The US Opioid Crisis

[BmorePat87]

So the issue of the opioid crisis in the US has come up a lot recently and Trump has started to address how he wants to handle it, starting with a law and order approach. His own commission, headed by Christie, has urged him to declare the epidemic an emergency (which Trump and Price have rejected).

http://www.politico.com/story/2017/08/08/trump-opioid-epidemic-heroin-241416

Quote:President Donald Trump on Tuesday vowed his administration would beat the opioid epidemic by beefing up law enforcement and strengthening security on the southern border to stop illegal drugs from entering the country.

Trump, joined in Bedminster, New Jersey, by Health and Human Services Secretary Tom Price and other administration officials, emphasized a tough law-and-order approach, rather than new treatment or social programs, as the White House's primary strategy for halting an epidemic that kills 142 Americans every day, according to federal statistics.

The administration also backed the GOP's Obamacare repeal-and-replace proposal that the CBO estimated would slash Medicaid — the largest payer of behavioral health services — by $800 billion. Advocates have stressed that such a proposal would almost certainly result in less access to treatment for people with addiction.

About 1.2 million people with substance abuse disorders got insurance through the Affordable Care Act's Medicaid expansion, according to a study published in Health Affairs. It also has paid for 35 percent to 50 percent of all medication-assisted treatment administered to help fight opioid addiction, according to the National Council for Behavioral Health.

Trump said of opioid use: “The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don't start, they won't have a problem. If they do start, it's awfully tough to get off. So if we can keep them from going on and maybe by talking to youth and telling them: No good, really bad for you in every way. But if they don’t start, it will never be a problem.”

This does not really mesh with how people are starting to use opioids, however. While 80% of opioid users in the 60's first used heroin, today the trend is completely different. Most users start with prescription drugs. 86% of those using injection drug between 2002-2012 first used prescription drugs. I think most people have a friend or family member who had an issue with prescription drugs. It can be tough when the drug is given to you by a doctor for your health.

The commission has also called on Trump to waive limits on the number of medicaid recipients who can receive residential addiction treatment. So far the rhetoric has been aimed at a law enforcement approach rather than a treatment approach.


Thoughts on how this issue should be approached? I'm in the boat of approaching the root cause first.

[oncemoreuntothejimbreech]

Beefing up law enforcement and border security to combat a problem which is mainly due to the misuse and abuse of legal prescriptions is like using a screwdriver to hammer a nail. It's the wrong tool for the job and exactly the type of ineffectual strategy I would expect from someone who can't be bothered to spend a minimum of five minutes learning the bare minimum needed to have an informed opinion on the subject let alone make policy decisions and who gets his advice from idiots like Jeff Sessions whose knowledge of marijuana comes from 1930s era propaganda on par with Reefer Madness. Hell, Reefer Madness might be more accurate than Sessions. Complete incompetence.

[ballsofsteel]

(08-09-2017, 12:02 AM)oncemoreuntothejimbreech Wrote: Beefing up law enforcement and border security to combat a problem which is mainly due to the misuse and abuse of legal prescriptions is like using a screwdriver to hammer a nail. It's the wrong tool for the job and exactly the type of ineffectual strategy I would expect from someone who can't be bothered to spend a minimum of five minutes learning the bare minimum needed to have an informed opinion on the subject let alone make policy decisions and who gets his advice from idiots like Jeff Sessions whose knowledge of marijuana comes from 1930s era propaganda on par with Reefer Madness. Hell, Reefer Madness might be more accurate than Sessions.  Complete incompetence.

[Au165]

Locking people up doesn't fix the drug problem, but it does fix the under crowded prison problem someone else mentioned yesterday.

[*michaelsean*]

Can someone show me where all this starts with LEGAL prescriptions? I was just reading a story on Middletown, OH which is apparently just being destroyed by heroin, and these people didn't get there because they became hooked on legal prescriptions, and switched to heroin.

As an aside, one guy in the story who has now been clean for a couple of months ODed 8 times in seven days and was revived with Narcan. Once a day plus one. That's nuts.

[oncemoreuntothejimbreech]

(08-09-2017, 10:22 AM)michaelsean Wrote: Can someone show me where all this starts with LEGAL prescriptions? I was just reading a story on Middletown, OH which is apparently just being destroyed by heroin, and these people didn't get there because they became hooked on legal prescriptions, and switched to heroin.

As an aside, one guy in the story who has now been clean for a couple of months ODed 8 times in seven days and was revived with Narcan. Once a day plus one. That's nuts.

http://www.senate.ga.gov/sro/Documents/StudyCommRpts/OpioidsAppendix.pdf

According to this source, in 2015 12.5 million Americans admitted to misusing pain meds while 914,000 admitted to using heroin. And that's just the people who self reported. I can show you more later.

[oncemoreuntothejimbreech]

https://www.cdc.gov/drugoverdose/data/index.html

The chart at the bottom indicates "common" prescription opioid ODs exceed illicit opioid ODs for at least 16 consecutive years and counting. Most likely longer, but the chart doesn't include data before 2000. It also doesn't combine "common" prescription opioids with ODs from prescription fentanyl and tramadol listed under other synthetics.

[*michaelsean*]

(08-09-2017, 10:44 AM)oncemoreuntothejimbreech Wrote: http://www.senate.ga.gov/sro/Documents/StudyCommRpts/OpioidsAppendix.pdf

According to this source, in 2015 12.5 million Americans admitted to misusing pain meds while 914,000 admitted to using heroin. And that's just the people who self reported. I can show you more later.

I didn't say it very clearly.  I meant how people say the heroin epidemic is the result of people using legal prescriptions and then moving on to heroin.  Or maybe i'm misunderstanding. I thought people said that a large percentage of people using heroin got hooked on their legal prescriptions, and turned to heroin because it was cheaper and maybe easier to get.

[GMDino]

(08-09-2017, 11:10 AM)michaelsean Wrote: I didn't say it very clearly.  I meant how people say the heroin epidemic is the result of people using legal prescriptions and then moving on to heroin.  Or maybe i'm misunderstanding.  I thought people said that a large percentage of people using heroin got hooked on their legal prescriptions, and turned to heroin because it was cheaper and maybe easier to get.

Little of column A, little of column B.

I had a doctor explain that the medical societies / regulations were pushing for more "pain control" so the prescriptions for the opioids went up dramatically.  Then when they started to see people moving from the prescriptions to illegal drugs...or passing their legal pills to others...they started pushing to prescribe FEWER pills.

He was deadset against legalizing even medical marijuana because he was afraid of it being a gateway to heavier drugs, but even he had to admit it can't be any worse than it is now.

[oncemoreuntothejimbreech]

(08-09-2017, 11:10 AM)michaelsean Wrote: I didn't say it very clearly.  I meant how people say the heroin epidemic is the result of people using legal prescriptions and then moving on to heroin.  Or maybe i'm misunderstanding. I thought people said that a large percentage of people using heroin got hooked on their legal prescriptions, and turned to heroin because it was cheaper and maybe easier to get.

Click the heroin overdose data tab. It has information pertaining to your questions.

[*michaelsean*]

(08-09-2017, 11:39 AM)oncemoreuntothejimbreech Wrote: Click the heroin overdose data tab. It has information pertaining to your questions.

Got it.  Thank you.

[*michaelsean*]

And this fentanyl aspect seems insane. With that added, it's no longer a question of if you will overdose. It seems assured, and one of those times it's going to kill you.

[Millhouse]

I saw a study done by Princeton researchers of opiod prescriptions written from 2006-2014. Basically "Economics professors Molly Schnell and Janet Currie, the co-authors of the study, discovered that physicians who attended top medical schools wrote significantly fewer opioid prescriptions than those who completed their initial training at lower ranked schools. Further, between 2006 and 2014, nearly half of all opioids prescribed by doctors were issued by general practitioners."

Pretty interesting that there could be a correlation between where a doctor went to school and the number of opiods he/she may prescribe.

https://www.usnews.com/news/national-news/articles/2017-08-08/doctors-from-top-medical-schools-less-likely-to-prescribe-opioids-princeton-study-finds

[oncemoreuntothejimbreech]

(08-09-2017, 12:13 PM)Millhouse Wrote: I saw a study done by Princeton researchers of opiod prescriptions written from 2006-2014. Basically "Economics professors Molly Schnell and Janet Currie, the co-authors of the study, discovered that physicians who attended top medical schools wrote significantly fewer opioid prescriptions than those who completed their initial training at lower ranked schools. Further, between 2006 and 2014, nearly half of all opioids prescribed by doctors were issued by general practitioners."

Pretty interesting that there could be a correlation between where a doctor went to school and the number of opiods he/she may prescribe.

https://www.usnews.com/news/national-news/articles/2017-08-08/doctors-from-top-medical-schools-less-likely-to-prescribe-opioids-princeton-study-finds

General practitioners or family practice doctors have a different disposition than say an orthopedic surgeon. In general, I've found them to be more friendly and probably more willing to please their patients or meet their expectations. Some providers have a hard time saying no and want to avoid confrontations. Some of it is dictated by financial pressuevev n though it shouldn't be. Also, some probidersvwrite prescriptions because it is easier to write a prescription they don't need them explain why they don't need it which is wrong, also. The last two deal more with antibiotics than pain meds.

[Belsnickel]

(08-09-2017, 12:34 PM)oncemoreuntothejimbreech Wrote: General practitioners or family practice doctors have a different disposition than say an orthopedic surgeon. In general, I've found them to be more friendly and probably more willing to please their patients or meet their expectations. Some providers have a hard time saying no and want to avoid confrontations. Some of it is dictated by financial pressuevev n though it shouldn't be. Also, some probidersvwrite prescriptions because it is easier to write a prescription they don't need them explain why they don't need it which is wrong, also. The last two deal more with antibiotics than pain meds.

Would it also be true that most doctors coming out of the higher tiered med schools don't work in family medicine, but rather in other specialties?

[Benton]

(08-08-2017, 11:33 PM)BmorePat87 Wrote:   While 80% of opioid users in the 60's first used heroin, today the trend is completely different. Most users start with prescription drugs. 86% of those using injection drug between 2002-2012 first used prescription drugs. 

Which makes me think about the folks who rail against legalizing marijuana to treat minor pain/chronic conditions. It's frustrating, and shows a lack of understanding of the issue.
People fighting the use of pot medicinally treating pain don't seem to have any issue with doctor's doling out highly addictive opioids. Or maybe they do, but stay quiet about it. I don't know. But it's absurd we have highly add drugs being legally regulated, which superficially seems to have led to increased abuse of harder drugs, and there's still federal obstacles toward less addictive, non-lethal substances.

[oncemoreuntothejimbreech]

(08-09-2017, 01:07 PM)Belsnickel Wrote: Would it also be true that most doctors coming out of the higher tiered med schools don't work in family medicine, but rather in other specialties?

I don't know the answer to your question. I also believe "general practitioner" is a misnomer used to describe a family practice doctor.  A family practice doctor is a specialist who specializes in the 1000 most common conditions which need medical treatment.  An orthopedist isn't going to treat hypertension because they probably haven't done it since they were a resident.  Some people want to be family practice doctors because they like to do a little bit of everything and the continuity of care with the patient over time.  Some people are interested in the certain specialties.  There is also a shortage of family practice doctors because they make less money than other specialties. 

[oncemoreuntothejimbreech]

(08-09-2017, 01:39 PM)Benton Wrote: Which makes me think about the folks who rail against legalizing marijuana to treat minor pain/chronic conditions. It's frustrating, and shows a lack of understanding of the issue.
People fighting the use of pot medicinally treating pain don't seem to have any issue with doctor's doling out highly addictive opioids. Or maybe they do, but stay quiet about it. I don't know. But it's absurd we have highly add drugs being legally regulated, which superficially seems to have led to increased abuse of harder drugs, and there's still federal obstacles toward less addictive, non-lethal substances.

The NFL is a prime example.  They recently made claims against marijuana use by the players.  However, their doctors write prescriptions for opioids and they sell alcohol at the stadiums.  Opioids and alcohol are both addictive, can cause chronic health issues, and can lead to death.  The number of people suffering from opioid addiction and alcoholism far exceed the number of people who may have a substance abuse or other health issues related to marijuana.  They're attitude is emblematic of the hypocrisy within this country related to opioids, alcohol, and marijuana.

[Belsnickel]

(08-09-2017, 07:18 PM)oncemoreuntothejimbreech Wrote: I don't know the answer to your question. I also believe "general practitioner" is a misnomer used to describe a family practice doctor.  A family practice doctor is a specialist who specializes in the 1000 most common conditions which need medical treatment.  An orthopedist isn't going to treat hypertension because they probably haven't done it since they were a resident.  Some people want to be family practice doctors because they like to do a little bit of everything and the continuity of care with the patient over time.  Some people are interested in the certain specialties.  There is also a shortage of family practice doctors because they make less money than other specialties. 

I agree on the GP term usage, to me it's just a common usage thing, but I know family practice is, in itself, a specialty. Your comment about there being less money in the field is why, at least in my understanding, graduates from top tier med schools aren't typically found in that field. This is just anecdotal information I have, though, so it could be wrong.

[BmorePat87]

(08-09-2017, 10:22 AM)michaelsean Wrote: Can someone show me where all this starts with LEGAL prescriptions?  I was just reading a story on Middletown, OH which is apparently just being destroyed by heroin, and these people didn't get there because they became hooked on legal prescriptions, and switched to heroin.  

As an aside, one guy in the story who has now been clean for a couple of months ODed 8 times in seven days and was revived with Narcan.  Once a day plus one.  That's nuts.

https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

This is where my numbers came from.

Between 2002-2012, 80% of people seeking treatment for heroin abuse reported that they first started by using prescription drugs.