538 has a good write up on the changing patterns of causes of death in the United States. There is one part I want to pull out:
Mortality due to substance abuse has increased in Appalachia by more than 1,000 percent since 1980….
The linked study has a great set of customizable maps. For substance abuse, it shows the southern most counties of West Virginia being one of the epicenters of substance abuse deaths in the country.
And now I want to focus on the specific from the West Virginia Gazette:
Rural and poor, Mingo County has the fourth-highest prescription opioid death rate of any county in the United States.
The trail also weaves through Wyoming County, where shipments of OxyContin have doubled, and the county’s overdose death rate leads the nation. One mom-and-pop pharmacy in Oceana received 600 times as many oxycodone pills as the Rite Aid drugstore just eight blocks away…
Cardinal Health saw its hydrocodone shipments to Logan County increase six-fold over three years. AmerisourceBergen’s oxycodone sales to Greenbrier County soared from 292,000 pills to 1.2 million pills a year. And McKesson saturated Mingo County with more hydrocodone pills in one year — 3.3 million — than it supplied over five other consecutive years combined…
At the height of pill shipments to West Virginia, there were other warning signs the prescription opioid epidemic was growing.
Drug wholesalers were shipping a declining number of oxycodone pills in 5 milligram doses — the drug’s lowest and most common strength — and more of the painkillers in stronger formulations….Between 2007 and 2012, the number of 30-milligram OxyContin tablets increased six-fold, the supply of 15-milligram pills tripled and 10-milligram oxycodone nearly doubled, the DEA records sent to Morrisey’s office show.
This is a complete system failure. There were good actors. It seems like WalMart from the story was doing a good job of actually telling abusers and addicts “no” as they were not filling high dosage prescriptions nor passing out an inordinate number of pills. But there are enough cracks in the system for unscrupulous prescribers, unscrupulous distributors who were solely responsible to pump up next quarters’ stock price, and usually small and locally owned pharamcies to pass a quasi-legal product out in droves without concern about how many people it was killing and how many lives it was disrupting and ruining.
I don’t know how to fix this problem. I just know it is a problem and it needs to be fixed.
This is the WV legislator’s priorities in 2016. Opiate problem ignored.
We got a right-to-work law. We lost the state prevailing wage.
We got more restrictions on abortion. We lost restrictions on carrying concealed handguns.
We got Uber and raw milk. We didn’t get help for West Virginia’s patchy broadband network or its deteriorating roads.
We do not have a budget. And, lacking that budget, the fate of much-feared “draconian” benefit cuts for state workers and retirees on the Public Employment Insurance Agency remains unsettled.
– See more at: http://www.wvgazettemail.com/news/20160311/wv-legislature-sees-big-changes-but-still-no-budget#sthash.Rb3UufNN.dpuf
I watched an “Adam Ruins Everything” on drugs in America over the weekend. He talked about opioid abuse and had an interesting statistic. Nearly twice as many people died from Oxy ODs than from heroin ODs. He also, as is the current CW, blamed Oxy and its maker for the heroin epidemic in the US.
Two problems with this. First, later in the show he mentioned that addiction rates are about what they have been for years; if Oxy caused the problem wouldn’t the rates have skyrocked after its introduction? Second, the estimates are that there are four times as many Oxy addicts as heroin addicts so the death rate for Oxy would be less than half that for heroin.
If the my first premise is correct (and I admit to only a little googling) then Oxycontin, no matter what damage it actually has done, is not responsible for the current “heroin epidemic” because there is no epidemic. If the second premise is correct I would not be surprised because there is no control over the formulation or cleanliness of street drugs but it would indicate abusing Oxy is less dangerous than heroin by about 2 to 1.
His conclusion that the war on drugs has been a massive failure and, as shown clearly by quotes from Nixon administration, an intended attack on people of color, is spot on but we need to fix the real problems. To fix the real problems we have to have a clear idea what they are.
Same way it was fixed last century. Regulation.
The regulatory capture of the FDA must be put to an end.
That will only happen when Public Financing of election campaigns is, at minimum, an option for candidates running for office.
Purdue Pharma pleaded guilty to misbranding a drug with intent to defraud or mislead.
Oxy was specifically marketed as NOT addictive- the company claimed the time release formulation of the drug made it addiction-proof. That’s how they gained market share and expanded the market- they told physicians they could prescribe it more frequently, safely.
I would recommend Dreamland by Sam Quinones. It’s an in depth look at the many factors that led to the opioid epidemic.
If Corporations are people too, then there needs to be more accountability. They have jails for that purpose.
If only there had been a candidate for president who had promised to make this an important focus and issue in her administration. I thought there might have been, but I can’t remember her name or what happened to her. Oh well, not important, I guess. And thank God that I just don’t care. And I guess I just don’t know. Oh, and I guess I just don’t know
My daughter and SIL lived in southern WV several years ago. If you have ever seen the movie “October Sky,” then you have seen a depiction of that area before the mines started removing mountain tops to get the coal. Now, the streams are polluted and the hills are bare. There are not enough jobs, and many of the people who live there are on SS disability. They supplement their income by selling the opiates prescribed to them. You can see the drug sales taking place, openly and without fear of arrest. I do not know how to address this problem, because the good jobs are not coming back.
Just say no.
Drop pallets of oxy on every moribund economically hamlet around. Let it work its magic, and then maybe the numbers ofvreflexive conservative voters will change.
So “personal responsibility” hasn’t already solved this problem?
@Dadadadadadada: I’m starting to question the efficacy of bootstraps as well.
To all you Juicers who still retain a sense of decency and humanity, I’m impressed and disdainful.
Just my own experience with one such actor:
My ex married a small town pharmacist from an old local family, you go down to the county courthouse and you’ll see his ancestors on the walls. Until I got locked up in a legal battle with him I didn’t have much thoughts one way or the other outside of he was an asshole. I’d heard rumors but accusations spoken around a campfire didn’t carry much weight with me. Once the legal shit began I heard more stories, these from more credible people such as that at one point in time it was well known that if you wanted it, his store was the place to go. The lawyer who related this to me told me that LE authorities were getting close to filing for warrants when there was a break in at his pharmacy during which all kinds of drugs were stolen and a fire that destroyed a lot of records.
I later on experienced these kind of convenient happenings when motions that had been filed were mysteriously lost and never saw a judges eyes, or when a private conversation with the Chief of Police resulted in a very specific death threat in less than 20 mins (this one was pointed at my 80+ yr old parents) There were others. Having had those kinds of experiences, I came to believe that all the stories I’d heard had more than a little truth to them.
It is hard to “get” someone who has many layers of protection based on family loyalties that go back a century or more.
Appalachia has entered the same world as the slums of Baltimore and like the black people depicted in the “the Wire” they are “surplus, unnecessary people.” The neoliberal capitalist world consigned black working class to to the pile of surplus people 35 years ago. It did the same to the white people of Appalachia 25 years ago. Eventually it will do it to most of us.
“,,,In his long and brilliant introductory essay to the 2009 book The Wire: Truth Be Told (a collection of essays by people involved in the making of the series), Simon wrote: “The Wire depicts a world in which capital has triumphed completely, labour has been marginalised and moneyed interests have purchased enough political infrastructure to prevent reform. It is a world in which the rules and values of the free market and maximised profit have been mistaken for a social framework, a world where institutions themselves are paramount and everyday human beings matter less.
“Unemployed and under-employed, idle at a west Baltimore soup kitchen or dead-ended at some strip-mall cash register – these are the excess Americans. The economy staggers along without them, and without anyone in this society truly or sincerely regarding their desperation. Ex-steelworkers and ex-longshoremen, street dealers and street addicts, and an army of young men hired to chase and jail the dealers and addicts, whores and johns and men to run the whores and coerce the johns – and all of them unnecessary and apart from the new millennium economic model that long ago declared them irrelevant…This is the world of The Wire, the America left behind.”
Of course, under Trumpism, we are about to get “triumphant capitalism” with a vengeance.
As Steve M. points out, here are two overarching themes that unite everything Trump does.
I think there are two “overarching theories” in the Trump administration:
“1. KA-CHING! Money is meant to flow to the plutocracy, especially Trump family members, Putin fans, and other captains of dirty-fuels industries.
2. What do liberals hate? That’s what the Trump administration intends to do.”
Dr. Ronnie James, D.O.
The opioid prescription registries that are in place now in NJ, PA and other states are helpful – if a patient comes asking for pain relief, you can look up if they have multiple active Rx from other doctors. Especially helpful to have entire regions involved if you’re in a border area like NYC/ PHL where there are mutiple states nearby.
Well-run competent pain management centers are also a godsend: they explore every non-narcotic option first (and there arr literally dozens), “rotate” opioids to minimize tolerance, and are very careful to keep patients below a certain safe threshold of “morphine equivalent dosing” for overdose. They also make patients sign “pain contracts” ensuring doctor and patient treat each other ethically, and have patients submit to regular drug testing (to make sure the drugs *are* in their urine, not being “diverted”). Please note that most of these are things every other doctor can do as well (or they can just refer patients to pain mgmt).
But these places are beacons in the darkness – the hard part is fixing all the dark corners where these things aren’t practiced (IIRC there was an investigation in FL that found ~2 dozen occupational health centers were responsible for ~80% of opioid prescriptions in the state). Docs I work with keep saying the DEA is “cracking down” on opioids, they’re reluctant to prescribe to anyone now, etc. but I’ve heard literally no specifics on what this entails, what the guidelines FDA’s following are, etc.
Heroin’s also very cheap, apparently. I’ve started seeing a few patients who substituted heroin for pain killers (or in one case antidepressants) when they lost their insurance. Worth mentioning on Electoral College Day…
Since this is a Mayhew thread, let me ask: who is paying for all these pills? I would think insurers would see a trend in their patients prescriptions and start denying claims.
It really was the case that the health system was over-prescribing these sorts of medications. My father got piles of them that he didn’t use and eventually threw away. By the time that I had serious surgery last year they had gotten religion on tightening access to them, and they were far less willing to send out lots of pills. (In both of our cases, we dislike them intensely enough that having too many or too few wasn’t an issue. For others, pain management is a real problem.) This is both the conventional wisdom and the personal experience of my family.
The bitterness towards people who are suffering, because they live in areas that didn’t vote for our candidate, makes the people expressing it look terrible, and it makes their claims of tolerance and compassion hollow. No matter how tempting, we shouldn’t walk down the road of only wanting to help our political supporters.
I have had several prescriptions for oxy, most if not all were from dentists or oral surgeons. I didn’t use them all and have leftovers I am debating what to do. when you have serious pain, it does work better, but when you don’t need the full dose it makes me woozy. I typically start cutting the pills in 1/2’s and 1/4’s and self tapering which the dentists and docs have been pleased with. Can’t stand that feeling. When you are in pain, the body seems to not have that feeling. Of course I am odd. I have never been drunk and haven’t tried drinking since I turned 21 and discovered I hated it. the whole idea of being high or drunk seems unattractive to me. that makes me clueless and insensitive to how other people feel about it.
So anyway, regulations need to include dentists.
My sister the doctor passed up buying a certain practice because the last owner and the one before that had been busted for running pill mills, that’s why it was for sale. On the one hand she would have a period where she would have to be telling a lot of patients no and them getting angry, and on the other she said it would impact her reputation with other doctors. Assumptions would be made etc. she said it was a problem because a small town therefore had no local doc. other towns hadn’t gone that way and were fine.
Florida seems to have a lot of regulations about that. Not sure it’s totally effective, but there are rules.
Substance abuse is pretty rampant in Ohio too, to the point where EMTs and cops carry Narcan with them and pharmacies sell it over the counter. Some people (conservatives, I’d bet) have been complaining about the cost to taxpayers. This is like a whole new layer of “Get off my lawn-ism.”
@Luthe: Since the regions most affected are poor, is it Medicaid or Medicare?
@Dr. Ronnie James, D.O.:
Unpossible! Job killing regulations can never ever ever be effective or in the public interest.
Amanda in the South Bay
Alas for my roommate, its easier to get narcotics from an ER for a toothache than psych meds for psychosis.
@Facebones: Second that. I am reading it now. Really good.
Aaaaand the people in chronic pain are fucked. Again. The Puritan mentality that people should suffer if that’s their lot, and that stigmatizes “unapproved” methods to relieve pain, affects even progressives.
Or do we think that people addicted to opiates aren’t actually in pain – at least not any pain that counts?
And Daddy Opioid Industry is taking it international. Purdue Pharmaceuticals is a bad MF. They’ve been on the Los Angeles Times’ radar for a while. Go, real journalists.
Pretty sure I found the mention of the movie, Oxyana, in the comments here recently.
Very moving documentary about life in a place that’s awash in prescription painkillers.
Anecdotally, I can say that the normal vector of opiates into rural communities is via an over-the-hill peni5 of the local pharmacist or physician (usually both). Lots of favor trading occurring.
@Elmo: Good morning, Elmo.
Am curious. How do they handle this in first-world Europe? Am thinking maybe more holistically. Not just shoving a prescription.
Homeowners’ insurance policies, via all the theft claims.
@Facebones: Thank you for the recommendation. I just placed a hold on it at my library. Looking forward to the read.
@AnonPhenom: I must admit that after 50 years of seeing the recurring meme of drug epidemic, I take these media panic stories with a large grain of salt. There is of course a real and chronic problem that some portion of the population is prone to drug and alcohol abuse and addiction, and that the side effects of these additions are nasty for both the person, their families, and overall society. But since the media sensationalism is usually about ratings and eyeballs and spreading panic. Actually, the rate overall of illegal drug use has gone down and been stable, https://www.drugabuse.gov/publications/drugfacts/nationwide-trends. But when we deal with population growth, the same, or even lower rate may mean an increase in absolute numbers. Nevertheless, I believe that places that have been left economically devastated by the triumph of capital over the last 35 years, you will find greater drug use as a by-product of that devastation. (From May 2016 Scientific American: “…The reality, however, is that as long as there is distress and despair, some people are going to seek chemical ways to feel better.”
I’d be content to be the MiraLAX distributor for WVa to make my fortune – all those opioid abusers = a shit-load of folks stopped up with severe constipation.
@sherparick1: The difference is that most of us here want it addressed as a health issue and not a criminal matter.
@MomSense: I’d actually be curious to know how different states regulate drugs. I have a friend in Maryland who was diagnosed with stage 4 pancreatic cancer and the doctor prescribed oxycontin in a strong dose, but the paperwork he had to submit to fill the prescription showed that the state was clearly monitoring use. (This is a good thing is in my book.) I thought this applied everywhere but maybe it’s just true for Maryland and a handful of other states with sensible regulations.
@Baud: But the point is that any approach that starts with “Regulation!” is going to frighten away practitioners and result in less pain relief, and greater suffering.
It’s odd that the JAMA authors spent so much time breaking down causes for things like unspecified cardiovascular disease, but left cirrhosis and chronic liver disease lumped in their own category. Most of those are probably due to alcohol or IV drug hepatitis, and adding those in could be important if your interest is substance abuse even though the liver category is only 2 percent of deaths.
This is all true, but the step that wasn’t then taken that should have been was to take it off the market at the point in time it became clear it was being abused. Instead, DEA came down hard on physicians (some of whom were complicit in what they must have know was illegitimate drug seeking of all kinds).
At any rate, regarding wholesalers, Florida has gone after some wholesalers, but the wholesalers are shipping pursuant to orders. Because no one wants to see Mom & Pop Pharmacist frog marched for ignoring drug dealers or filling 8 prescriptions for the same person within five days, that’s who will be used precisely because they are much less vulnerable to being maligned in the press and stopped from just doing what it takes to survive. WalMart, on the other hand, sells a lot more than drugs, which it often views as a loss leader. It can afford to refuse to fill prescriptions to people who have no intention of buying anything else except drugs.
At any rate, in other states doctors are now required to check databases before writing Schedule II prescriptions in order to prevent patients from doctor shopping. Most doctors will not knowingly write multiple prescriptions to the same patient before the first one should have run out. The DEA has accomplished that much. So many people visit multiple doctors. Most also go to multiple pharmacies because, increasingly, they also have F&A databases that they comb to make sure they are not dealing with someone who is most likely abusing or selling the drugs. Which brings us back to Mom & Pop Pharmacist. They need to stop or be stopped.
Want to bet whether incoming US AG Sessions’ first legal move toward addressing the opioid epidemic will be to crack down on…wait for it…states that have legalized medicinal and recreational marijuana, with the double-bonus that nearly all of them so far are blue states or at least purple trending strongly to blue like Colorado. It almost certainly won’t be against any big Pharma companies pushing opioids.
We don’t help kids with emotional pain or teach them how to handle it early. It’s the same nervous system, and I think part of pk use, besides addiction, is the need to relieve physical pain in the brain. Especially kids, especially in depressed areas, (but also everyone everywhere), get exposed to bad situations they can’t change. One way or another the drive to escape severe pain takes over our nervous system. So the state says: Let them buy guns and underwear from China that doesn’t fit right.
@Luthe: Insurers do have fraud and abuse databases and they do put in place fraud management controls when they figure out that someone is likely abusing or selling drugs. People who abuse/sell drugs are very wily about these things. They don’t have to use an insurance card, especially if they are selling the drug. They may be more than happy to pay cash given the value per pill of their Oxy inventory. Others who abuse the drugs might sell just enough to finance their own habit. So while all these things help, it’s the doctor databases that help the most. However, you also run into the family enterprise, where multiple members of the family will get prescriptions that are being sold/used by only one or less than all the family. It is really hard to contain drug abuse once it gets started.
@Aleta: This ties in to studies that have been done on rats with substance abuse- I read of one study where rats were given access to cocaine, and kept in very plain containers. The rats quickly became addicted. When the rats were switched into containers with lots of stuff to do (“behavior enrichment,” in zoo-keeperspeak) the rats’ cocaine use declined.
There was another article (recent)- maybe on The Guardian, but I can’t remember- about rehab for very rich kids (the Affluenza teen, etc) and what I took from it is that a lot of rich kids who get addicted suffer from low self-esteem, often due to a lack of attention from their parents. Like a lot of poor kids, rich kids have parents who work long hours (though for better compensation) and while they get material things, the emotional outcome is the same- lonely, insecure kids, but with parents who really don’t understand how this happened because don’t they give their kids everything? I confess, I went in prepared to hate-read and came out feeling really bad for these kids.
A friend of mine commented during the election that the candidates were excellent examples of the results of a securely attached child and an insecurely attached child.
@Elmo: This seems to be an article of faith among many people that no one ever seems inclined to challenge or put to proof. There is A LOT of research showing that Oxy and similar drugs do not relieve pain for any period of time that is longer than two months. It also shows that Oxy and other morphine analogs lower the pain threshold for people and sensitize them to feelings of pain. It is impossible to feel another person’s pain, but especially with chronic pain — arthritis, back pain, etc. — what people are saying about their own pain is not being backed up in controlled studies. People may feel equally better taking anti-anxiety medication or anti-depressants, which have fewer side effects and are not subject to the same kind of abuse. Until they do so, they will never know, and I, for one, presume that many people have become physically dependent on drugs and have conflated that dependence with pain management. And just to emphasize, even if you are functioning well on these drugs they have many side effects, including chronic constipation, insomnia, and dangerous driving. They also can never be mixed with alcohol or any other kind of sedative, and alcohol is often involved in many deaths that are classified as opioid overdoses.
@Schlemazel: Something seems to have changed about opiate/opioid deaths in the last few years. My mom died this year (CHF, etc.) and they decided that she needed an autopsy. It took 2-3 months because of the backlog caused by the seemingly never-ended number of opiate/opiod deaths (in SW Ohio). Whether most of the delay is mainly due to cutbacks in the coroner’s office, I dunno – I’m just relaying what I was told.
My FIL had scoliosis which many of his physicians figured would have killed him by the time he reached his 50s. He lived to be 88, but was addicted to MS con.tin (mor.phine) and per.cocet before we moved him in with us. We were able to wean him off them, but it took many, many months. If the medical system in the ritzy Boston suburbs can’t prevent that kind of addiction from happening in the first place, then it’s hopeless in the tiny towns off WV.
There’s lots of money to be made off addiction, and always has been. When big companies are part of the addiction chain, then there’s a recipe for disaster. :-(
There’s an ad I pass on my way to the bus stop everyday about a medication to help address the side-effect of constipation from long-term use of opioids. That depresses me.
I just had surgery a few weeks ago and was prescribed oxycontin for pain but every single nurse or doctor I saw during the hospital stay stressed the constipation side effect, I suspect as a way of scaring me out of using too many. It was a pretty successful technique for me- I quit taking them after the second day home.
What I was unaware of, and only my actual surgeon mentioned, is that there is acetaminophen in most prescription oxycodone. He told me so I could be sure not to end up taking too much acetaminophen over the course of a day. Soooo… it’s marketed as an excellent pain killer but it still needs a little “help” from something else? Sigh.
@Nicole: You write such astute and humane comments. Really enjoy your takes.
As a chronic pain patient, with real back issues and joint pain from multiple accidents over the years, I dread the day when my doctor doesn’t provide pain relief that works for me.
I’m not addicted, but use the medication to sleep (one a day) or if I have to work hard, to prevent the pain from causing muscle spasms making it hurt that much worser.
I’m not addicted to other drugs, either, I cut drinking to one a day with dinner, and gave up smoking cannibis years ago, tho I did test positive after being at a wintertime party where those around me were smoking a lot. Just a contact buzz, I guess.
But since others are suffering from medication misuse, those of us we who suffer will suffer the most.
ETA: as for many here. But the attached vs. non-attached psyche; that’s so interesting.
Major Major Major Major
…and I’m sure we’ll all be shocked (shocked!) to find a racial disparity in pain management practices, as in a recent study wherein doctors were less likely to prescribe effective medicines to African-Americans.
And these degenerates all voted or would have voted for Trump.
More from a May 2016 article by the LA Times, which has been following Purdue/Oxycontin for a while. Kay addressed this upstream; Purdue claimed — falsely — that their miracle drug was nonaddictive. They also marketed that it was long-lasting. Not necessarily.
LA Times: ‘YOU WANT A DESCRIPTION OF HELL?’ OXYCONTIN’S 12-HOUR PROBLEM
I have chronic pain also. After a year of repeated injury I have been able to accumulate a small horde of v!cod!n. Like you I only take them to help me sleep but even then only when the pain is excessive. I read about a month ago that the FDA is ordering a decrease in the manufacture of all opioids and in particular is reducing v!cod!ns by 60%. My hoarding has now reached extreme measures. In the last week and a half, I had a period of at least 8 days in a row of 3-4 hrs of sleep per night due to pain in my shoulders. I decided against taking a V until I got to the point of non-functionality. Fortunately, I slept the last 2 nights and maybe the cycle is broken.
The Red Pen
Market forces fix everything!
The Red Pen
History repeats itself. After World War I, morphine addiction in vets was a serious problem. A new formulation of opiate was developed to fix the problem. It was guaranteed not to be addictive. In honor of the heroes of The Great War, it was named “heroine.”
@Elizabelle: Thank you; that’s really nice to read. :)
I do recall hearing that the crackdown on Oxycontin abuse in New England has been fairly successful, but the addicts just moved to heroin, which arguably made the social problem worse.
I remember reading the LA Times article that Elizabelle mentioned above, and had been wondering if there was any followup on this. Is the real problem just that prescription opioid manufacturers are tailoring their recommended dosages to foster addiction (either deliberately, or to bolster false claims about effectiveness)?
I’m going to be kind of an asshole here, so bear with me:
1. I get to deal with the family wreckage perpetrated by opiate addicts on a routine basis. Five years ago, this was rare. Now, it is practically intractable and crosses all walks of life.
2. My perception is that the root of the genesis for most is in laziness – lazy physicians and lazy patients who don’t initiate pain management without an end game. There is an unwillingness on the part of both legitimate chronic pain patients and patients with manageable temporary pain to endure some discomfort while they attempt alternate means of management (including weight loss, physical therapy, diet, stretching, etc.). Also missing is any real commitment to or acknowledgement of the reality of dependency or the roads out of it once the condition is managed.
3. Compounding this is money – the money made by pain management clinics to keep people onboard, and the money made by methadone/suboxone clinics (methadone is $100 a week, and they do a great job of terrifying their customers that they will die if they tail off the methadone use – which is dutifullybreported to family members as gospel). As a result, people who are perfectly able to come off are psychologically manipulated to stay on.
4. Don’t kid yourself – long term opiate use and kind term methadone management affect every aspect of the addict’s life to the negative. Work (if they’re bothering at all) becomes hard, the relationships suffer due to indifference, children and necessary life tasks get neglected and the pain and addiction become excuses for every failure.
I have very little personal concern for the opiate user who isn’t suffering from chemo and is refusing to try to terminate their use.
@Nicole: Yeah, I’ve watched that happen to 3 kids from wealthy families who I’ve known since they were born. In the summer one was my neighbor and came down the road to the cabin every day. If we were still asleep he’d sit quietly in the woods until we woke up. Took him hiking, found remnants of pirates, discovered buried rusty metal. Fortunate family. His daddy’s rich and his mama’s good looking. Everyone talented, smart, great toys. Vicious fights, distrust. Lots of the risk factors were there for him, and I always worried. He’s 20 now; I haven’t had a talk with him while he’s sober for 4 or 5 years. He’s been in the zone of figuring how to support his habit (steal or deal or get jobs but quit or hang with anyone who will give you some ) for the last 3. Last summer he hung with a kid who was stealing ox from his grandfather. Now the news says that the answer to that question has become cheap heroin.
@OzarkHillbilly: @Anonymous patient: There are many, many people with chronic pain – pain that is not caused by, say, terminal cancer – who do well on opioids, who are able to manage their use of the medication, who are physically dependent (i.e., they would need to carefully taper off, not just stop) but who are not addicts, who do not need to keep upping their intake, but who stay pretty stable on their regular dosage. Hydrocodone is really effective for some types of pain, for some people, and those people are going to suffer as prescribing restrictions tighten.
I get that there really is an epidemic of opioid abuse, that it’s killing people, and that we have to address it. All of y’all are saying important things, and the studies and articles are essential reading. But part of me wants to remember that the abuse starts with pain or a related need (anxiety or depression) and people start taking it because it makes them feel better. It makes the hard edges softer; it provides comfort. Misuse quickly becomes a huge problem, but in addition to the pharmaceutical and prescribing remedies, we can’t lose sight of the underlying motivation that people experience: deep, unrelenting despair and a vision of a bleak and pointless future. We know Oxy doesn’t fix that. But our national unwillingness to provide public funding for clinics and social workers and outreach and intervention isn’t helping.
@Botsplainer: Opiates are closely related to natural neurochemicals in the brain. It’s not simply lack of will-power that keeps people addicted.
The Neurobiology of Opioid Dependence: Implications for Treatment:
Without intensive help via human interactions and proper medications, it’s a very, very difficult problem to treat.
@Botsplainer: Opia.tes are closely related to natural neurochemicals in the brain. It’s not simply lack of will-power that keeps people addicted.
The Neurobiology of Opi.oid Dependence: Implications for Treatment:
Without intensive help via human interactions and proper medications, it’s a very, very difficult problem to treat.
[edit: trying to get past the FYWP filters…]
@Botsplainer: I’m going to respectfully disagree that long-term treatments like methadone are merely due to laziness. I do agree that our medical industry can be too quick to turn to painkillers as a fix for some (note: SOME) problems that could be addressed via things like physical therapy, but that’s also because it’s cheaper than PT, and that’s something that is hard to fight against when an industry is out to make money.
It’s true some pain could be handled via weight loss, but weight loss is incredibly difficult for many people. HBO has done a good series of documentaries on America’s obesity crisis, and it’s equal parts informative and depressing, especially regarding childhood obesity. People who lose large amounts of weight are pretty much restricted to what can be starvation levels of caloric intake for the rest of their lives unless they have the kind of life that lets them exercise 6-8 hours a day, every day, because the metabolism has changed to accommodate the weight. That’s hard to do. It’s every bit as much of a lifetime sentence as being on methadone, only the side effects include feeling hungry most of the time.
Methadone can also be a useful, long-term solution for some former addicts, because the brain has changed due to the addiction and is not going to go back to where it was before. Not all; you’re right that some people can get off and stay off, but I think it’s not helpful to apply a “one size fits all” solution on either end (i.e., painkillers for all or painkillers for none). It’s akin to telling a diabetic that because some diabetics are able to go off insulin after losing X amount of pounds, all diabetics should be able to go off insulin after losing X amount of pounds. It’s just not how organs work (and the brain is an organ too, albeit the only one smart enough to name itself). Some pain conditions are not going to be treatable by stretching more.
Of course, it’d be better for people never to become overweight or become addicted to pain killers in the first place, but once they are, I think we have to be flexible about what the best practices are to help them function to the best of their abilities. And that varies, depending on the individual and their circumstances.
I say we let Russia handle this problem for us. They voted for the Russian candidate after all.
Flood the community with opioids. Keep the population stoned out of their minds. Fill their addled heads with fake news and resentment.
WV, you get this: Trump 68.7%, Clinton 26.5%.
I understand that, and also see the difference in client personalities before ceasing use of opiates and, if they are on it, methadone maintenance and after. The differences are striking. I tend to present it to them with the ultimatum about having a relationship with their children.
About 2/3 can’t seem to be bothered to make the effort. Each one who has stopped has reported that it wasn’t as hard as they’d been led to believe.
@The Red Pen:
This is pretty much bullshit. Bayer marketed diamorphine as a morphine substitute (and cough suppressant!) and trademarked it as Heroin in the 1890s.
They’re not even trying, which is my problem.
The Red Pen
@Steeplejack: I obviously got the war wrong.
And those Oxy pills are expensive $100’s per month versus cheap (15cents a day= less than $10/month) morphine.
I will also note that I bet that substance abuse 1000% number does not include alcohol and cigarette related deaths.
@Nicole: To me it all comes back to a single point: why get anyone started down this road? Let’s set aside someone who is 58 years old and really needs a knee replacement but can’t afford one and so wants opiates to control pain. Even in that case, you can make a pretty decent argument that high dose NSAIDs, even if imperfect, are better in the long-term. But what about people who are in their 20s or early 30s. Most of these people don’t have chronic pain. They may have started down this road with a prescription for some kind of muscle pain or a dental procedure. Or even worse, they are buying from people like the arthritis sufferer who sells pills for profit after they get injured on the job but can’t afford to visit a doctor, and this is clearly happening in states like West Virginia. Nobody knows how their own brain will react to drugs or how vulnerable they are to addiction. That’s what I tell my own kids. You can’t know whether you will be the one who ends up stealing and going to prison because you feel like you are going to die half the time and during that time the only thing you are doing is trying to find your next fix. I am sorry for people who are in pain, I really am, but society has to make reasonable trade offs here and, yes, it is hard for me to believe that we as a population are in so much more pain now than we were 40 years ago.
Charles Pierce and The West Virginia Gazette-Mail are on it:
There are times when I think the pharmaceutical industry ought simply be nationalized.
BCHS Class of 1980
@Dr. Ronnie James, D.O.: Nothing related to the opioid epidemic in WV except that my home county seems to be about median (again), but I just got your username. Pretty sure that makes me the last in line. ?
@Raven Onthill: I am not defending pharmaceutical companies, but G*d dammit, physicians write scripts and pharmacies fill them and no one else can make it happen without their participation.
@Barbara: I think that comes down to much deeper societal problems, certainly. If we were in a culture that prioritized people having something useful to do with their lives over shareholders getting profits. I grew up near Hershey, PA- every decade or so there’s an attempted sale of the company, with the argument that the shareholders- the main one being the Milton Hershey School, which has more $$ than it knows what to do with- deserve bigger profits. And I wonder, because providing jobs (though even many of those have been outsourced) and keeping a town going isn’t a valuable end unto itself? When do we value people at least as much as we value money?
And maybe the problem has always been there (Unemployed Lily Bart SPOILER ALERT died of an accidental drug overdose in The House of Mirth, after all), but we just make medication much better and stronger now.