 60mg a day and before I moved to mail order refills when I'd get issues with pharmacies I discovered that the baclofen got rid of almost all withdrawal, essentially going from extreme pain to 'this sucks but I'll live" as long as I didn't have an 'attack'. If it worked better as an anti spasmodic I'd drop the opiates in a heartbeat. Pill mill doctors were defiantly a thing especially where I live (WPB Florida) but before that opiates were not that big of a deal, you could get refills by phone as long as you saw your PCP every three months but thanks to people abusing that to hell and back people who really do need them now have to go through hell. Even though I have alcohol issues I don't think that means other people should not be able to get alcohol but because of people like No Butt Stuff just using them to get stoned for a year people who do actually need them get penalized which is my problem. Edit: What are your feelings on alcohol and say Paxil? Alcohol withdrawal and benzo withdrawal can actually kill you, most people trying to get off Paxil will say it's months of living hell, forget feeling poo poo for 3 weeks, try 6 months of seriously contemplating suicide. If addiction is the most important factor to consider, why does it only apply to things like opiates when there are dozens if not hundreds of other prescription drugs or legal things that are far worse to kick, that's not even counting things like I think it was a toenail fungus med that had "sudden death" as a possible 'side effect', Edit 2: Ketoconazole. Side effects are potential liver damage severe enough to require a liver transplant and sudden death due to heart problems. For fungal infections (it has other uses granted) . Pure opiates when not abused you risk 3-4 weeks of feeling like you have a severe flu but are otherwise essentially non-toxic but becaus some people abuse them to get high it's somehow worse. Toasticle fucked around with this message at 02:18 on Jan 23, 2016 |
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Jan 23, 2016 01:37
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BarbarianElephant posted:There is a real lack of painkillers between "headache pills" and opioids. If medical science could create a painkiller as strong as percocet but non-addictive and not significantly dangerous long-term, a lot of people's lives would be improved. There actually are, they just aren't well known or researched. Disassociative drugs, while having dangers, are not as addictive and physically addictive as opiates. A mild disassociative mixed with a mild opiate has a synergistic effects. Its just not prescribed or used much, because doctors don't know, and because DXM and morphine are both out of patent.
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Jan 23, 2016 22:42
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Ketamine is the answer.
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Jan 23, 2016 23:32
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Morphine doesn't really get you high if you take it as prescribed so while you'll definitely feel it if you're taking it for a long time and stop you're not going to get high like oxy assuming its a standard liquid solution. I
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Jan 23, 2016 23:35
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BarbarianElephant posted:There is a real lack of painkillers between "headache pills" and opioids. If medical science could create a painkiller as strong as percocet but non-addictive and not significantly dangerous long-term, a lot of people's lives would be improved.
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Jan 23, 2016 23:38
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Guavanaut posted:Kratom derivatives might show some promise here. Or do they count as opioids? based off the amount of TCC posters getting massive addictions from it probably but that might have been the tincture that was probably an opiate research chemical
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Jan 23, 2016 23:41
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Also whether there is a difference in the dependence liability of use under a pain management professional and use under the internet.
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Jan 24, 2016 01:01
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Unfortunately, this is an issue that hits real close. I grew up and live on Long Island, and I guess that epidemic is the right word for this situation. It's been rather mind-boggling how its all happened within the past 10 or so years. I do firmly believe that since it's now affecting the suburbs and middle/upper class whites, that its *mysteriously* an epidemic now. Long Island is known to be heavily segregated (thanks Levittown and white flight!) with pretty noticeable levels of economic disparity. When you're 1 of 10 nonwhite students in a HS of 800, you notice it verrrry quickly what part of the island you're at. I notice in hindsight that it was considerably easier to get pills in HS (2005-2009) than it was to get pot, and kids would just bring their parents leftover Percocet or Vicodin into school and take a few for kicks during lunch. I once had some classmate in my sophomore Bio class bring in mysterious blue pills that his father had, and he just shared it with my friend and I. I took 3 (I loving parachuted them, as it was recommended by another classmate) midway through class, and two periods later in World History, I had to write an essay. I had two sentences written, a bit of a weird wavy line, and then nothing, as I had sort of nodded off. I never really ventured any further into pills beyond that incredibly bizarre Percocet experience. The stigma of addiction is real in a status conscious area, coupled with the sheer ease of access to pills, has lead to a lot of parents burying their children. 9th grade is when I really started noticing opiates being a thing, and by senior year, we had people leaving used syringes near an elementary school and the beach by my house. Opiates became heroin fast. Seeing track marks for the first time on your close friend is something surreal. Kids would just be gone for months at "rehab" and sometimes come back clean, but then starting right up where they left off a few weeks later because you couldn't really escape it. I've personally lost a few people to heroin, and I have a lot of friends who have sought out treatment. Some are doing well, but they have a strong support system of family and friends. Others...not so much. Someone I knew is in prison for attacking his close friend and their father because of $100 bucks used for heroin. Then there was this, which happened less than 2 miles from my elementary school. This happened at a urgent care clinic I once went to (my PCP was out of town), and I distinctly remembered the signs plastered all over the waiting room stating that they wouldn't give controlled substances to first time patients. I was recently in a car accident and the way the nurse asked if I wanted any pain meds was like waitstaff recommending daily specials at a restaurant. What was even more disturbing was some people coming out of the woodwork to ask if I had any meds left over that I "didn't need" a few weeks later. The whole situation is loving horrendous and I wouldn't wish for anyone to deal with an iota of it. I see little effort being done outside of legally punitive measures. Any sort of measured progress would require acknowledging a lot of harsh realities and problems, and that simply doesn't happen on Long Island.
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Jan 24, 2016 18:35
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Toasticle posted:Alcohol and I guess nicotine are the only two drugs I have problems stopping, haven't had a drink in 10 years at least. The fact that they are legal just makes it that much more depressing. And I've done quite a few other drugs. http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates pangstrom fucked around with this message at 02:35 on Jan 26, 2016 |
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Jan 26, 2016 02:32
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Does every single topic in this forum have to be seen through a racial lens?
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Jan 26, 2016 03:11
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Cuzbruz posted:Does every single topic in this forum have to be seen through a racial lens? I know, can't we just talk about the opiate abuse problem in normal communities without making reference to inner city drug epidemics?
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Jan 26, 2016 03:18
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Cuzbruz posted:Does every single topic in this forum have to be seen through a racial lens? Lol
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Jan 26, 2016 03:30
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GreyjoyBastard posted:I know, can't we just talk about the opiate abuse problem in normal communities without making reference to inner city drug epidemics? The whole line of thinking "Nobody gave a gently caress about drug abuse until it happened to white people" reads like it's straight out of /r/conspiracy.
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Jan 26, 2016 03:32
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blackguy32 posted:I wouldn't doubt that a lot of it is related to how competitive hospitals can be. Where I work, we assess pain once per shift and ask about their pain every hour. Hcaps surveys also ask how well pain is controlled and hospital reimbursement is based on the surveys. This is a big part of it. Running chains of hospitals is now big healthcare business. They meticulously track patient satisfaction scores, pain scores, etc for each doctor. And hospitals themselves are tracked on the same scores by both private sources online and publicly. I know Medicare was considering penalizing you a certain percentage of your reimbursement if your patient satisfaction was too low. 90% of your patients, if asked their satisfaction with their care, would say you're doing a good job, regardless of how well you're doing. They don't know any better. But do you know the number one cause of complaints? Not giving the patient what they want, even if they don't need it, even when it's bad for them. So when you have 40 patients in your busy ER and you're running from room to room spending 5-10 minutes per patient, and you just need them to go away, are you really going to take the time to sit down and patiently explain to them why you won't be giving them their meds? Or why the patient you're discharging from the hospital can't have "just a little more to cover me until my next refill?" Are you going to risk getting chewed out over easily preventable bad satisfaction scores? No. You'll give the patient what they want. That's, unfortunately, the mindset I see in my collegues. They know there's a problem, but the system actively disincentivizes you to do anything about it.
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Jan 26, 2016 03:43
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Cantorsdust posted:This is a big part of it. Running chains of hospitals is now big healthcare business. They meticulously track patient satisfaction scores, pain scores, etc for each doctor. And hospitals themselves are tracked on the same scores by both private sources online and publicly. I know Medicare was considering penalizing you a certain percentage of your reimbursement if your patient satisfaction was too low. Yeah, it's awful from a nurses end. Patients want pain meds yet they are falling asleep standing up or they want Phenergan iv, never mind if it will eat up your vein. Meanwhile the hospital keeps riding on you to say stupid poo poo designed to bring scores up such as "for your comfort" etc. It's now resulting in some patients taking advantage
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Jan 26, 2016 04:06
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Cuzbruz posted:The whole line of thinking "Nobody gave a gently caress about drug abuse until it happened to white people" reads like it's straight out of /r/conspiracy. At the very least, the policy responses are... dissimilar.
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Jan 26, 2016 05:03
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A few big things happened that changed the heroin situation in white communities (also overall availability, but I mention white communities because holy gently caress heroin/opioid abuse have blown up in the last 10-15 years). 1) Stigma against opiate use has almost completely disappeared among youth. Gone are the days of the Requiem for a Dream "if you take opiates you're going to get hosed by a black guy." 2) Heroin got majorly romanticized in the tail end of the 90s and the early 2000s. At first, the stigma still was strong, but by the mid 2000s, the stigma was wearing off, yet the romanticization of heroin use (and the lifestyle associated with it in particular) was growing rapidly. 3) Once the economy imploded and the housing bubble popped, teenagers started working less (16-24 was the hardest hit demographic). Similarly, a statistically significant bunch of kids went through homelife upheaval (either due to family losing work, houses foreclosed, money for college not there, etc.). Kids with stressful home-lives and minimal prospects for the future are always at high risk for drug abuse. Pills generally being cheap or free in the beginning and heroin being extremely cheap (considering how far it goes in opiate-naive users) make for a ready escape. 3a) A lot of those same factors applied to middle/upper-class families as well as a ton of families were living well beyond their means. Even for those with economically stable home-lives, factors 1 and 2 were influential. Especially 2. If you spent time around affluent, alternative communities in New England, there were a lot of people who thought that life was meaningless and they just wanted a short, brief hedonistic experience. Similarly, heroin was perceived as 'real' and 'authentic' and 'edgy.' It definitely became a status symbol and for a lot of people it seemed to be a way that you could buy a sort of authenticity and human connection (cause if you've got H you are playing with fire and you are going to have people around if you want them). Moreover, especially for younger people, shooting up seemed to get weirdly communal and intimate. [I heard this basic account over and over and over again in group therapy sessions with heroin addicted teenagers] 4) After 2001, a lot of federal resources and manpower went from pursuing drug dealing, production, and smuggling into terrorism or fighting the wars in the ME. Since then, drug availability, purity, and cheapness have been on an almost across-the-board rise (this is true of all the most common drugs). Methamphetamine is making a massive comeback that is now beyond where it ever was at the height of the previous meth epidemic in many states. That's not the purview of this thread, but it's going to be in the news a lot more. Actually, where heroin has moved into well-off white communities, meth is now prevalent in minority communities with whom it didn't used to be particularly popular. For whatever reason, since 2010 especially, drug availability and purity are way up while price is way down. 5) There's a worldwide heroin epidemic. Afghanistan is once again producing an absolute mountain of heroin and even though it isn't making its way here, the quantity of heroin flowing in black market channels is the highest it has been in a long time. Also since heroin production exploded in Eurasia (by which I mostly mean Afghanistan), it's safe to assume that smuggling resources that were previously getting heroin and cocaine to European markets from Central/South America aren't bothering to compete with dirt cheap Afghan heroin, freeing up some amount of smuggling/organizational resources to focus specifically on American markets. There are obviously more factors involved, but at the moment we're in a perfect storm situation for a heroin epidemic. Similarly, we're in the buildup to a massive meth epidemic, too, if it isn't already here. A lot of the factors that kickstarted the opioid epidemics (high rates of use of pharmaceutical opioids among teenagers/youngish adults) are equally true of amphetamines. If you spend time around the under 25s, you'll see a pretty astounding rate of amphetamine use and abuse. Meth is still fairly stigmatized, but it's getting more mainstream and is getting a dark sort of glamour to it, as well. Personally, I find the meth epidemic a lot more concerning as meth users are more violent and toxic to whatever community they live within. Heroin addicts are a nuisance, but less of a physical threat (until you start talking about them as an infectious disease vector). Herstory Begins Now fucked around with this message at 07:12 on Jan 26, 2016 |
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Jan 26, 2016 07:08
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I'm an addict and it's insane to me to think that someone could take all those painkillers and not be high. Not saying it's the case but just throwing it out there to show how crazy it might seem to some people. My son's mother's mother is a doctor shopper and has a whole shelf of drugs that she gets her husband to drive her 100 miles on one of his few days off so she can re-up. It's real hard not to just want to tell people like that to gently caress off when they get the kid gloves compared to crack addicts and even meth heads (as much as I hate them). My son's mother was drugged and raped by a pill popper who we found out had later turned into a heroine addict. Like I said, it's hard to have sympathy for people like that who seem to get a pass because they're white and the drugs they get started on are legal.
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Jan 26, 2016 07:33
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GreyjoyBastard posted:At the very least, the policy responses are... dissimilar. What're Hillary's and Bernie's plans for dealing with the issue?
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Jan 26, 2016 07:36
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Cuzbruz posted:The whole line of thinking "Nobody gave a gently caress about drug abuse until it happened to white people" reads like it's straight out of /r/conspiracy. 90% of first-time heroin users are now white, and it's hitting rich as well as poor. There's been a huge shift in the profile of a typical user and scope of the problem over the past decade. The kindler, gentler approach to how it's being dealt with is one of the consequences of that.
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Jan 26, 2016 08:09
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If a more treatment-based approach emerges because it's white people now and the government isn't as dumb about this issue now then great. Obviously it's not ideal and it doesn't always or even often go this way, but a lot of former-addicts say jail was the best thing to happen to them. Right now the "kinder" approach has been to clamp down on prescription abuse, and while I am for that and I'm sure some other former-addicts say THAT was the best thing to happen to them it's just going to make a lot of addicts hustle harder or turn to heroin.
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Jan 26, 2016 13:10
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A lot of people here have probably already seen it, but this doc is pretty relevant: https://www.youtube.com/watch?v=wGZEvXNqzkM It's specifically about how easy it was to get pills from pain clinics down in Florida. So I guess it's now significantly more difficult to get there rather than just driving up, saying "I have a lot of pain please, pills please!" ? If so I wonder how the main subject in the doc is coping now.
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Jan 26, 2016 13:22
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Is there a story where for some (say, emergency) surgery the anesthetic didn't work because the patient was an opioid addict? It seems like that would happen.
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Jan 26, 2016 13:28
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Mercury_Storm posted:If so I wonder how the main subject in the doc is coping now. http://www.nopetaskforce.org/memorial.php?id=557
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Jan 26, 2016 13:50
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Jeez. While it doesn't come as a surprise, that's nevertheless pretty depressing.
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Jan 26, 2016 14:02
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Cuzbruz posted:The whole line of thinking "Nobody gave a gently caress about drug abuse until it happened to white people" reads like it's straight out of /r/conspiracy. Kind of true, though? When it happens to Others the solution is prison, when it happens to Us the solution is compassion.
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Jan 26, 2016 15:30
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I think one aspect of this problem is that many doctors are very ignorant about opioids and addiction. It's a very common belief among doctors, for example, than the medication tramadol (trade name Ultram I think) isn't addictive. This is complete and utter nonsense and objectively false, yet it is commonly believed by doctors because doctors generally believe whatever drug reps tell them.pangstrom posted:Is there a story where for some (say, emergency) surgery the anesthetic didn't work because the patient was an opioid addict? It seems like that would happen. This kind of scares the poo poo out of me as someone on suboxone (which not only gives you a tolerance to opiates, but actively blocks other opiates). While I carry a card in my wallet that is intended to notify people of this, the amount of opiates that would be required to be effective is so huge that I imagine doctors would be hesitant to use them even if they knew about the suboxone. I just try not to think about how hosed I would be if I got in a serious car accident or something.
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Jan 26, 2016 18:37
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Ytlaya posted:I think one aspect of this problem is that many doctors are very ignorant about opioids and addiction. It's a very common belief among doctors, for example, than the medication tramadol (trade name Ultram I think) isn't addictive. This is complete and utter nonsense and objectively false, yet it is commonly believed by doctors because doctors generally believe whatever drug reps tell them. That's... weird because in the UK it's a little difficult to get tramadol, I've only ever gotten it from the main hospital, GPs generally prescribe codeine phosphate or something.
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Jan 26, 2016 18:57
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Ytlaya posted:This kind of scares the poo poo out of me as someone on suboxone (which not only gives you a tolerance to opiates, but actively blocks other opiates). While I carry a card in my wallet that is intended to notify people of this, the amount of opiates that would be required to be effective is so huge that I imagine doctors would be hesitant to use them even if they knew about the suboxone. I just try not to think about how hosed I would be if I got in a serious car accident or something. http://suboxonetalkzone.com/im-on-suboxone-can-i-have-surgery/
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Jan 26, 2016 19:28
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Ytlaya posted:I think one aspect of this problem is that many doctors are very ignorant about opioids and addiction. It's a very common belief among doctors, for example, than the medication tramadol (trade name Ultram I think) isn't addictive. This is complete and utter nonsense and objectively false, yet it is commonly believed by doctors because doctors generally believe whatever drug reps tell them. Yes, my doctors told me this, which I found to be patently false as well.
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Jan 26, 2016 19:30
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OwlFancier posted:That's... weird because in the UK it's a little difficult to get tramadol, I've only ever gotten it from the main hospital, GPs generally prescribe codeine phosphate or something.
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Jan 26, 2016 19:31
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A few years ago someone in the heroin supply chain started kicking up up the product with Fentanyl. I don't believe street-level dealers or even mid-level distributors are responsible for this change in the product. They busted a fentanyl lab in Canada a few weeks ago but prior to that the only plausible (to me) theory I'd heard was that it was getting mixed in at the source in Mexico. Heroin, while dangerous, didn't used to be nearly as deadly as when hot spots of fentanyl started showing up in it. If the crackdown on prescription Hydrocodone, among other RX opiate painkillers, has driven people to heroin, then it has driven people to a potentially much deadlier substitute than it used to be. The DEA could not have been unaware of this eventuality when they pushed forward the new rules on prescribing opiates. It reminds me of when liquor prohibitionists felt that a few (thousand) casualties from consumption of denatured alcohol were a reasonable price to pay to deter drinking. The cynic in me wonders if the DEA felt that a few (hundred thousand) casualties from driving people from pills to spiked heroin were considered acceptable collateral damage. Prosecutors have recently stepped up their own war on heroin dealers by charging them with murder if someone overdoses on the product. I have a theory that if a cheap disposable test kit to identify super-potent (fentanyl laced) heroin were available to dealers and end users that it might just save some lives. There's also the Naloxone factor. It's saving some lives but at $42 a kit is making the producer a bunch of money when perhaps it ought to be fully subsidized. Just a few thoughts on the subject.
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Jan 26, 2016 21:52
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No Butt Stuff posted:Yes, my doctors told me this, which I found to be patently false as well. FYI, this is not just a belief taught to doctors by drug reps but it part of the design of the drug (its a sort of targeted opioid that was supposed to have all of the benefits and fewer of the opioid side effects). Moreover, in a lot of countries this also means that the drug is less well regulated as it is not a controlled substance like morphine. This in turn means it is easier to get through doctor shopping etc. Without looking at any real papers i feel this explains at least partially the high rate of tramadol addicts.Tramadol it's quite good as a painkiller and is certainly les addictive than morfine /fentanyl. quote:Information from 2 tramadol safety databases allowed calculation of the incidence of abuse or dependency as 0.21 and 0.12 cases per million defined daily dosages (DDDs), with lower incidences in recent years. That doesn't mean its impossible to get addicted, just that it is a lot harder to form an addiction. I recently saw a patient using 2500mg of tramadol a day that she got through a reputable internet pharmacy. For her the route to non-adiction is starting with high dose fentanyl patches and slowly working back from there in a month long process. In general, short tem use of well monitored opioids is not addictive. If your doc wants you to take them for a short while for pain dont feel pressured to do so but also do not think that he's just a shill for big pharma trying to get you addicted. edit: as an aside, the fear of opioids instilled in some parts of the population is so great that terminal oncologic patients painfully awaiting death still routinely refuse opioid drugs because they dont want to end their life as an addict. IAMNOTADOCTOR fucked around with this message at 22:20 on Jan 26, 2016 |
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Jan 26, 2016 22:14
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IAMNOTADOCTOR posted:edit: as an aside, the fear of opioids instilled in some parts of the population is so great that terminal oncologic patients painfully awaiting death still routinely refuse opioid drugs because they dont want to end their life as an addict. That's ridiculous. If I knew I was going to die, not only would I use whatever painkillers I could get, but I'd become addicted to every other substance as well, because why the hell not? You better believe I'm gonna smoke 2 packs a day if I know I'm dying in a few months anyway.
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