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I mean, maybe. Doing the global comparison thing again, it's hard (for me at least) to say the US is worse than the global average in an individual despair sense. edit: I should say THAT MUCH worse. Like, put addiction/OD deaths per capita vs. suicide deaths per capita (or something similar you think makes sense). pangstrom fucked around with this message at 05:49 on Dec 10, 2018 |
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Dec 10, 2018 05:43
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pangstrom posted:I mean, maybe. Doing the global comparison thing again, it's hard (for me at least) to say the US is worse than the global average in an individual despair sense. Americans are increasingly socially isolated. That right there is a major driver in misery even in people that are materially comfortable. Humans are social as hell. Babies literally die if nobody touches them. That's not an exaggeration; a baby that never gets touched by another human dies. Babies that aren't snuggled and held enough have increased risks of depression, addiction, anxiety, self-harm, and being the victims of various crimes when they grow up. Then once people become adults lacking any close friends that you can talk about basically anything with increases the chances of addiction, depression, early death, and even a poo poo load of physical ailments. One of the main reasons American health sucks so much is because of how individually isolated we're becoming as a society. There are numerous reasons why but even simple things like "I have somebody in my life that I can have sex with regularly" is a major indicator of how happy a person is. Unhappy people are way more likely to become addicts and, surprise surprise, a person with a poo poo load of money but no friends is practically guaranteed to be a miserable addict that hates existing. ToxicSlurpee fucked around with this message at 05:54 on Dec 10, 2018 |
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Dec 10, 2018 05:49
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ToxicSlurpee posted:Most people who use drugs are partiers who otherwise lead what you'd call a pretty normal life. That can lead to addiction but it doesn't always. One very interesting thing I read is that most people who have major surgery actually don't get addicted to the morphine at all. One reason that addiction is going up is because in contemporary society we're increasingly isolated. Lacking social and emotional support leads to other ways of venting bad emotions. That can at times lead to addiction; so somebody mostly living in isolation gets a script for some opiates then things progress and...yeah. Addiction is obviously a complex issue but one thing I read that was very interesting is that only a single digit percentage of people who try cocaine ever get addicted. Mostly it's just something people do occasionally at parties. Opiates are obviously more addicting but even then most people don't get addicted. Decriminalization and clinics where the drug can be safely administered aren't continuing "the war on drugs" though. Alcohol isn't a very good comparison, because prohibition is a matter of reversing a pre-existing status quo where alcohol has a huge cultural/societal role. The best harm reduction option is probably to give people the option of having opioids prescribed even for recreational reasons, since if someone is drug-seeking to that extent they're probably going to end up finding opioids at some point (and likely in a less safe way). But having them available to purchase in the same way as alcohol is probably a terrible idea, and that sort of logic ends up going strange places when you start talking about other prescription medications (like benzodiazepines, etc) and that's not even getting into the very high danger of using those kind of drugs together. Regarding opiates prescribed for surgery, I think that it depends how long someone is cumulatively exposed to opiates, and whether they have freedom of self-administration. In my case, I was prescribed opioids medically a few times without any problems, and it wasn't until the fourth or fifth time that I really started to consider the possibility of abusing them (and even then it likely never would have escalated to addiction if not for the availability of internet grey market opioids like (at the time) poppy pod tea). Most people, even if they enjoy the affects of medically prescribed opioids, aren't going to really know where to turn to access more of them. And if they're being prescribed for serious pain, they might not even make the mental connection that the medication could be enjoyable in non-medical settings (since their only experience is being bed-ridden and having it manage severe pain). If anything, the low percent of people prescribed opioids who become addicted can pretty easily be described by the fact that drat near everyone has been prescribed opioids medically at some point. Also, I am very skeptical, to say the least, of the claim that recreational opiate use mainly occurs in party settings. There are millions of addicts and most likely fall outside of the age range that commonly participates in (non-alcohol) drug-involved partying. I could maybe buy that with other types of drugs, like stimulants, but not opiates (or benzos for the same reason).
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Dec 10, 2018 05:52
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So how are the "number of prescriptions per x people" figures determined anyway? Are they prescriptions per year, or month, some other time? Do we count both 3 pills as a one-off from a surgery as equal to a 30 day supply to someone who's been on them for 5 years straight? And when you start comparing between countries, there's stuff like how certain preparations of codeine are available over the counter in the UK but would need a prescription in the US.
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Dec 10, 2018 05:52
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What country are you proposing even gets close, fishmech.
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Dec 10, 2018 05:57
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pangstrom posted:What country are you proposing even gets close, fishmech. I'm trying to ask what's being measured with that number in the first place, dude.
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Dec 10, 2018 06:01
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fishmech posted:I'm trying to ask what's being measured with that number in the first place, dude.
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Dec 10, 2018 06:02
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pangstrom posted:I'm trying to ask which country would even come close regardless of how you measure it, dude. That would require us to know what is being counted!
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Dec 10, 2018 06:05
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Captivating but also deeply sad, at least to me: https://www.nytimes.com/2018/12/11/us/overdoses-youtube-opioids-drugs.html
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Dec 12, 2018 04:08
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.motherfuckers act like they forgot about Portugal
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Dec 12, 2018 04:28
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Chinese business association seeks to quash exemption for safe injection sites Oh my god gently caress offfffff
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Dec 12, 2018 07:36
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it's basically what you imagined going on anyway but: for profit healthcare, ladies and gentlemen https://www.nytimes.com/2019/01/15/health/sacklers-purdue-oxycontin-opioids.html
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Jan 16, 2019 15:12
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pangstrom posted:it's basically what you imagined going on anyway but: for profit healthcare, ladies and gentlemen this is some "nah guys smoking is great for you look at all the doctors who smoke" poo poo right here
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Jan 16, 2019 17:15
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Does anyone here have any experience (provider, patient, or other) with Sublocade, the injectable buprenorphine? Apparently it's coming down the pipeline in Canada and I know nothing about it.
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Jan 18, 2019 23:42
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Recently got approval in the US. I believe you have to have the X waiver to prescribe it. Insurance maybe/maybe not covering it yet. Don't know how it stacks up versus methadone vs Suboxone vs Vivitrol/Naltrexone
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Jan 19, 2019 01:26
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Albino Squirrel posted:Does anyone here have any experience (provider, patient, or other) with Sublocade, the injectable buprenorphine? Apparently it's coming down the pipeline in Canada and I know nothing about it. At least in the states, it's a shameless cash grab being marketed heavily to judges and prisons because patients can't just take generic subs instead of the $1500 shot if it's specified by name on a court order.
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Jan 19, 2019 03:33
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This is why clean injection sites and readily available access to clean needles and funding for medical supervision and just funding in general is really really needed and should not be written off as simply: "gently caress those drug yooserrrrrrs!!!" It's a major public health concern. You could even say it puts your ordinary, God-fearing, never do drugs ever citizen at risk because it actually does. And that's just with Hep-C. What about every other blood born disease or every other opportunistic bug that can use a skin break as the front door key to a mass production replication factory aka human?
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Jan 19, 2019 13:45
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Yeah you're going to have a lot of people arguing that the answer is longer prison sentences, harsher laws, and more police.
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Jan 19, 2019 14:00
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shame on an IGA posted:At least in the states, it's a shameless cash grab being marketed heavily to judges and prisons because patients can't just take generic subs instead of the $1500 shot if it's specified by name on a court order. In the judicial setting, I don't really see Sublocade taking off when you have Vivitrol as an alternative. If you're feeling authoritarian, why not go with the one that completely blocks heroin and you can't possibly get "high" on? All long acting injectable medications are expensive, even the generic ones.
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Jan 19, 2019 23:49
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The first story on This American Life is predictable but affecting. It is about the podcast Dopey. https://www.thisamericanlife.org/667/wartime-radio
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Feb 6, 2019 14:16
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This screened in 1992 and the US has still gone backwards since then: https://www.youtube.com/watch?v=Zy_86iVhmkQ
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Feb 26, 2019 03:53
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Just an aside, but: an infectious disease podcast I listen to ("A Gobbet o' Pus", gross name yes) is mostly just quick case studies of exotic infections. Last couple of years it's had a lot of cases of opioid addicts giving themselves infections humans "shouldn't" get by mixing their drugs with tap water or worse before injecting them -- one guy thought dog poo poo might be black tar heroin.
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Apr 1, 2019 21:36
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I'm going to the American Society of Addiction Medicine conference for my first time this year, and going through the course list like a third of the sessions are "How not to get arrested while prescribing opioids!" or something of that nature. We... do not have sessions like that at the Canadian version of this conference. and also what the gently caress, America. Also the 'advanced' harm reduction sessions are mostly focused around buprenorphine. Suboxone's certainly my first choice, but are there really no safe injection sites in the US? To say nothing of prescription injectables?
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Apr 2, 2019 19:03
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Albino Squirrel posted:I'm going to the American Society of Addiction Medicine conference for my first time this year, and going through the course list like a third of the sessions are "How not to get arrested while prescribing opioids!" or something of that nature. We... do not have sessions like that at the Canadian version of this conference. your sentences seem to be full of words, and they're individually comprehensible, but ???
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Apr 3, 2019 01:30
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GreyjoyBastard posted:your sentences seem to be full of words, and they're individually comprehensible, but ??? "How not to get arrested while prescribing opioids!" is a loving weird thing to be teaching doctors. "How to prescribe opioids responsibly and without prejudice" should be what we're teaching doctors, and "how not to arrest doctors or patients when they're prescribing/prescribed opioids" should be what we're teaching law enforcement. Also there should be safe injecting spaces and harm reduction shouldn't be focused around brand names but around generics that work like diamorphine.
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Apr 3, 2019 08:31
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lol welcome 2 America 
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Apr 3, 2019 14:57
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GreyjoyBastard posted:your sentences seem to be full of words, and they're individually comprehensible, but ??? It's darkly hilarious that one of the lead themes at a conference dedicated to addiction medicine is "not getting indicted," because apparently the DEA is coming after doctors for doing their jobs. The conference is promoting buprenorphine as 'advanced' harm reduction, when it's really very basic harm reduction. My city is setting up a prescribed injection opioid site (using hydromorphone, it's way easier to access than diamorphine), and my clinic has a safe injection site in the basement.
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Apr 3, 2019 15:11
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What should be done about the issues around safe injection sites? We've had one opened up reasonably near me, and there are apparently issues with property crime in the area, since addicts still can't get their drugs for free. I think either the drugs should be freely provided (probably a hard sell) or safe injection sites should be so numerous that they are unable to concentrate any negative effects in a specific area. Honestly, I have a hard time with the centralization of services provided to addicts. Putting everything in one place concentrates the harmful externalities of addiction, and it allows too many people to simply wash their hands of the problem and ignore it because it's no longer near them. And what happens when someone tries to get clean? They're established in an area with a huge concentration of addicts and dealers! How the gently caress is that going to work? This stuff needs to be at the nice shiny mall in the suburbs as much as on skid row, both because there are still addicts there, and also because, gently caress you, you don't get to ignore the problems in our society and make it someone else's problem.
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Apr 4, 2019 05:42
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Most experts (like actual experts who care, not like ideological appointees or retail politicians) agree that would be the right approach. But locals in middle class and wealthier areas still control what happens in their little neighborhoods, most people still view drug use in primitive moral terms, and safe injection sites poll like hell in the US. So a lot has to change for that to happen.
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Apr 4, 2019 15:14
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PT6A posted:What should be done about the issues around safe injection sites? We've had one opened up reasonably near me, and there are apparently issues with property crime in the area, since addicts still can't get their drugs for free. I think either the drugs should be freely provided (probably a hard sell) or safe injection sites should be so numerous that they are unable to concentrate any negative effects in a specific area. What issues? We have a single injecting centre Sydney and there have been no issues: https://www.bocsar.nsw.gov.au/Pages/bocsar_media_releases/2010/bocsar_mr_bb51.aspx
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Apr 5, 2019 04:35
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KingEup posted:What issues? https://globalnews.ca/news/4903800/crime-spike-report-calgary-supervised-consumption-site-resources/ Crime is going up. And it's not necessarily the drug addicts causing the problems -- in many cases, they are the victims, and dealers are taking advantage of them. As the article points out, it's still a service that needs to exist, but we shouldn't just accept the increase in crime as a natural consequence. We all accept that poverty and addiction have negative externalities, I hope, and anything that serves to concentrate those social ills in one area is going to be harmful.
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Apr 6, 2019 02:22
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In the US at least the first steps would be to make bupe a hell of a lot easier to prescribe and to genocide all the boomers.
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Apr 6, 2019 02:37
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PT6A posted:https://globalnews.ca/news/4903800/crime-spike-report-calgary-supervised-consumption-site-resources/ In the Boston area, they need to open several safe injections sites at once in different parts of the state. The second Boston opens one up, all the other towns around them (and other cities in the Northeast) will pull a Guliani and send their addicts here. Spreading the services out, in theory, would help spread the the concentration.
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Apr 6, 2019 02:52
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Albino Squirrel posted:Sorry, I threw that up between patients and I think I spliced a couple of sentences together. while I appreciate your elaboration I was being a funnyman and not understanding what was wrong with the American approach and pretending the good ideas were alien
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Apr 6, 2019 02:54
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Mooseontheloose posted:In the Boston area, they need to open several safe injections sites at once in different parts of the state. The second Boston opens one up, all the other towns around them (and other cities in the Northeast) will pull a Guliani and send their addicts here. Spreading the services out, in theory, would help spread the the concentration. Exactly; the concentration is the problem. I'm not saying Not In My Back Yard, I'm saying, "Yes, But In Everybody's Back Yard." No single community should bear the full weight of addiction, homelessness and poverty while other areas get to ignore the problem. It didn't work with housing projects, why would we assume it can work with supervised consumption sites?
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Apr 6, 2019 03:24
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quote:At nearly 22 deaths per 100,000, its mortality rate in 2018 was higher than the US in 2017 (the most up to date figures available), and three times the UK average. I guess Scotland needs to shut down the pill mills too?
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Jul 18, 2019 02:54
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Not taking that dumb KingEup bait other than to say yeah Scotland is different. It's had a ton of opiate use for a long time, the spike in deaths is mostly due to benzos showing up in force and maybe in smaller part fentanyl increasingly getting into the street opiates. Agree that decrim, injection sites, and maintenance for at least the real bad cases etc. are the best way options out.
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Jul 18, 2019 17:08
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Also they've got the 'Trainspotting Generation' of people who started using in the 80s who are getting into their 50s and 60s now and just keeling over from the chronic effects of hepatitis and polydrug use (also poverty and austerity).quote:Robertson is currently working on a report that follows his original cohort of drug users 30 years on, which will be published next year. His previous studies have shown that one in four had died, almost entirely for reasons linked to long-term drug use, and others were suffering from the effects of hepatitis C and liver and lung disease. One in three was still injecting heroin and two-thirds were on methadone. Less than one in five had come off drugs and of the survivors, most were living in social housing, on benefits or working in low paid jobs.
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Jul 18, 2019 17:26
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pangstrom posted:maintenance for at least the real bad cases etc. are the best way options out. how do we figure out who these are? is it only ppl with visible abscesses and hep C, or is it also ppl who have maintained a habit for several years or w decade without bankrupting themselves yet still suffer from mental issues, inconsistent supply, withdrawals, and having to be scared of falling out all the time? do we cut the “bad cases” off after they pass an arbitrary metric and arent “bad cases” anymore? also i guess we should do this for alcohol as well right? sea of losers fucked around with this message at 18:48 on Jul 18, 2019 |
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Jul 18, 2019 18:45
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I don't know, and the addict's choice obviously matters. Just acknowledging that it can be a little "expedient" in that yeah it often keeps people alive and functioning but it's not where you'd ideally want things to end, it's hard to get off, and a clinician probably wouldn't give it to their kid unless they were real bad etc. So I that's why I said "at least" the real bad cases.
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Jul 18, 2019 19:05
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