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I don't think you can lay the blame for opioid overdoses , the spread of blood borne viruses and other assorted opioid related harms squarely at the feet of 'over-prescribing doctors' and corporate greed. Allow me to remind this thread the White House Office of National Drug Control Policy actually thought it was a good idea for people to overdose and rejected proven harm reduction measures as 'unscientific' at every opportunity:  Furthermore, iatrogenic opioid addiction is rare (even though it appears to be accepted as quite common ITT). A review published by the The Cochrane Library in 2010 concluded that serious adverse events such as "iatrogenic opioid addiction [during long-term opioid therapy], were rare." http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006605.pub2/abstract The conclusions of a review published in 2012 are as follows: "The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence." http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.04005.x/abstract A study of 9940 persons who received 3 or more opioid prescriptions within 90 days for chronic noncancer pain between 1997 and 2005 identified only 6 fatal overdoses: https://www.ncbi.nlm.nih.gov/pubmed/20083827 Almost every case of opioid related death involves poly substance [mis]use. The stats don't lie: "overdose death among those co-dispensed benzodiazepines and opioid analgesics were ten times higher (7.0 per 10,000 person-years, 95 percent CI: 6.3, 7.8) than opioid analgesics alone (0.7 per 10,000 person years, 95 percent CI: 0.6, 0.9)." https://www.ncbi.nlm.nih.gov/pubmed/26333030 A review of over 1000 fatal overdoses reported that in 96.7% of cases at least one other plausible contributory drug in addition to oxycodone was detected, the most prevalent drug combinations were oxycodone in combination with benzodiazepines, alcohol etc: https://academic.oup.com/jat/article/27/2/57/706312/Oxycodone-Involvement-in-Drug-Abuse-Deaths-A-DAWN An Australian review of all cases of fatal oxycodone toxicity from 1999-2008 and concluded that "In all cases, psychoactive substances other than oxycodone were also detected" http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1556-4029.2011.01703.x/abstract The steps that need to be taken to reduce the harms of opioid addiction are as follows: Decriminalise all forms of non-medical opioid use. It shouldn't be a crime to make poor health choices. Fund needle and syringe programs and distribute equipment far and wide. Give out naloxone kits for free and offer free naloxone administration training for the families of opioid users. Offer free opioid substitution therapy including Heroin Assisted Therapy. Fund supervised consumption rooms where people can take drugs with staff on hand to help them if needed. Repeal opium prohibition - we know for a fact that opium prohibition led to a dramatic increase in heroin use (most of it IV):  http://adlrf.org.au/wp-content/uploads/2012/02/Westermeyer-1976-The-Pro-Heroin-Effects-of-Anti-Opium-Laws-in-Asia.pdf KingEup fucked around with this message at 15:21 on Jan 26, 2017 |
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Jan 26, 2017 14:54
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pangstrom posted:Maybe in the meantime you can regale us with what you think happened in the last decade. The government continued to fund a drug war against people whose personal drug preference was oxycodone and other prescription drugs. The predictable consequences of fighting this drug war intensified. This included a deterioration in the health of prescription drug users (including overdose, BBVs, social breakdown, incarceration and financial problems). This prompted the government to escalate their drug war and crack down (as they always have) on the supply of drugs. This led to an increase in the use of street drugs as the supply of prescription opioids began to dry up. When the (predictable) consequences of fighting the drug war intensified further the government began to blame 'over-prescribing doctors'. It is better if they can shift the blame for the failures of their own drug war (for obvious reasons - they don't have admit that drug prohibition has failed and is actually counterproductive). The government then began to slowly reverse their oppostion to harm reduction such as lifting the ban on federal funding for needle and syringe programs and promoting the use of naloxone, repositioning themselves as the people who would rescue us from the 'opioid epidemic', all while maintaining that the predictable condequences of funding drug prohibition was in-fact entirely the fault of doctors who 'over-prescribe'. The government then promised to save us from 'over-prescribing doctors', 'abuse deterrent formulations' and evil 'doctor shopppers' by getting tougher, introducing prescription drug monitoring programs and 'new guidelines' that are designed to reduce the prescription of opioids. KingEup fucked around with this message at 12:39 on Jan 27, 2017 |
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Jan 27, 2017 07:27
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Lote posted:You're drawing the wrong conclusions from the papers and interpreting the numbers wrong. Under the heading that says: quote:Authors' conclusions It says: quote:serious adverse events, including iatrogenic opioid addiction, were rare. Do you reject the Cochrane findings?
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Jan 27, 2017 07:35
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Eej posted:KingEup sounds like a Purdue Pharma rep. What do you think the availability of free generic diamorphine for anyone who currently has a problematic relationship with Oxycontin would do to their sales? The correct way to handle opioid addiction is to say: "oh, you like to crush and inject oxycodone into your groin and you've sold everything you own to pay for it, contracted HIV, alienated everyone who ever cared about yo, spent several years in and out of jail and now you're sleeping rough? Well, from now on we're going to take care of you, the police are going to stop hassling you, here's a nice sanitized secure environment where you can safely use without being robbed or beaten, there are medical professionals always on hand to assist you and you won't have to pay for your gear ever again." KingEup fucked around with this message at 12:48 on Jan 27, 2017 |
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Jan 27, 2017 12:38
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KingEup posted:The government then promised to save us from 'over-prescribing doctors', 'abuse deterrent formulations' and evil 'doctor shopppers' by getting tougher, introducing prescription drug monitoring programs and 'new guidelines' that are designed to reduce the prescription of opioids. ...and here we have the success of US drug policy designed [they say] to reduce the harms of non-medical opioid use laid bare: Success from a law enforcement perspective, hurrah!:  Success from a public health perspective, err... not so much:  quote:"Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin." So much for the government and big pharma rescuing us from the harms of non medical opioid use problem with 'abuse deterrent' formulations of prescription opioids. KingEup fucked around with this message at 13:16 on Jan 27, 2017 |
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Jan 27, 2017 12:57
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pangstrom posted:That said, surmising that the opiate epidemic cause is "intensification of government crackdown" is weapons-grade obtuse. You reject the view that the government has stepped up law enforcement efforts to fight prescription drug use? You reject the view that this has adverse side-effects, so called 'unintended* consequences'? *Although entirely predictable. When will people realise that the prevelance of prescription opioid use doesn't matter. The only thing that matters is harm. Our focus should be on mitigating the harms of opioid use, not trying to reduce prescriptions, diversion and doctor shopping with law enforcement and stricter prescribing criteria. I don't give a gently caress how many people spend time in the sun for example, only whether they are harmed by the UV light or not*. It shouldn't be any different for opioids. US drug policy is equivalent to banning the sale of sunscreen to deter people from abusing themselves with sunlight. KingEup fucked around with this message at 13:25 on Jan 27, 2017 |
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Jan 27, 2017 13:08
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pangstrom posted: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. No, the government didn't get them addicted, the government's drug policy exacerbated the harm of taking opioids for non-medical reasons. pangstrom posted: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. The preoccupation with 'availability' is the problem. As you can see from the stats I posted above there was a dramatic reduction in opioids prescribed in Ohio but during the same period the harm from taking opioids increased dramatically. Policy choices can have serious adverse consequences, just like drugs. Your so called 'sane doctors' who altered the frequency they prescribed opioids and switched to 'abuse deterrant' formulations are also responsible for harms this has exacerbated. If the number of people dying from opioid involved OD increases after your change in practice, then the only sane thing to do is abandon the practice as a failed experiment. KingEup fucked around with this message at 13:43 on Jan 27, 2017 |
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Jan 27, 2017 13:34
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pangstrom posted:Yes, what insane doctors, not enlightened about how restriction is the monocausal problem and availability is the monocausal solution like KingEup Most doctors are not drug policy experts and as many people in this thread have already pointed out, have not received any training in addiction medicine and don't even realise that people can form addictive relationships to Tramadol. I mean how the gently caress did they swallow the bullshit from Purdue that Oxycontin was someone less prone to misuse in the first place? The idea of non-addictive drug that produces euphoria is as absurd as the idea of a non-flammable liquid that is easy to ignite. Most doctors will follow government recommendations without question lest they draw attention to themselves and invite additional surveillance of their prescribing habits. They should however be able to look at the stats and see that adhering to government drug policy has been a counterproductive failure especially when it comes to opioids. KingEup fucked around with this message at 13:58 on Jan 27, 2017 |
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Jan 27, 2017 13:49
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Albino Squirrel posted:the initial point of access for people was... doctors! Who probably should have been more careful about opioid prescribing for pain! Who is to blame when someone abuses their horsepower? The dealer who sold the car in the first place? Should the dealer have been more careful about who he sold the car to? Should he have interogated the buyer to see whether he/she had a history of abusing their horsepower? Surely a sane dealer would try to reduce the numbers of motor vehicles they sold so less people would abuse their horsepower. Drugs do not have the power to cause addiction, neither do doctors. Addictions to pain killers form for the same reasons people form addictions to anything else. People who overcome their addictions, and quit pain killers, do so for the same reasons as someone who quits smoking tobacco. Incidentally, millions of people have ended their addictive relationship with tobacco, not because the supply of tobacco has changed, but because they wanted to. Would anyone here argue that the solution to America's cigarette problem is to reduce the supply of them? KingEup fucked around with this message at 22:38 on Jan 28, 2017 |
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Jan 28, 2017 22:29
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Albino Squirrel posted:See, this is my issue with your line of argument... citing old [from 2010 and 2012] data that states that iatrogenic drug addiction during treatment for pain is rare, when newer data (and, in my case, copious anecdotal experience) indicates that that is NOT TRUE. Where are your data? NEJM 2016: quote:addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities
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Jan 28, 2017 23:05
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The_Book_Of_Harry posted:Hydromorphone as replacement therapy is undesirable, due to its short half-life, in this methadone-maintained ex-junky's opinion. Why can't you have both at the same time? Here is a video about a Swiss patient who gets diamorphine and methadone from the clinic: http://www.swissinfo.ch/eng/drug-treatment_-without-the-heroin-programme-i-d-probably-be-dead-/37819830
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Jan 29, 2017 05:28
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The_Book_Of_Harry posted:Huh? As I said, VIDEO. There is no reason you can't have both methadone and hydromorphone. As you can see from the VIDEO, there are patients already receiving bother methadone (long acting) and diamorphine (short acting) so there is no reason patients couldn't also take methadone and hydromorphone. KingEup fucked around with this message at 20:45 on Jan 29, 2017 |
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Jan 29, 2017 20:42
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Tim Raines IRL posted:has this thread discussed hypothetical agonist/antagonist mixtures as a way to mitigate risks of both dependence and overdose? https://forums.somethingawful.com/showthread.php?threadid=3760945&userid=0&perpage=40&pagenumber=17#post468790948
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Jan 30, 2017 03:03
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Megasabin posted:I don't think this article tells us much at all. It's entirely too vague. I love how a Cochrane review and the head of NIDA writing in the New England Journal of Medicine can be dismissed so easily. So far not one person has provided any evidence to the contrary. Are we arguing in good faith here or what?
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Jan 30, 2017 05:23
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Megasabin posted:Just because an article is from NEJM or Cochrane, does not mean it is perfect, and every article needs to be read and interpreted on an individual basis. Your'e right, it doesn't mean it's perfect. All scientific knowledge is incomplete. I'm not, however, going to dismiss the findings from a goddamn Cochrane review and reject the opinion of the head of NIDA (which reflects these findings) because Megasabin posted a 100 word critique. Show me data that says iatrogenic addiction is the the norm. KingEup fucked around with this message at 08:02 on Jan 30, 2017 |
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Jan 30, 2017 07:20
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Lote posted:I'm not providing new evidence because I'm quoting the papers that you're citing. Most of the people who end up dead or addicted are using pills prescribed for someone else. Iatrogenic addiction is not the problem. People are gettng into trouble when they are taking opioids for non medical reasons, opioids which they have sourced from somewhere else. It does demand change to ensure that the people who take opioids for non-medical reasons dn't suffer the kinds of harm that they have been. KingEup fucked around with this message at 16:37 on Jan 30, 2017 |
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Jan 30, 2017 16:31
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pangstrom posted:Another paragraph from the intro of the article: Yes, diversion and subsequent 'improper' use is common. I don't dispute that. I dispute the idea that people who take opioids which have been prescribed for them are at any serious risk of iatrogenic addiction. I also dispute the policy response to reign in opioid prescriptions, encourage the switch to abuse deterrant formulations as well as the belief that prescription monitoring programs work. I take issue with the effectiveness of supply side drug interventions in general. When have they ever reduced harm?
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Jan 30, 2017 16:58
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FreshlyShaven posted:Not necessarily. Imagine for instance a pain patient living off of disability who sells some of his pills on the black market so he can afford to pay rent and bills. The prescription may be perfectly responsible given the severity of his pain but as long as he needs an extra source of income to survive and as long as those pills fetch a high price on the black market, diversion is going to continue to be a problem. I think you meant to say: as long as there is poverty and good healh care is inaccessible to a large segment of the population then diversion is still going to happen.
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Jan 30, 2017 17:06
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New paper from downunder. Conclusions: quote:Prescription opioid poisoning may not be a direct consequence of increased prescription opioid use in the population
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Feb 10, 2017 06:15
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pangstrom posted: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. They're investigating GHB as an antidepressant too. It almost seems like everything is an antidepressant!
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Feb 27, 2017 21:44
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https://twitter.com/JohnTuckerPhD/status/841051247964708864 Oh but hey: quote:the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids http://www.nbcnews.com/health/health-news/cut-opioid-abuse-watch-doctors-study-says-n586596 It's a success I guess! KingEup fucked around with this message at 23:55 on Mar 30, 2017 |
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Mar 30, 2017 23:44
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This is a pretty good article:quote:A credible epidemiologic account of the opioid epidemic is as follows: although opioid prescribing by physicians appears to have unleashed the epidemic prior to 2012, physician prescribing no longer plays a major role in sustaining it. The accelerating pace of the opioid epidemic in 2015–2016 requires a serious reconsideration of governmental policy initiatives that continue to focus on reductions in opioid prescribing. The dominant priority should be the assurance of subsidized access to evidence-based medication-assisted treatment for opioid use disorder. Such treatment is lacking across much of the United States at this time. Further aggressive focus on prescription reduction is likely to obtain diminishing returns while creating significant risks for patients TLDR: the focus on reducing opioid prescriptions is misguided. Need harm reduction services.
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Mar 31, 2017 14:37
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pangstrom posted:I think reasonable people can agree that over-prescribing opiates in large part caused the problem We would not have the problem we do today if the Gov had not obstructed efforts to establish harm reduction services. You can't pin the blame exclusively on doctors. The problem was that the government essentially banned sunscreen and sun protection at a time when doctors were recommending ppl spend more time outdoors. KingEup fucked around with this message at 15:03 on Mar 31, 2017 |
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Mar 31, 2017 15:01
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Another good article:quote:The drug war is the problem, not opioids
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Apr 1, 2017 23:45
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Subvisual Haze posted:Implementing prescription opioid controls doesn't have a strong link to increased heroin use, although that line is the new favorite tactic of the drug manufacturer sponsored patient pain groups that oppose any degree of legislative action across the country. [/url] I did not realise that RAND had ties with big pharma: quote:Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin. http://www.rand.org/pubs/working_papers/WR1181.html
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Apr 2, 2017 06:06
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BarbarianElephant posted:Since round about then until recently there has been a lot more prescription of opioids because of a shaky study that said people in pain don't get addicted. Turns out they do, They sure do! quote:the CDC reported that de novo addiction among patients receiving chronic opioids for pain is infrequent at lower doses, affecting 0.7% of persons receiving 36 milligrams morphine equivalent (MME), rising to 6.1% among persons receiving 120 MME.3... most persons treated for prescription opioid use disorder do not have any chronic pain diagnosis.28
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Apr 3, 2017 14:19
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This one is an interesting read too:quote:States have responded to rising rates of prescription-opioid overdose by adopting laws that restrict the prescribing and dispensing of controlled substances...
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Apr 3, 2017 14:21
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BarbarianElephant posted:Providing freely available opioids would help current addicts live a normal life, but would inevitably create new addicts. New addicts who could live a normal life? What's the problem? KingEup fucked around with this message at 14:51 on Apr 3, 2017 |
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Apr 3, 2017 14:44
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quote: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. Some people don't feel normal unless they take it, some people don't feel normal unless they abstain. And my position is that it be left up to the user to decide what is best for them.
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Apr 3, 2017 23:16
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People just don't die if they are given a supervised setting to use heroin. There should be no shame in using heroin or telling someone else you are planning to use, There should be no reason to use alone. Our drug policy is killing people who have different drug preferences. The correct policy is as follows: Heroin use is removed from the criminal code Heroin is sold or given for free in a variety of formulations (nasal spray, prefilled syringes etc) in medically supervised settings and cannot be taken off the premises. Opium is sold at licenced stores for non medical use. All opioids sold for therapeutic use should come packaged with naloxone. KingEup fucked around with this message at 02:48 on Apr 18, 2017 |
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Apr 18, 2017 02:39
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Albino Squirrel posted:Heroin is only about 2.5x as strong as morphine; hydromorphone is 5x as strong and we use that all the time. We also use these lollipops all the time too: http://www.journals.elsevierhealth.com/cms/attachment/2037837012/2052294166/gr5.jpg A good read: https://www.theatlantic.com/health/archive/2017/04/joblessness-and-opioids/523281/ KingEup fucked around with this message at 08:18 on Apr 20, 2017 |
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Apr 20, 2017 07:49
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https://twitter.com/StefanKertesz/status/854816331249725440
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Apr 20, 2017 10:26
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call to action posted:Why do so many people ignore the economic aspect of this epidemic? Look at where the epicenter of these addictions are - right in the middle of the part of the country hit hardest by the 21st century. quote:as the unemployment rate increases by one percentage point in a given county, the opioid-death-rate rises by 3.6 percent, and emergency-room visits rise by 7 percent. https://www.theatlantic.com/health/archive/2017/04/joblessness-and-opioids/523281/
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Apr 20, 2017 21:15
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Guess the luminaries Trump appointed to solve the opioid crisis: http://imgur.com/Ly5z34y
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May 12, 2017 05:49
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pangstrom posted:The rest of the panel seems surprisingly decent. You have to be loving kidding me: quote:Bertha Madras, deputy drug czar to President Bush, told National Public Radio that users shouldn’t have access to naloxone because “sometimes having an overdose, being in an emergency room, having that contact with a healthcare professional, is enough to make a person snap into the reality of the situation and snap into having someone give them services.” Madras told another reporter: “It is not based on good scientific data … It’s based on what some people would consider the right thing to do. But the studies supporting it are so sparse it’s painful.” https://www.theatlantic.com/health/archive/2014/12/the-fight-for-the-overdose-drug/383467/ quote:Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco’s consideration of such a [safe injecting] facility “disconcerting” and “poor public policy.”
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May 13, 2017 00:51
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Rhandhali posted:The "super labs" are in the same places that legitimate fentanyl &c come from. Namely, China, India, etc. China can't even police adulteration of their own domestic food supply. If they somehow do succeed in reducing the heroin supply won't there just be an increased incentive for traffickers to adulterate the heroin supply and lead to more overdose deaths? Have you ever heard of the iron law of prohibition? quote:The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases. Cowan put it this way: "the harder the enforcement, the harder the drugs"
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May 26, 2017 02:52
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OhFunny posted:lol fentanyl. That's weak poo poo. Here in New Hampshire people are overdosing on Carfentanil. Which is 100x stronger. Its sole purpose is for tranquilizing large game such as elephants. Misleading bullshit: https://twitter.com/davidjuurlink/status/859227636400349184
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May 26, 2017 03:03
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pangstrom posted:Well, if the bad news is that it will get worse before it gets better, then maybe you can spin this as good news. Hopefully the black tar stuff will stay popular and available in the West. Government drug policy largely to blame. Obstructed access to all harm reduction services that reduce likelihood of people dying for decades including: - Heroin assisted therapy and other OST - Needle and syringe programs - Supervised injecting centres - Drug checking services
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Jun 7, 2017 03:19
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pangstrom posted:The chicken he's loving is that government limiting access to opiates caused the epidemic in the US. I am only interested in reducing harm and yes, evidence shows that policy designed to limit access or deter either doesn't work or creates more problems than it solves e.g. quote:"Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin." http://www.rand.org/pubs/working_papers/WR1181.html quote:Laws that restrict the prescribing and dispensing of controlled substances showed few meaningful associations with the receipt of prescription opioids... quote:“We all have a sense of desperation as the immense number of opioid deaths pile up, but the response is increasingly misdirected,” said Dr. Stefan Kertesz, an addiction medicine specialist at the University of Alabama at Birmingham School of Medicine. “A significant number of chronic pain patients are killing themselves, and that should be a concern to society at large when people die as a result of something done to care for them.” - See more at: http://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink#sthash.U49VzRmE.dpuf We simply would not have an overdose problem now if the gov had supervided injecting centres, opioid substitution therapy, drug checking services and a willingness to embrace other harm reduction services from the get go. Sure, we might still have lots of people hooked on opioids but they wouldn't be dropping dead at their current rate. Don't let the perfect be the enemy of the good. KingEup fucked around with this message at 00:50 on Jun 8, 2017 |
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Jun 8, 2017 00:43
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Lote posted:Prescribing opioids as a treatment for addiction without a specialized license is currently illegal, and the DEA will come down on you hard if they figure out you're doing it. Hilarious that the DEA has more of a say than your doctor does about the best medical care for you.
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Jun 9, 2017 03:41
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