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The cause of the shift to heroin appears to be related to the closing down of the pill mills that were flooding oxy into communities in the first place. And the root cause of the pill mills was deliberate pressure by the people that stood to profit from sales. https://medium.com/@jasisrad/kingpins-1fa9331c705d#.hj1gb5ids That said, the rebound opiophobia among physicians is also a problem for people who are legitimately in pain. The US still seems to be better than a lot of other countries when it comes to pain management though, even though the DEA classes heroin as Schedule I with 'no medical use', which is patently absurd. Many other countries suffer highly rampant aversion to opiates even in terminal cases. http://www.npr.org/sections/goatsandsoda/2015/10/16/449243933/how-uganda-came-to-earn-high-marks-for-quality-of-death
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Jan 21, 2016 01:58
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Your Dunkle Sans posted:Is this supposed to be a joke or meant seriously? I can't tell with MIGF. The official line is that the cause of drug addiction is drugs, end of discussion. The only alternative research we have is things like Bruce Alexander's rat park, which isn't something that is marketed much to the public.
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Jan 21, 2016 11:44
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If you're doing a Marxist analysis of it, you could also blame the increased secularization of society. 
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Jan 21, 2016 14:37
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Are there any studies (non-Purdue funded) studies into how addictive opioid analgesics are when prescribed within a medical framework, as opposed for self medication of social malaise? Not an opioid at all, but doctors in California tried cocaine (under the brand name Esterene) as an insufflated arthritis treatment and found that it worked without anyone in the trial becoming addicted. It seems circumstance has a high correlation with likelihood of habituation and addiction. meristem posted:Heh, I thought I did, under 'support networks'. Churches often provide those. e: Maybe the reason they don't send you home with a bottle of percocet in the UK is because you can still buy Browne's Mixture OTC. Guavanaut fucked around with this message at 15:16 on Jan 21, 2016 |
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Jan 21, 2016 15:10
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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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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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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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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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Isn't the best maintenance drug for heroin addiction just heroin? It's ridiculously cheap as a prescription drug*, because it's been out of patent forever and is simple as hell to produce, and the Swiss clinics and the work of Dr. John Marks at his Liverpool clinic shows that giving metered pharmaceutical grade doses to patients gives them freedom from dealers and constantly trying to find ways to come up with cash while allowing them to taper at their own pace. And also drives a lot of dealers out of the area or forces them to resort to more visible dealing that gets them arrested. Which in turn reduces violent crime and gang membership. *Except in the US, where it is Schedule I and can't be prescribed by anyone, because reasons.
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Jan 29, 2016 13:11
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Definitely, it's not easy. But the raw stats from John Marks's study shows that a generous compassionate heroin maintenance has better outcomes than other opioid maintenance while reducing ODs, drug dealing, gang violence, theft and robbery, and HIV transmission. And then they shut him down under DEA pressure.  It's a bit like the wet house programs for homeless people with alcoholism; we know enabling alcoholism is a bad thing, but pragmatically wet houses, compassion, and optional recovery seems to cause less overall suffering and sometimes better results.
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Jan 29, 2016 13:43
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Here's a thing about the continuing and ongoing failure of opium policy overseas. Looking at the timeline the post 9/11 lull seems to match nicely with when Mexican cartels started picking up opiate production instead of just trafficking coke. It's nice when NAFTA partners help each other out.
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Feb 22, 2016 22:29
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Probably shut the app down and arrest everyone involved for conspiracy. Remember Silk Road?
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Mar 8, 2016 18:54
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OwlFancier posted:Drugs are not expensive enough to merit being reused, if you object to paying a lot for them there are better solutions to that. 
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Mar 9, 2016 14:24
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There's a difference between applying something and withholding something though. Like food, or water, or oxygen. If someone desired a peaceful, pleasant even, end to their life, they could just have a room where a breathable atmosphere is created from separate tanks of oxygen and nitrogen and then withdraw their consent for the oxygen tank to remain on after the staff member has left the room. Encouraging people to kill themselves just because you consider them a burden on society is horseshit though. (Except maybe land monopolists, but that's a completely different derail.  ) But from the evidence that we have, "just let addicts be addicted" actually works in a number of cases, whether it's Dr. John Marks's Liverpool clinic or the prescription heroin clinics in Switzerland. When you give a heroin addict a prescription for heroin, they are in large part cut loose from the chaotic lifestyle of trying to get money for drugs.It's a dirt cheap drug on the pharmacy market too, it has been out of patent for over a century and costs about $20/g pharma grade if you could get a manufacturer willing to supply. Ideally this would be supplemented with good social care to tackle any other root issues in the person's life, but even without that it seems to work, and reduces crime, drug dealers, and other peripheral problems of addiction under prohibition. Overall it saves lives too, as reliable doses and prepacked drugs cause infections and overdoses to drop massively, so it's the opposite of "just let them kill themselves" really.
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Mar 17, 2016 12:06
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Weldon Pemberton posted:We already institutionalize people for being "a danger to themselves or others" and have essentially agreed as a society that people who would want to kill themselves in the first place are not competent to make the decision. They're just as likely to be right this time. I'm not sure how we can live in a society where dragging a life into existence without its consent is approved, encouraged even, but a consenting adult who decides that they no longer wish to exist is proscribed, and then turn around and say that as a society we value consent. But I guess that's why they have to medicalize it in order to brush inconvenient thoughts about existence under the carpet. Same goes for Alexander's Rat Park and the idea that some people remain constantly narcotized because their day to day existence sucks, rather than because of some intrinsic evil of the chemical itself. It's as if it's much easier to ban chemicals and institutionalize people than it is to make their lives suck less, because  .
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Mar 19, 2016 12:19
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A big flaming stink posted:hot take, but consider this: the vast majority of suicidal people literally have a problem with their brain. I'm willing to disrespect the gently caress out of consent if it leads to more living happy people, and stopping people from killing themselves tends to do that.  However going by references like Joiner's 'Why People Die By Suicide', the vast majority of suicides are neurotypical people who either feel alienated from their surroundings or feel as if they are a burden to other people or are in constant chronic pain. In short, their brain isn't broken but their life sucks. I don't even know how to address anyone who thinks that these people should be fixed by drugging them against their will, throwing them naked into a room under constant fluorescent lighting, and waking them up every three hours until their mental state improves instead of, I dunno, trying to make their life suck less. The exact same thing goes for addiction. People don't decide to become addicts because their brains are broken or they are inclined to criminality. They usually end up that way because of some combination of alienation or feeling of burden, or chronic pain like the post above mentioned. We've seen how much good throwing addicts into prison does at creating more living happy people.
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Mar 26, 2016 11:35
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Basically what OwlFancier said. Suicide can be seen to occur when a person's quality of life falls below what they are prepared to tolerate, coupled with a perceived lack of alternatives. As an example, several thousand disabled people in the UK have ended their lives shortly after being found 'fit to work', having their disability benefit sanctioned, or otherwise facing cuts. If you subscribe to the 'broken brain' theory you'd either say "well their brain is all hosed up so they'd probably have done it anyway, fact of life, our sympathies to the family, P.S. ban any research into causal links with our policies" (this is the official government response) or "well their brain is all hosed up better shove them in a psychiatric facility until they stop trying, that'll improve their quality of life." It seems to me that the obvious solution here would have been not to make their lives awful in the first place. Criminalizing or medicalizing (which is de facto criminalizing) suicide and addiction is a cop-out that allows the social causes of it (alienation and making people's lives suck rear end) to be neatly dismissed.
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Mar 26, 2016 18:41
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I think my comparison there was badly phrased. I meant more in the sense that the psychiatric community has been used for aggressively bad political ends in the past, and the same thing may be in play here. I don't want to go down a  route of evil psychiatrist cabals or whatever, I just mean in the softer route of governments or society in general not wanting to own up to the fact that treating people like poo poo makes them more likely to be addicted or suicidal, and instead turning it into a 'broken brains' thing, not that suicide is a wonderful thing that they're keeping us from.There is something of a link with the homosexuality thing though, because a big part of its medicalization was "these people have such lovely lives, therefore it must be an illness" which discarded the possibility that maybe they had lovely lives because of how other people were treating them. Same goes here for the stigmas behind addiction and suicide. By medicalizing I mean the complete transference of the issue to an individual medical issue with no wider causes. Of course if someone goes to the doctor and says 'I'm feeling suicidal' or 'I can't stop taking these painkillers' the medical system should endeavor to help them. It's when it gets to court ordered rehabs and abusive suicide watch methods that I find the whole thing gets a bit sketchy (and often not proven to do much good).
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Mar 26, 2016 19:01
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SedanChair posted:If being suicidal is not mental illness, nothing is. And maybe nothing is, but that strikes me as something of a separate debate.
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Mar 26, 2016 21:40
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Being as this whole thing started with a post saying 'lol junkies should just kill themselves' I think it's important to identify who we're actually talking about here. A chronic pain patient told to quit morphine cold turkey, an alienated addict being thrown through the wringer of a drug camp, and someone who has voices saying 'kill yourself' all have different reasons to end their life. In the first case they need proper pain care, and if denied that I could understand suicidality, everyone has a limit. In the second case they need a support network, not demonization, but it's more of a social issue so it's more complex. Social alienation is a major cause of both addiction and suicide though, so I can understand while at the same time hoping for a non-clinical solution like 'people being dicks less'. The third case is the only one I'd call mental illness, but is beyond the scope of this thread really outside of any comorbidity of addiction and mental health.
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Mar 26, 2016 22:40
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Cugel the Clever posted:You guys are sounding an awful lot like anti-choice zealots saying: Or are you saying it should be a public service offered to everyone? That's a different argument and one where I think there are some points that could be made in favor of that if it was tightly controlled, such that it might actually decrease the suicide rate and stop parasuicides, but this is the opioid addiction thread and that would be a debate better settled elsewhere, although iirc the suicide thread got locked because it turned to poo poo.
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Mar 27, 2016 23:30
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Only if you find them within under 5 minutes of shooting up. The whole point of heroin is that it's a prodrug that is converted rapidly into other things within the body, which then have a longer lasting analgesic effect. Unless you plan to arrest people for possession of endogenous drugs, in which case better arrest everyone for possession of DMT.
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Apr 4, 2016 23:07
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The_Book_Of_Harry posted:I'm not really sure what you mean by spending money on preventing people from becoming addicted. Everyone knows drugs are addictive and unhealthy.
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Apr 6, 2016 23:25
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Yeah, I think it's key to differentiate between addiction and physical dependence. Physical dependence is an internal factor caused by prolonged presence of a chemical changing the nature of a regulatory feedback system, whereas addiction appears to be driven mainly by external factors and doesn't even need a exogenous chemical at all, like the dopamine feedback response in gambling addiction. It's interesting looking at the addiction rates for inpatient opiate courses vs. those for people just given a bottle of pills and sent home or those actively seeking drugs. If it were only based on opportunity and repetition, PCA pumps would cause massive rates of addiction, but it is only seen rarely, usually in patients with a history of drug or alcohol related disorders. They do still suffer from physical dependence if given a long course and require tapering. Addiction itself seems based on completely different factors, like social alienation.
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Apr 9, 2016 17:55
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jet sanchEz posted:Manufactured in China, it easily crosses our porous borders, triggering a heroin-like bliss in users
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Apr 9, 2016 18:09
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Subvisual Haze posted:Fentanyl is a dangerous drug, but an interesting one if you like studying chemistry at all. It's an opioid, meaning it hits those same feel-good receptors in your body, but it's not an opiate. If you look at the chemical stuctures all the naturally occuring opiates and their derivatives (morphine/codeine/oxycodone/hydromorphone/hydrocodone etc.) they all share the same chemical ring structure and really only differ based on -OH group here or there. Although as with any clandestine chemistry there's the chance for things to go very wrong, like the guy that accidentally synthesized MPTP as a side reaction while going for MPPP and a bunch of people got Parkinson's. Guavanaut fucked around with this message at 18:53 on Apr 9, 2016 |
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Apr 9, 2016 18:51
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ToxicSlurpee posted:Opiate addiction is also exceptionally nasty because once you get that physical addiction rolling your brain is telling you that you are literally going to die if you don't get any opiates. From what I've read it's worst than feeling like you're starving to death, which is why heroin addicts can want drugs more than food.
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May 29, 2016 03:01
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My Imaginary GF posted:How did America overcome the first great opiate addiction crisis in the 20s and 30s?
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May 31, 2016 00:15
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It's the same as with all these synthetic cannabinoids that cause seizures and can actually cause full blown physical dependence. The past century of opioids is a story of "this is terrible, ban it" followed by something even stronger hitting the market and being taken up no matter how terrible it is because of lack of alternatives, followed by "this one is even more terrible, ban it, we're super serious", rinse, repeat. For all the talk of "doctors who overprescribe opioids should be thrown in jail" itt, Dr. John Marks's scheme of prescribing standard doses of heroin to addicts proved to save a ton of lives and drove all the dealers out of the area, and the reaction of outraged moralists and the US Embassy in London was to force a change in the law to shut his clinics down. Any restrictions on prescription law should definitely have clear exceptions for addiction treatment, which has been driven too far in the other direction.
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Jun 6, 2016 13:23
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Spoondick posted:But. You sure as gently caress aren't helping by giving addicts exactly what they want, free of charge, plus refills. We tried that. Opioid over-prescription is an issue. Giving someone 60 days of high potency narcotics in one container because of minor surgery is an issue. But 'giving addicts exactly what they want, free of charge' works better than any of the alternatives tried to date. It's a shame that's not what they're actually doing.
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Jun 7, 2016 08:59
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Spoondick posted:Again. We tried it and it didn't go so good. Unless those addicts are deliberately looking to overdose (the vast vast majority aren't) then prescription schemes of metered standard doses massively decreases overdose deaths. There wasn't a single overdose death during the running of Marks's clinic program. After it was forcibly closed, of the 450 clients, there were about 40 overdose deaths within two years. "by giving addicts exactly what they want, free of charge" didn't kill anyone there, and is massively different to overprescription, inappropriate prescription, or allowing addictive drugs to be mass marketed and pushed onto opiate-naive individuals, which is a serious problem.
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Jun 7, 2016 14:08
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Spoondick posted:Giving opioid addicts opioids in a supervised clinical setting to specifically ameliorate the effects of opioid abuse is very different than writing a prescription to someone who clearly presents as an addict, knowingly giving them such high doses and quantities of drugs they would likely die if they actually took them (perhaps taking small consolation knowing that most of them will be diverted (and kill someone else)), and calling it pain management. The former works pretty well. The later kills a lot of people. I understand doctors weren't given enough training on opioids and addiction, and it didn't help that the fine folks at Perdue were talking up how not addictive their opioids were. When the dust settles on this whole thing maybe 10 years from now, I think we're going to see a large majority of the opioid prescription overdoses are linked to a small number of doctors. While your naive GP and metric-obsessed ambulatory care provider weren't helping by giving out too many opioids, I really think pill mills did most of the damage by far. The addiction treatment doctors are already stained with the stigma of addicts, and tend to get steamrollered, or forced into using 'maintenance' type opioids that have lower success rates than Marks's program of "They want heroin? Okay, let's give them pharmaceutical grade heroin* and clean gear for as long as they want and make sure they don't sell any of it on." Even for people who don't give a poo poo about addicts the reduction in property crime and gangs sells the method. *Which is drat near impossible in the US anyway currently, due to being Sched I.
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Jun 8, 2016 16:15
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Subvisual Haze posted:That's a good idea. But as long as they're making that opioid they should also make sure it doesn't shut down your bowels, or suppress your testosterone, or cause substance dependence via dopamine release in the nucleus accumbens, or generate a euphoric effect independent of analgesia, or generate tolerance to dose effect over time, or make you sedated, or cause terribly unpleasant withdrawal symptoms, or cause opioid induced hyperalgesia. But yeah, once you get rid of those minor defects, opioids would be a wonderful class of medication!
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Jun 9, 2016 09:50
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It's big in Northern Ireland for some reason. http://www.bbc.co.uk/news/uk-northern-ireland-37574709
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Oct 19, 2016 22:38
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If your elephant has a tooth infection. Other than that, I have no idea. You need less of it to make a point of street 'heroin' but surely that's outweighed by the insane handling and manufacturing conditions to not die.
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Dec 18, 2016 12:46
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KingEup posted:Decriminalise all forms of non-medical opioid use. It shouldn't be a crime to make poor health choices. Decrim in Portugal has reduced the most harmful forms of drug use by 10-15%. Sharps programs are proven important in the fight against HIV/Aids, with some reports showing a 30% decrease in transmission and an 80% greater likelihood of engagement with other services. The take-home-naloxone program has reduced opioid related deaths in Scotland by 22% in the trial group, against a background 17% rise in the general population. John Marks' Liverpool clinic saw an amazing reduction in crime by the provision of heroin maintenance therapy, and opioid related deaths in the catchment area fell to zero. I don't know the statistics for supervised injection areas, but it seems like Vancouver had some success with them, and it makes sense to do something like that if you're doing the above things. And the prohibition of the safer opioids has always led to increased use of more concerning ones, opium prohibition begat heroin, heroin prohibition begat dibenzoylmorphine, broad semi-synthetic prohibition begat fentanyl, now there's loving carfentanyl on the streets. (And lol at trying to prohibit something that can grow wild in a ditch across half the planet)
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Jan 27, 2017 12:39
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The first gen antipsychotics were basically antihistamines that had too many side effects for general use as that, notably sedation which is why people thought it might calm down schizophrenic patients. There's a ton of structural similarities between first gen antihistamines and typical antipsychotics. A lot of the earlier antidepressants were developed by the much loved (by everyone from Shulgin and academic researchers to 'legal highs' developers and patent evergreeners) method of taking familiar structures and changing one of the functional groups. Some of the starting points were drugs like novel antibiotics that were found to have incidental mood effects, or structures related to neurotransmitters themselves. So yeah, by accident and then by formulaic iteration of the results of that accident. Thus goes 20th century pharmacology.
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Feb 23, 2017 23:55
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call to action posted:What if depression is a rational reaction to societal anomie and general instability? It's also part of the reason that people of color often don't trust the mental health system, in addition to historical unethical behavior. There are a lot of times when your psychological response is perfectly rational given that it's society that's treating you like poo poo. Women have suffered the same, but I don't think there's the same level of general distrust there. It leads to an overall difficult situation where it's obviously bullshit that we should be saying to people "hey take these pills so that we don't have to make society less poo poo" but also should be treating the melancholic cases. Eej posted:Death is a natural reaction to getting Measles and it doesn't mean we should stop trying to prevent it.
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Feb 24, 2017 01:07
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Like Xu Naiji did when he said that China should undercut the British by establishing domestic opium plantations and taxing non-medical opium instead of the Emperor's policy of torturing addicts more and more severely and burning opium stocks to solve the problem, which famously worked great?
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Apr 1, 2017 17:34
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Nissin Cup Nudist posted:Standardized dosages of heroin already exist. Its called Morphine  It's often found to be the superior analgesic in late stage cancer, and administered intranasally it's better at alleviating pain from fractures in young children, due to the lower dose, faster onset, and route of administration. It is about 2.5x as strong as morphine. They make the vials smaller.
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Apr 18, 2017 22:42
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