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Yeah, unfortunately a drug is going to have to get into the pain pathways at some point and the low-hanging pharma fruit has been plucked. Hopefully one of the next gens will work but the good news for the US at large is that when it comes to opiates, the BULK of the answer is already pretty clear. We just need to use way fewer opiates. Not easy, of course, but it's not a R&D problem that's going to fail in clinical trials or something.
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Jun 9, 2016 14:49
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computer parts posted:Because when we do that, we get heroin outbreaks. pangstrom fucked around with this message at 15:23 on Jun 9, 2016 |
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Jun 9, 2016 14:57
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I guess at least the opiate ODs are yielding a lot of organs. Still way too many old sick people for them to go around, though. http://www.npr.org/sections/health-shots/2016/10/14/497799446/organ-donations-spike-in-the-wake-of-the-opioid-epidemic
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Oct 19, 2016 04:05
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It has been the way things were going in general since 2011 (when the Florida pill mills got shut down, when the first doctors started getting prosecuted etc.). Basically that's when the price for oxy etc. started to go up, heroin-related deaths started to go up, etc. A lot of doctors knew what was up over decade earlier, but my sense was that 2014-ish was when the bulk of even out-of-it doctors had come around. A few are still behind the curve, of course.
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Dec 14, 2016 21:50
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Yeah, a lot don't know addiction (e.g., Dr. Drew says a lot of doctors get super pissed when they find out their patients lied to them, while people with experience are like "yeah no poo poo, that's what addicts do, don't take it personally") and also the quick taper probably leaves a doctor with the least legal liability. It's not always really clear what they SHOULD do, to be honest, if the patient doesn't have a lot of money (in which case hey go to rehab). It's not like most people can pull of a gradual taper on their own, either. The lowest hanging fruit is not getting a lot of new addicts out of people just having outpatient procedures etc.
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Dec 14, 2016 22:09
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That (along with a similar compound) is the stuff the Russians pumped into the theater to resolve a hostage situation in 2002 https://en.wikipedia.org/wiki/Moscow_theater_hostage_crisis not a terrible idea if they had given everyone naloxone afterwards but they didn't so lots of people died
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Dec 18, 2016 12:56
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OhFunny posted:The full breakdown of 2015 deaths from the CDC has been released: The analysis I want to see is a rough forecast, based on extant addiction and current levels of people maintaining, dying, or stopping using, how big the rest of this iceberg is going forward.
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Dec 18, 2016 13:03
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Putting straightforward suicide attempts aside, what proportion of users-mixing-opiates-with-depressants-who-OD knew they were playing with fire, do you guys think? Seems like it would be high. Feels semi-suicidal, at least the "gently caress it" sense.
pangstrom fucked around with this message at 16:24 on Jan 4, 2017 |
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Jan 4, 2017 16:21
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I will cobble together a response to that this weekend. Maybe in the meantime you can regale us with what you think happened in the last decade.
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Jan 27, 2017 00:54
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Lote posted:I would use more up to date findings. You're using a paper from 2010. The author that you're citing wrote the new CDC guidelines in 2016 for prescribing opiates which draw completely opposite conclusions and recommendations. KingEup: totally agree that harm reduction stuff is definitely part of the solution, though we might disagree on the specifics (I don't have strong opinions here, it's hard to say for sure, though I wouldn't say "open the oxy floodgates" for example). Totally agree taking opiates in isolation isn't that bad for you biologically (though you can push it to losing-your-hearing levels, narcotic bowel syndrome levels [toasticle?], etc.). The thread has been these places and most people agree, I think. In a world where addiction tends to cause other parts of your life and decision-making to unravel, it's a problem... OD is now the leading cause of "injury death". Government policy is PART of that world, sure. That said, surmising that the opiate epidemic cause is "intensification of government crackdown" is weapons-grade obtuse.
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Jan 27, 2017 12:58
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You're shifting it a bit already, which is fine, but: I reject that that a government crackdown was what got 2+ million people addicted to prescription opiates, which is more THE CAUSE of the epidemic. The government recently cracked down on prescription opiate availability, which many sane doctors had already done on their own, because they didn't want that number to keep going up.
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Jan 27, 2017 13:24
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Yes, what insane doctors, not enlightened about how restriction is the monocausal problem and availability is the monocausal solution like KingEup
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Jan 27, 2017 13:40
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Yeah, sorry I didn't get around to doing an effortpost, not that it's a great loss or anything I just said I would and the weekend got away from me. If the rate of iatrogenic opiate addiction were just MEDIUM (in an absolute sense) then like 20% of the country would be addicted. There were a ton of opiate prescriptions. That's the main base-rate thing that KingEup is eliding with his evidence. People definitely get addicted in part for endogenous reasons, but there's a reason the rate blew up recently and it's not that mysterious and it was the opposite of a crackdown. And yeah, things are going to be bad for awhile regardless of what policy is. We've got ~2 million opiate addicts walking around. pangstrom fucked around with this message at 01:05 on Jan 30, 2017 |
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Jan 30, 2017 01:03
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Another paragraph from the intro of the article:quote:However, two major facts can no longer be questioned. First, opioid analgesics are widely diverted and improperly used, and the widespread use of the drugs has resulted in a national epidemic of opioid overdose deaths and addictions. More than a third (37%) of the 44,000 drug-overdose deaths that were reported in 2013 (the most recent year for which estimates are available) were attributable to pharmaceutical opioids; heroin accounted for an additional 19%. At the same time, there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014.9 Second, the major source of diverted opioids is physician prescriptions.10,11 For these reasons, physicians and medical associations have begun questioning prescribing practices for opioids, particularly as they relate to the management of chronic pain. Moreover, many physicians admit that they are not confident about how to prescribe opioids safely,12 how to detect abuse or emerging addiction, or even how to discuss these issues with their patients.13 KingEup you're locked in on this narrative that isn't true and even without the redtext you have the smell of somebody who either can't or won't think straight about anything, only gets worse with increased "expertise", and is totally fine with scorched earth debating and goalpost shifting. It's hard to tell how much of it was iatrogenic versus diverted, but in the context of pill mills those sources are basically the same thing. Both are "availability". And, ultimately, the "how did we get here" isn't the same question as the "how do we fix it", where people to varying extents will agree with you. I'm not super interested in hearing your thoughts on that topic, either, to be clear, but at least we don't have to spend time on sky-is-blue stuff.
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Jan 30, 2017 16:38
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Well, if we could go back in time to the mid 90s and change prescribing guidelines on opiates, or strangle oxycontin in the crib, or something similar along these lines, well that would have decreased a lot of harm!
pangstrom fucked around with this message at 20:30 on Jan 30, 2017 |
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Jan 30, 2017 17:04
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Jesus don't tell people taking percocets to switch to suboxone, wtf https://forums.somethingawful.com/showthread.php?threadid=2621435&pagenumber=367&perpage=40#post468879086
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Jan 30, 2017 17:07
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KingEup what's your "angle", on addiction, history-wise? Like are you a former addict, had parents with issues (I'm this), are a doctor, what? Just curious and interested in the topic? Like I don't think you're a pharma rep but I don't get you at all.
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Jan 30, 2017 17:09
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Along those lines, the recent This Life podcast with Battlefield Addiction was interesting. The guests aren't great as far as "how to be on a podcast" goes, but you hear a lot about different kinds of users in different places, different reasons for their using, different approaches to treatment, how things are changing, etc. http://drdrew.com/thislife/ As a total aside, I think Dr. Drew thinks doctors are responsible for the epidemic and NOT pharma for a few reasons, but one of them is because he got ID'd as taking $ from GSK for talking up Wellbutrin's lack of sexual side effects (or even positive sexual side effects), which he defends himself from by saying it was consistent with his clinical experience etc. In other words, pharma is just pharma being pharma and it's the doctor's job to do the right thing, which he claims he did.
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Feb 8, 2017 15:46
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Yeah I think he basically did get paid to tell what he thought was true, problem is he didn't disclose he was paid by GSK etc. A no harm no foul thing but also pretty obviously not-great ethics-wise.
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Feb 8, 2017 16:26
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Interesting, knew vaguely that "giving opiates in the hospital didn't result in addiction" got fuzzed into "giving opiates doesn't result in addiction" but didn't know kind of the original lynch-pin of that.
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Feb 9, 2017 14:45
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Sure. Caffeine helps, too.
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Feb 23, 2017 21:43
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I would blow Dane Cook posted:Weren't a lot of psychiatry related drugs discovered by accident?
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Feb 24, 2017 00:40
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Don't recommend this podcast in general (it's "outside my comfort zone" / borderline homework for me) but there was a good interview with Sam Quinones (author of Dreamland) on EconTalk about the heroin epidemic. His "beat" is Mexico and Mexican Americans so he knows most about that side of things. http://www.econtalk.org/archives/2017/01/sam_quinones_on.html
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Feb 24, 2017 16:29
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There is decent evidence that Ketamine might be a new antidepressant tool. In general though yeah antidepresants aren't a huge psychiatry success story for mild or medium depression and they wouldn't be the first thing I'd try. Put me in the psychiatrists aren't typically morons camp, though.
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Feb 27, 2017 14:44
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LIfe expectancy dipped a bit in 2015 in the US, which doesn't happen often outside of things like the AIDS epidemic. They're kind of agnostic about it in the article but since nothing killing young-ish people has increased I'm pretty confident that opiate-related ODs are driving it. http://www.npr.org/sections/health-shots/2016/12/08/504667607/life-expectancy-in-u-s-drops-for-first-time-in-decades-report-finds
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Mar 30, 2017 03:30
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Ytlaya posted:How does this work? I was under the impression opiates didn't actually cause any harm to the body outside of the respiratory depression if you take too much. People can experience side effects like malnutrition due to their addictions, but that isn't directly caused by the drug.
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Mar 31, 2017 03:01
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I think reasonable people can agree that over-prescribing opiates in large part caused the problem (which we can deduce by comparing the United States to other countries or being even mildly curious or even passingly knowledgeable about the timeline of oxy and pain as 5th vital sign or not being ideological morons, etc.) AND that pulling the rug out from that without a sensible policy about where these addicts would go would result in more OD deaths when they started doing heroin etc. Guessing narcan wasn't part of that 2011 Ohio plan, either. There would have been plenty of deaths--and even more fresh iceberg created under the surface--if they just kept the pill mills running, though. Hard to know what that lag would look like in aggregate, but if you care about human beings then another line you'd like to see on that chart is "# of new addicts/potential addicts".
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Mar 31, 2017 14:52
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I'm not overstating things at all when I say your top-line takes are no less dumb than saying the opiate problem in 19th century China was due to government crackdowns or under supply.
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Mar 31, 2017 15:15
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~23k drug convictions are going to be vacated in Massachusetts, though it took a long time by any standard to get here. http://www.nbcnews.com/news/us-news/stunning-drug-lab-scandal-could-upend-23-000-convictions-n739626
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Apr 2, 2017 23:53
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Addicts generally don't lead normal lives and it's not just government policy that causes that.
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Apr 3, 2017 21:07
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What would you guess is the over under on what those folks would choose if it was "just" a choice, though?
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Apr 3, 2017 23:21
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Ytlaya posted:Yeah; even on suboxone I never felt quite the same as I did back before I had ever used. Even ignoring the psychological issues, I couldn't experience feelings like pleasure or excitement in the same way I could when clean. I know that some addicts are able to feel totally normal on suboxone, but for me it just made things tolerable and preferable to using a short-acting opioid.
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Apr 4, 2017 12:55
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Teriyaki Koinku posted:What is the significance of the exemption specifically? Is it part of the crackdown on pill mills? I have kind of the opposite reaction because yeah, tapers are loving painful which means hopefully-temporary loss of function and the BU-BUT HIPPOCRATIC OATH! response seems very disingenuously pearl-clutch-y to me.
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Apr 20, 2017 14:56
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I think it has pulled less focus in part for the same reason that nobody is talking about the genetic risks of addiction. It's tough to legislate genes and it's almost as tough to legislate hope. It's also kind of hard to argue that rural white Americans are uniquely hopeless and the opiate trend hasn't tracked (say) economic prospects that closely. Another aspect working against it is that the high profile deaths are all Heath Ledgers and Philip Seymour Hoffmans and Princes etc. THAT ALL SAID, yeah it's obviously part of what is going on.
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Apr 20, 2017 15:39
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Oh, the other factor that hasn't come up I don't think is child abuse. People who were abused as kids are way more likely to become addicts. http://www.nijc.org/pdfs/Subject%20Matter%20Articles/Drugs%20and%20Alc/ACE%20Study%20-%20OriginsofAddiction.pdf
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Apr 20, 2017 20:25
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If you're a for-profit pharmaceutical hater, I can't think of a better recent argument than this lamebrain podcast about investing in companies with potentially-profitable "solutions" https://www.fool.com/investing/2017/04/18/can-drugmakers-cure-the-opioid-crisis.aspx
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May 2, 2017 03:51
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I think reasonable people can disagree, here, but while Christie is a bad guy who should be in jail he's probably the best we could have hoped for (among plausible alternatives) in terms of being inform-able and reasonable on policy. The rest of the panel seems surprisingly decent. It probably helps that being associated with trying to fix the problem isn't exactly a plum assignment. Our healthcare system is geared ridiculously poorly to actually deal with this though so it wouldn't surprise me if the response amounted to handing out federal money to over-promising scammers but, even if they do great policy, we're still solidly on the going-to-get-worse-before-it-gets-better side of things.
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May 12, 2017 11:26
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tetrapyloctomy posted:I saw my first probable carfentanil/sufentanil overdose recently. Naloxone worked so transiently that we needed to intubate, we literally would have obliterated the pharmacy's stocks trying to run a drip at a high enough rate. We're going to run out of vents and ICU beds if a big batch of it lands. Going just off word of mouth and a few articles and there is a clear observation bias there but it seems batches of overpowered stuff landing in a specific location is how this often goes down... haven't heard of facilities being overrun at least.
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May 12, 2017 14:47
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tetrapyloctomy posted:My hospital had over thirty overdoses in one weekend last year. Luckily most were just slightly-fentanyl-spiked heroin or the usual stuff, so they got a single dose of naloxone and walked. A lot of them don't get counted in the official stats: people bring them in a private auto apneic, blue, and limp; we butterfly them in the seat and slam in a dose of naloxone without moving them because it's faster than trying to drag dead weight out of a car into a chair or stretcher; they wake up, refuse to come in, swear at you for loving their high; and then their friend drives them off. There are dozens and dozens or users at The Tracks pretty much all the time, and if you get a batch of carfentanil-laced dope there, well, a lot of people are going to end up intubated or dead. Maybe you have a few more in the ambulances?
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May 12, 2017 15:49
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KingEup posted:You have to be loving kidding me:
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May 13, 2017 22:01
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