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The enclosure movement ended in the 17th century MIGF please update your memory banks
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Mar 28, 2016 23:57
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Hopefully this isn't too tangential for this thread. A recent NYT piece focused on the proliferation of (mostly) unregulated and untested eating disorder treatment centers. Why am I posting this in the opioid thread? - Opioid dependence and EDs are both highly stigmatized conditions that are hard to treat successfully, partly because sufferers are "doing it to themselves" - Much like opioids, many people argue that for (some, not all) people with EDs, the ED is a powerful coping mechanism to deal with terrible life situations - It can be very hard to get insurers to pay for a full course of what we think is the most effective treatment. A lot of the residential ED treatment centres can be like "vacation time" from the real world (I've heard drug rehab can be like this too). In particular, I thought these quotes: NYT posted:The rapid growth of the industry — there are more than 75 centers, compared with 22 a decade ago, according to one count — has been propelled by the Affordable Care Act and other changes in health insurance laws that have increased coverage for mental disorders, as well as by investments from private equity firms. NYT posted:Many eating disorders specialists agree that some patients require the supervision of residential programs and benefit from the treatment. But studies showing the programs’ effectiveness are scant, Dr. Guarda and other experts said. The methods of the handful of studies that exist have been criticized. gave me some real deja-vu to the (Atlantic?) article someone posted about the failure of our rehab industry. EDs actually have pretty high comorbidity with substance issues as well. Does anyone have policy proposals for how we can effectively evaluate/regulate these sorts of residential programs (for substances or for EDs)? I posted this because I think there is pretty significant overlap in terms of insurance fuckery, lots of money to be made with basically no oversight, and a very weak evidence base.
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Apr 1, 2016 18:52
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bartlebyshop posted:Hopefully this isn't too tangential for this thread. Why the gently caress are you posting this in the opioid thread?
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Apr 1, 2016 19:13
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Spacman posted:Why the gently caress are you posting this in the opioid thread? I thought I answered this in the post itself? I think there are similarities in the (failures) of the treatment models between both sets of conditions.
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Apr 1, 2016 19:14
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bartlebyshop posted:I thought I answered this in the post itself? I think there are similarities in the (failures) of the treatment models between both sets of conditions. This is the opiod thread not the eating diorder thread... Start a new thread maybe? e:I'm not trying to be a dick, but I want to learn about and see first hand accounts of opiate abuse. Eating disorders likely need their own thread as it, no doubt, has merit. I won't lie, I likely will not read the eating disorder thread because I don't care about eating disorders, but I'm interested in opiate abuse. That's why I read the opiate abuse thread... Spacman fucked around with this message at 19:35 on Apr 1, 2016 |
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Apr 1, 2016 19:17
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Woop woop, Sgt Spacman of the Thread Police is here and he's PISSED
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Apr 1, 2016 19:53
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Radbot posted:Woop woop, Sgt Spacman of the Thread Police is here and he's PISSED I'm quite disappointed that you are not taking my interest in opiate abuse seriously. Opiate abuse is an immense problem effecting hundreds of thousands of humans, I find your blase attitude regarding this issue both offensive and sadening. e: I won't be so flippant and clarify for you. Opiate abuse is an issue that I see constantly and deal with in my daily life. I really care about opiate abuse, I want to understand the issue so that I, as an individual, can effect change. I really don't care about eating disorders as an extremely tenuous subset of opiate abuse. Spacman fucked around with this message at 20:50 on Apr 1, 2016 |
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Apr 1, 2016 20:31
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That a failure in treatment produces a comparable result in behaviour by sufferers of a different condition would seem to be relevant to the discussion of opiate abuse as it lends credence to the idea that opiate abuse is not a moral failing but rather a social one.
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Apr 1, 2016 21:36
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Seems like the H-Bomb is moving aside for the F-Bomb with all the Fentanyl deaths.
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Apr 1, 2016 21:38
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OwlFancier posted:That a failure in treatment produces a comparable result in behaviour by sufferers of a different condition would seem to be relevant to the discussion of opiate abuse as it lends credence to the idea that opiate abuse is not a moral failing but rather a social one. I agree. I think the ED discussion and comparison in outcomes is relevant for this thread, so says I.
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Apr 1, 2016 21:51
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pangstrom posted:Seems like the H-Bomb is moving aside for the F-Bomb with all the Fentanyl deaths. Is that happening across North America now? It was a huge thing in Western Canada this year, but I didn't know it was a more widespread problem than that.
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Apr 2, 2016 00:29
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PT6A posted:Is that happening across North America now? It was a huge thing in Western Canada this year, but I didn't know it was a more widespread problem than that. I'm quoting the NYT a lot today, it seems. They had a recent article about it. quote:In some areas in New England, fentanyl is now killing more people than heroin. In New Hampshire, fentanyl alone killed 158 people last year; heroin killed 32. (Fentanyl was a factor in an additional 120 deaths; heroin contributed to an additional 56.) quote:Nationally, the total number of fentanyl drug seizures reported in 2014 by forensic laboratories jumped to 4,585, from 618 in 2012. More than 80 percent of the seizures in 2014 were concentrated in 10 states: Ohio, followed by Massachusetts, Pennsylvania, Maryland, New Jersey, Kentucky, Virginia, Florida, New Hampshire and Indiana.
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Apr 2, 2016 00:36
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bartlebyshop posted:I'm quoting the NYT a lot today, it seems. They had a recent article about it. That's not good. Fentanyl is pretty much the perfect way to execute the "what if we just let addicts off themselves?" plan from a while back. Around here, they're saying that a lot of fentanyl is being produced by Chinese superlabs, but I don't know how accurate that is. EDIT: I've at least heard of heroin addicts kicking their habit and living normal lives. I've never heard a story of a fentanyl user doing anything but dying (and usually really loving quick).
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Apr 2, 2016 00:45
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PT6A posted:That's not good. Fentanyl is pretty much the perfect way to execute the "what if we just let addicts off themselves?" plan from a while back. Around here, they're saying that a lot of fentanyl is being produced by Chinese superlabs, but I don't know how accurate that is. Very few junkies do fentanyl only. Not only is it far less euphoric than other opioids, it's far more scarce in the market. I've done it maybe a dozen times, and I greatly preferred regular dope. ---- It is a great way to beef your china, though, so I'm never surprised to see it as a cut/additive. -------- Also, the study of effectiveness of treating eating disorders has a great deal of cross-application to other addictions/afflictions...IMO
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Apr 2, 2016 00:53
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What ended up happening with krokodil? That's what we were all freaking out about last year, I recall.
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Apr 2, 2016 00:56
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Spacman posted:This is the opiod thread not the eating diorder thread... Start a new thread maybe? Enjoy.
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Apr 2, 2016 01:04
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PT6A posted:What ended up happening with krokodil? That's what we were all freaking out about last year, I recall. It was an overblown media fad that was milked for clicks and then left by the wayside one the novelty wore off. Otherwise probably still mostly unchanged, just like the folks huffing solvents etc.
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Apr 2, 2016 01:17
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OwlFancier posted:That a failure in treatment produces a comparable result in behaviour by sufferers of a different condition would seem to be relevant to the discussion of opiate abuse as it lends credence to the idea that opiate abuse is not a moral failing but rather a social one. So what's the best way to structure and run a rehab program? Imagine you had $10 million and authority to implement the processes you'd like to see.
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Apr 2, 2016 19:07
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My Imaginary GF posted:So what's the best way to structure and run a rehab program? Imagine you had $10 million and authority to implement the processes you'd like to see. Immediately demand more money because $10m is a paltry sum. Assuming you gave me the required money, relocate the person to a controlled facility where they can be looked after, and be given controlled, clean doses of whatever they're addicted to. Work with the individual to figure out how their addiction works, what triggers their desire to use, and then work with them to figure out alternate solutions. Reduce their dosage as practical to minimise withdrawal, keep working to build and reinforce new behavior patterns which don't center around reliance on their drug. Also look to address any issues which contribute to their condition such as depression or chronic pain or anxiety or anything else that they feel they need some escape from, whatever it is that they use their drug to help deal with. Once their addiction is under control, work with them to get them rehoused and re-employed, possibly with support payments to keep them on their feet while they adjust to a working and more independent life, continue to offer counseling and other support, including drug doses if they need it, because encouraging people to relapse outside of the program will make it harder to help them if they do. Remove the reasons to use, work to minimize the withdrawal, and work to help the person develop solutions which work better. If you can't do those then I would suggest that you will have difficulty fixing addiction, because continued use seems like a rational choice under those circumstances. OwlFancier fucked around with this message at 19:19 on Apr 2, 2016 |
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Apr 2, 2016 19:16
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OwlFancier posted:Immediately demand more money because $10m is a paltry sum. Hmm. Sounds like what jail used to be in America, back when rehabilitation was the focus of corrections. What are the reasons to use? Seems like they all stem from some sort of social failure.
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Apr 2, 2016 19:43
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Well, yeah, the point is to take a behavior that is detrimental to a person and help them change it. Though I suppose with prison it's also a greater focus on the danger they present to others. Therapy, rehab, and corrections should all really be considered to intersect quite a bit. As to why people use you could probably just ask the people who do. Personally I never have used anything but that's entirely because alcohol does nothing for my depression and I really don't think drugs would help. If I did find something that helped I'd probably use it because there's not really much else available and wanting to spend all your time asleep is no way to live. Maybe I would avoid it because I've had enough family smoke and drink themselves to death, maybe not. If my circumstances changed and I didn't have other things to turn to, I probably would. OwlFancier fucked around with this message at 19:50 on Apr 2, 2016 |
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Apr 2, 2016 19:46
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My Imaginary GF posted:What are the reasons to use? Seems like they all stem from some sort of social failure. Curiosity, escape, depression, rebellion, socially, religiosity Might as well ask anyone why they do anything. In the broadest sense 'use' can stem from any motivation. Addiction, and to be more precise the vicious cycle of abuse, has definite roots in societal failure, namely in that once a person is stuck in that cycle they are largely shunned by society. Rigged Death Trap fucked around with this message at 20:00 on Apr 2, 2016 |
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Apr 2, 2016 19:57
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Also real fast while a lovely life situation that leads to suicidal thoughts might not be mental illness per se, the neural pathways that you would make in your brain from repetition of these thought patterns will turn a normal brain into a sadbrain.
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Apr 2, 2016 20:08
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My Imaginary GF posted:Hmm. Hahaha. Look at you. Rehabilitation has never once been the focus of corrections. It went straight from warehousing criminals because of the same reasons we warehoused the mentally ill, to warehousing criminals for profit. Junkies should be treated like the mentally ill and be given appropriate care, since addiction is far closer to a mental illness than a crime (I have issues with the disease model of addiction, since you need far more than the chemical wiring for addiction to wind up a drug addict, you need exposure to a substance to get addicted to and a reliable source for that substance to become addicted, both of which are societal issues...And why you saw higher rates of meth abuse than anything else in the Midwest. Lack of access to anything other than old doctors that grew up on farms and thought that anything less than traumatic amputation to be undeserving of painkillers, and a lack of heroin at all led to it being rather difficult to develop an opiate habit. Now you have doctors like my friend's who prescribe 240 4mg dilaudid a month...i never saw someone become a dope fiend so quickly in my life, and I'm a recovering heroin addict) As for why people use, there are as many answers to that question as there are addicts. I will say the amount of people who didn't grow up around heroin addicts that jumped right into dope is 0. Everyone I know that did dope either started as a young teenager because their parents/caretakers were junkies or started with an almost always legitimately obtained rx. And it was only after the doc stopped prescribing and after pills became overpriced for them that they switch when presented with the chance. Some people never wind up with the chance or the need to switch, either because dope is unavailable or because they're never given the need to go through anything but a doctor for their fix. Bringing back prescription grade heroin and providing safe spaces with a nurse and plenty of narcan and new syringes would do so much to save lives. ODs are overwhelmingly caused by winding up with dope that is less cut (or cut with something like an RC or Fent) than what someone is used to. (Or combining drugs, but frankly you can't stop that one). A standardized potency would reduce ODs, what's left will be treated by narcan, and you eliminate a lot of disease risk...including diseases that don't involve sharing needles but are directly related to iv drug use being so stigmatized, like MRSA and ringworm and tuberculosis, not just hep and HIV. Which is all a net benefit to the healthcare system, since now none of those people would be taxing the emergency system. Ounce of prevention> pound of cure. There's no way to remove addiction, especially opiate addiction, without also punishing innocent people. There are way too many legitimate uses for narcotics to just not prescribe them. And is it really fair to deny a cancer patient pain control just because their rear end in a top hat neighbor is going to take the leftovers after he dies to make a quick buck?
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Apr 3, 2016 05:09
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PT6A posted:What ended up happening with krokodil? That's what we were all freaking out about last year, I recall. I don't know much about the chemistry, but I read that since one of the precursor drugs, codeine is controlled, it is not profitable to cook in the US. In Russia codeine is over the counter, which is why it is a huge problem there.
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Apr 3, 2016 05:17
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My Imaginary GF posted:What are the reasons to use? Seems like they all stem from some sort of social failure. Coincidentally, people seem to fail socially a lot more when they are cut off from resources, support, and safety. Like, when there's a massive recession. I know, I know, they should move to chicago and/or learn to code.
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Apr 3, 2016 06:30
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I was a model student from a solid family and I didn't get into drugs until college. I wanted to "expand my consciousness" like Huxley, and do ALL THE DRUGS like the beats, and especially like Burroughs. I was desperate to try H. I couldn't find it at my school (in a small city in upstate NY) except once, but I absolutely loved it. I did become rapidly enamored of cocaine and alcohol, though, as the central pillars of my identity began to crumble and morph. 1) I lost the young woman I assumed I'd marry 2)I lost faith in all gods, and I didn't get grasp the joyous liberation possible within existentialism 3) Econ, Organizational Development, and Labor History convinced me that my dream of fighting for the unions was a lost cause. One thing that never failed me, however, was getting wasted with my friends. The depression got worse as I never took time for anything but class, work, and partying. As the semesters and years went on, my usage increased and my participation decreased. Eventually, it was either kill myself, take a year off, or fail 4/5 classes. So at this point, I'm 21 or 22, depressed as hell and I have a drug problem. But you couldn't tell me that. I had a 'money' problem, the drugs 'didn't affect my work or my life.' So I just worked and did drugs until I'd get fired and eventually run out of money, causing more depression and self-loathing. Eventually I got access to obscene amounts of painkillers and didn't have to worry much about money. But you know how that goes...eventually money became a problem again, and dope (heroin) was suddenly affordable and consistent, with sober dealers who ran on time. That was 6-7 years ago, and I don't need to tell you the rest about my using. It's all depressing. Just know the my 3 trips through inpatient rehab, the outpatient treatments, zillions of AA/NA meetings, both half-way houses, all the psych ward trips, my jail time....none of that was ever enough to keep me off drugs/booze one month in the real world. But my current methadone-assisted treatment, including group and individual counseling, combined with my separate psychiatric doctor and counselor, along with dramatic life/health improvements, has been spectacularly successful. I finally made it a month off dope/booze...more than 6 months ago, and I'm still sober tonight.
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Apr 3, 2016 07:03
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A common thread to addiction and abuse is the depression and self-loathing that comes from the self and the user's relationship with society. The cycle (in my layman's view) is something like this: Can't adequately engage with work/responsibilities/goals/self-care -> self-loathing/shame/embarrassment/guilt over inadequacy, leading to -> use and abuse to numb self from these feelings -> more shame and guilt over problematic use, leads to -> deeper use and abuse to numb/deflect from added shame -> deeper spiral of inadequacy due to growing addiction, leading to -> even more abuse in total submission to lack of control -> cycle repeats on and on until jail, hospital, death, or treatment/cycle is broken Usually the original problem that led to the abuse in the first is not dealt with and continues to fester, putting even more aggravation and strain on the cycle as said problem gets worse. Note that not just substances can be used for this escapism and numbing, whether it's sex, overspending, overeating, etc. It's about seeking enough pleasure, euphoria, good feeling, or release to avoid the constant torment in the background and can easily become a self-sustaining feedback loop as the shame/inner and outer torment compounds on each other and the tolerance to the pleasure source increases. E: This is probably also incidentally why AA and its message is most effective for people at the nadir of the addiction cycle. They've hosed everything up and have lost total control over themselves and their lives, so they're most likely to respond to a message of "submit yourself to a greater power/something bigger than yourself," whether that's God, a spirituality, or what-have-you and admitting/coming to terms with being unable to control everything that happens in your life. Teriyaki Koinku fucked around with this message at 01:17 on Apr 4, 2016 |
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Apr 4, 2016 00:58
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e: quote is not edit.
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Apr 4, 2016 01:02
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The thing is there are people who want to use or abuse opiates they want to get whatever feeling or relief they can get from them. The ting these days with fentanyl is, not unlike with molly, there's a lot of stuff passed around that's sold as one thing, Xanax, vicodin or whatever and people make up bogus pills that are easy as gently caress to OD on. http://www.sfgate.com/health/article/7th-death-in-Sacramento-County-linked-to-7221177.php Pretty sure the dealers don't want to kill their customers so much as just give them enough for them to get high/not get sick and then they keep coming back but with fentanyl the difference between a recreational dose and an overdose is ridiculously small. If people are doing pills to get high they may not know if they're getting a "legit" Oxycodone, perhaps stolen from a pharmacy, or a pill made to look like it only instead of 30mgs of oxycodone you get filler and 50 micrograms of fentanyl.
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Apr 4, 2016 01:24
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Also apparently the cartels have discovered a chemical process that makes fentanyl cheaper and easier to make than heroin.
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Apr 4, 2016 01:48
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Your Dunkle Sans posted:A common thread to addiction and abuse is the depression and self-loathing that comes from the self and the user's relationship with society. AA is actually pretty ineffective. Their recovery rates, last I heard, are better than people trying to get clean by themselves but not by much. Addiction is very complex and has a ton of causes but that absolutely hits on common cycles of addiction and is something that people fail to understand. The very interesting thing is that most people who take opiates at some point don't get addicted to them. Think about people getting morphine after surgery; most people don't come down with an addiction to opiates and can just walk away and resume their lives once they've recovered. It turns out that a common thread is adequate support; people with good social circles, be they family or friends, that are willing to help them through rough patches, whatever they need, are far, far less likely to become addicts of any type. However if you have a family that is pressuring you to be successful and telling you that you must accomplish X thing by Y age and why the gently caress do you still work at a restaurant? Is that all you want to be? Get with it, kid. What, you haven't planned out your whole life by 20? You don't want to be a doctor? What the gently caress is wrong with you, loser? it tends to lead toward stress which leads toward addiction. This is why mental illness also leads toward addiction; that lack of societal support just fucks people up, makes them hate their lives, and they turn to addictions to feel better. It's also why addiction doesn't give a poo poo what social class you are. Society is one of the biggest barriers to recover too. Once you are an addict society will happily discard you as worthless. It's your own fault; why should we help you?
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Apr 4, 2016 04:10
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I see a lot of this from the health care provider side of things. I'm a doctor in Kentucky and dealing with people who are addicted to opioids is probably the most challenging part of my day. Mostly because the addiction itself puts you and the patient in an almost oppositional relationship by default on the inpatient side of things. The heroin tends to cause health problems that tends to put you in the hospital that tends to put you into an environment with professionally placed IV access and a pharmacy stocked with dilaudid. I know they're going to withdrawal and that amounts to a temptation I will never understand, and I also know that unless they have something verifiably painful like pancreatitis or an ischemic digit giving them opioids is just feeding the addiction. It takes me a few minutes before walking into the room to get into the head space and remind myself they're here to get help, that they're people too, and that addiction is not something you can choose. It gets tough because there's not a lot of resources for recovery on the discharge end of the stay and even if you can get something set up, not much really works well to assist in recovery beyond social support networks.
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Apr 4, 2016 13:44
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On some podcast Tom Arnold mentioned he got in a motorcycle accident and while he was lying on the highway with a broken back his first thought was "sweet, I'm going to get morphine." And IIRC correctly he was in recovery for cocaine at the time and had just started/was in denial about the opiates. Pretty tough putt for the heath care provider when that's what's coming in the door.
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Apr 4, 2016 14:48
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pangstrom posted:On some podcast Tom Arnold mentioned he got in a motorcycle accident and while he was lying on the highway with a broken back his first thought was "sweet, I'm going to get morphine." And IIRC correctly he was in recovery for cocaine at the time and had just started/was in denial about the opiates. Pretty tough putt for the heath care provider when that's what's coming in the door. The difficulty is the frequent back and forth. If it's someone with say a fracture then they get the good stuff, and generally a lot more than what I would give a non addicted person (tolerance) and I'm ok with that. If it's someone with say a pneumonia, it will start with nursing paging me that they want something with pain. I'll order Tylenol. I get paged back later, the Tylenol isn't working, i'll give some naproxen. Page back that's not working. I explain no opioids. I get called in. Lots of anger directed at me, still no opioids. Often there's threats that they'll leave the hospital against medical advice unless they get the pain meds they want. Or you get people who really love to game the system. They'll come in with idiopathic pain that has nothing on labs or exam or imaging that can prove or disprove it. They'll know magic words for admission like vomiting blood or can't eat or drink at all. Then comes the strategic allergies. It's always toradol, tramadol, zofran, codeine, and morphine. Leaving dilaudid and phenergan for nausea and pain. It's super hard not to project onto people when you know they're gaming you, and when you try and directly but politely address the issue there's an 80ish percent chance they'll rain a stream of drama down on you while you have 10 other patients you could be seeing instead.
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Apr 4, 2016 15:05
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deathbysnusnu posted:I see a lot of this from the health care provider side of things. I'm a doctor in Kentucky and dealing with people who are addicted to opioids is probably the most challenging part of my day. Mostly because the addiction itself puts you and the patient in an almost oppositional relationship by default on the inpatient side of things. The heroin tends to cause health problems that tends to put you in the hospital that tends to put you into an environment with professionally placed IV access and a pharmacy stocked with dilaudid. I know they're going to withdrawal and that amounts to a temptation I will never understand, and I also know that unless they have something verifiably painful like pancreatitis or an ischemic digit giving them opioids is just feeding the addiction. It takes me a few minutes before walking into the room to get into the head space and remind myself they're here to get help, that they're people too, and that addiction is not something you can choose. It gets tough because there's not a lot of resources for recovery on the discharge end of the stay and even if you can get something set up, not much really works well to assist in recovery beyond social support networks. How's HB-1 and mandatory KASPER working out?
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Apr 4, 2016 15:34
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Rhandhali posted:How's HB-1 and mandatory KASPER working out? That's a really tough question that we probably won't be able to answer for a decade or so. So my take is that heroin use has gone way up because recreational pills are becoming prohibitively hard to get due to KASPER. On the flip side, I'm hoping heroin use overall will go way down in time because most people get on heroin because they first got addicted to pills which is becoming a lot harder now.
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Apr 4, 2016 15:36
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This is going to vary by situation and the doctor, but how often do you suspect the person is an addict, how often are you like pretty sure, and how often are you basically positive? Also, it's a small thing and I roll my eyes a little when people talk about stigma as like a primary cause of addiction but I want to just protest "love to" in front of the "game the system". You already know this since you're talking about projecting etc., but a lot of people don't get that addicts are capital-D Desperate and their thinking is broken. They're going after drugs like a starving person would be after food, eating rotten rats, etc. It doesn't make them noble or anything but they're not trying to get one over you, and it's AT BEST a huge hassle, but they're just doing what they do.
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Apr 4, 2016 15:38
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pangstrom posted:This is going to vary by situation and the doctor, but how often do you suspect the person is an addict, how often are you like pretty sure, and how often are you basically positive? Fair enough, my choice of words was very poor. So when I see things like strategic allergies that no human on earth could possibly have, that's a pretty big tell. Familiarity with pain meds for someone without a chronic condition or history of acutely painful conditions necessitating them is another. The ER history is another. Urine drug screens that contradict patient history is another. Often times you can see track marks on them. Generally speaking I don't let addiction history steer my pain management. If I would give someone with no addiction history morphine or dilaudid, I'd give it to addicted people. The problem is always the inverse. People angry that I won't give them dilaudid for things I would give no one dilaudid for. I'm not going to claim that addiction is a moral failing but some of the behaviors it manifests makes my job a lot harder and more dangerous. Take for instance the people claiming to be vomiting blood. Sure I know that they've had 6 negative endoscopies, capsule studies etc in the past 6 months. But do I want to risk their life on it and not do yet another thorough workup? Those workups have risks on their own terms, what if endoscopy number 7 causes an esophageal perforation and they die?
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Apr 4, 2016 15:51
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deathbysnusnu posted:Fair enough, my choice of words was very poor. Sounds like a desperate need for some tort reforms so that you can deny an addict another useless medical test which wastes everyone's time and money. gently caress addicts for bankrupting our public healthcare systems with bullshit medical testing and reported symptoms.
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Apr 4, 2016 18:00
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