The US Opioid Crisis

[*TheLeonardLeap*]

Crack down on the border, lower the amount of pain pills prescribed, fully legalize pot as a pain alternative to pain pills.

Then stop rescuing people after their first overdose. It won't be a popular choice, but simply put, if one near-death experience from overdosing doesn't make you stop, you're just going to have to be saved again, and again, and again, and again.

Why does the number of drug users keep growing bigger and bigger? You keep saving their lives over and over. Meanwhile the cost keeps rising for the injected anti-OD drug, and that's not counting the cost of the ambulance itself, and the medical care they need, and the personnel, and the fact that if they're busy saving junkies from trying to kill themselves, they're not available to save someone who DOESN'T want to die.

[SunsetBengal]

(08-08-2017, 11:33 PM)BmorePat87 Wrote: 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


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.

What do you see as the "root cause"?  Why are so many people willing to throw away life in search of a high?

[samhain]

(08-09-2017, 09:57 PM)TheLeonardLeap Wrote: Crack down on the border, lower the amount of pain pills prescribed, fully legalize pot as a pain alternative to pain pills.

Then stop rescuing people after their first overdose. It won't be a popular choice, but simply put, if one near-death experience from overdosing doesn't make you stop, you're just going to have to be saved again, and again, and again, and again.

Why does the number of drug users keep growing bigger and bigger? You keep saving their lives over and over. Meanwhile the cost keeps rising for the injected anti-OD drug, and that's not counting the cost of the ambulance itself, and the medical care they need, and the personnel, and the fact that if they're busy saving junkies from trying to kill themselves, they're not available to save someone who DOESN'T want to die.

I'm not really an anti-drug guy, but I totally agree about the implementation of Narcan.  Many moons ago when I was experimenting with this and that, I always subscribed to the great Hunter S Thompson quote: "Buy the Ticket, Take the Ride". 

You really never know what's going to happen when you ingest a psychoactive substance.  Whether it's a hallucinogenic trip that goes upside down b/c of general weirdness in your presence (usually shitty company), or just the plain and obvious fact that you never can be sure what's in the powder or pill you just bought, drugs aren't supposed to have a safety net.  There's no FDA regulation on what gets sold on the street.  No drug dealer is going to be held accountable for what happens to you after you consume his/her product.  It's your decision and responsibility when you use.  

I think drug use should should remain seedy and scary for prospective users.  It encourages people to weigh consequences.  If you think the cops or paramedics are just going bring you back from the brink of death, then it takes a key part of the experience (and a valuable one) away.

Personal philosophies aside, overdoses serve a purpose. If enough people die, then I tend to think that the general public's desire to do the drug will wane. Waves of drug popularity ebb and flow. Crack and meth have trashy stigmas and pretty much failed to become long-term epidemics across all demographics. When enough picks of dead bodies and little kids watching their parents turn blue start becoming prevalent, then perhaps the message will get out. If a person knows enough OD victims, maybe the idea gets through. 

[*jason*]

(08-09-2017, 09:57 PM)TheLeonardLeap Wrote: Crack down on the border, lower the amount of pain pills prescribed, fully legalize pot as a pain alternative to pain pills.

Then stop rescuing people after their first overdose. It won't be a popular choice, but simply put, if one near-death experience from overdosing doesn't make you stop, you're just going to have to be saved again, and again, and again, and again.

Why does the number of drug users keep growing bigger and bigger? You keep saving their lives over and over. Meanwhile the cost keeps rising for the injected anti-OD drug, and that's not counting the cost of the ambulance itself, and the medical care they need, and the personnel, and the fact that if they're busy saving junkies from trying to kill themselves, they're not available to save someone who DOESN'T want to die.

I'm off the opinion that they save people from overdosing to prosecute them. Sure sometimes they they don't have anything else on them, but in a lot of cases they have paraphernalia, dope, stolen shit, or other drugs on their person. At first people may roll their eyes when I say this, but when my cousin was shot while on duty, her partner shot her assailant 5-6 times. They then rushed him to the hospital (spending all kinds of money to keep him alive) so they can prosecute him, and sentence him to 80 years.

[*TheLeonardLeap*]

(08-09-2017, 10:17 PM)jason Wrote: I'm off the opinion that they save people from overdosing to prosecute them. Sure sometimes they they don't have anything else on them, but in a lot of cases they have paraphernalia, dope, stolen shit, or other drugs on their person. At first people may roll their eyes when I say this, but when my cousin was shot while on duty, her partner shot her assailant 5-6 times. They then rushed him to the hospital (spending all kinds of money to keep him alive) so they can prosecute him, and sentence him to 80 years.

That's because if her assailant died, he'd be called a gentle giant/hardworking young man/loving father, who was turning his life around and about to go to community college. His friend would tell people he didn't attack her and was shot in the back with his hands up.

Then the city would be burned to the ground while people looted, and she and her partner would be called racist liars and murderers, and be sent to a nationally covered trial. Her career and social life would be ended, she would spend all her money and go into massive debt defending herself in court, and then even if found innocent, would still be out of a job, virtually unemployable, and in debt.

You know, like how all police shootings have gone for a couple years now.

Buuuuuuuut that's a different thread from the drug epidemic. Lol

[oncemoreuntothejimbreech]

(08-09-2017, 10:04 PM)SunsetBengal Wrote: What do you see as the "root cause"?  Why are so many people willing to throw away life in search of a high?

For the same reason people kill themselves with cigarettes and alcohol. Addiction. Not everyone who ODs or gets addicted to opioids are doing it for a high. Many are, but let's try to avoid stereotyping everyone like that.

[oncemoreuntothejimbreech]

(08-09-2017, 09:57 PM)TheLeonardLeap Wrote: Crack down on the border, lower the amount of pain pills prescribed, fully legalize pot as a pain alternative to pain pills.

Then stop rescuing people after their first overdose. It won't be a popular choice, but simply put, if one near-death experience from overdosing doesn't make you stop, you're just going to have to be saved again, and again, and again, and again.

Why does the number of drug users keep growing bigger and bigger? You keep saving their lives over and over. Meanwhile the cost keeps rising for the injected anti-OD drug, and that's not counting the cost of the ambulance itself, and the medical care they need, and the personnel, and the fact that if they're busy saving junkies from trying to kill themselves, they're not available to save someone who DOESN'T want to die.

How would you suggest cutting back on prescription opioids?

[SunsetBengal]

(08-09-2017, 10:59 PM)oncemoreuntothejimbreech Wrote: For the same reason people kill themselves with cigarettes and alcohol. Addiction. Not everyone who ODs or gets addicted to opioids are doing it for a high. Many are, but let's try to avoid stereotyping everyone like that.

Well, I was hoping that Pat would respond, since it was his statement.  However, since you responded, and I do trust your views;  What do you see as the root cause of the opioid epidemic?

[oncemoreuntothejimbreech]

(08-09-2017, 10:09 PM)samhain Wrote: I'm not really an anti-drug guy, but I totally agree about the implementation of Narcan.  Many moons ago when I was experimenting with this and that, I always subscribed to the great Hunter S Thompson quote: "Buy the Ticket, Take the Ride". 

You really never know what's going to happen when you ingest a psychoactive substance.  Whether it's a hallucinogenic trip that goes upside down b/c of general weirdness in your presence (usually shitty company), or just the plain and obvious fact that you never can be sure what's in the powder or pill you just bought, drugs aren't supposed to have a safety net.  There's no FDA regulation on what gets sold on the street.  No drug dealer is going to be held accountable for what happens to you after you consume his/her product.  It's your decision and responsibility when you use.  

I think drug use should should remain seedy and scary for prospective users.  It encourages people to weigh consequences.  If you think the cops or paramedics are just going bring you back from the brink of death, then it takes a key part of the experience (and a valuable one) away.

Personal philosophies aside, overdoses serve a purpose. If enough people die, then I tend to think that the general public's desire to do the drug will wane. Waves of drug popularity ebb and flow. Crack and meth have trashy stigmas and pretty much failed to become long-term epidemics across all demographics. When enough picks of dead bodies and little kids watching their parents turn blue start becoming prevalent, then perhaps the message will get out. If a person knows enough OD victims, maybe the idea gets through. 

People already know cigarettes, alcohol, and illicit drugs can kill you, but people continue to use cigarettes, alcohol, and drugs. People know the dangers of speeding, drunk driving, riding a motorcycle without a helmet; yet, people still do all those things. Every year, people drown in the same part of the Chattahoochie River near where I live and it doesn't stop people from going to that same part of the river.

[GMDino]

As an aside we went to the funeral home this evening.  The 27 year old son of one our friends died of a drug overdose.

His parents were divorced but he had a loving relationship with both his father and mother as well as his step-father.  Boy scout, college educated (Penn State), loved the outdoors (fishing, hiking, etc).  Wonderful childhood filled with vacation and family.

And he OD'd.

I don't know what we can do.

[oncemoreuntothejimbreech]

(08-09-2017, 11:05 PM)SunsetBengal Wrote: Well, I was hoping that Pat would respond, since it was his statement.  However, since you responded, and I do trust your views;  What do you see as the root cause of the opioid epidemic?

There is no one root cause. It is multi factorial. When it comes to prescription pain medication there isn't a test you can order to verify their pain. Many providers, including me, usually give a new patient the benefit of the doubt when treating their pain. Unless they give me a reason to doubt them or they are blatantly faking. Usually it takes several visits to determine who the drug seekers are. The most successful drug seekers I've seen had me totally fooled. I didn't even suspect them they were that convincing. And I'm pretty good at detecting drug seekers and determining who is trying to bullshit me during an exam. Insurance companies are incorporating patient satisfaction surveys into reimbursement rates. Pain management is included in those surveys. Doctors and hospitals can see their revenue decrease because patients aren't given opioids they don't need, but demand anyway. Disgruntled, demanding patients who are drug seeking can can cause problems with their complaints. I've had them threaten me with their complaints. Basically, give me what I want or ill complain to everyone I can. My answer is, " Go ahead." Not everyone is willing to take that chance. Also, there isn't a national database for opioid prescriptions to help identify who is abusing opioids and doctor shopping. In Georgia we have PDMP. It is a state wide monitoring program for controlled substances so prescribers can check prescription histories to know who is getting what from the whom in what amounts and when and if they are getting multiple prescriptions from multiple providers filled at multiple locations. We've had it for about 5-6 years and membership and use has been voluntarily. Starting in 2018, the new law requires every provider to check PDMP before writing every prescription for a controlled substance for every patient every time IOT reduce misuse and abuse. But, that's only Georgia. Fill your prescriptions across state lines and I don't have any idea what you're taking if you aren't honest with me. There needs to be a national drug monitoring program. Just that one program would go along way ho cutting down on drug seeking behavior. Before PDMP, if I suspected drug seeking I would have to task a nurse to call all the pharmacies to check on the patient. That's one nurse not taking care of patients and instead doing my detective work for me. I'm not a damn detective. While we are doing that, it slows down the whole patient flow which means less patients which means less revenue for my employer.

That's just some of the BS just related to legal prescriptions.

[SunsetBengal]

(08-09-2017, 11:41 PM)oncemoreuntothejimbreech Wrote: There is no one root cause. It is multi factorial. When it comes to prescription pain medication there isn't a test you can order to verify their pain. Many providers, including me, usually give a new patient the benefit of the doubt when treating their pain. Unless they give me a reason to doubt them or they are blatantly faking. Usually it takes several visits to determine who the drug seekers are. The most successful drug seekers I've seen had me totally fooled. I didn't even suspect them they were that convincing. And I'm pretty good at detecting drug seekers and determining who is trying to bullshit me during an exam. Insurance companies are incorporating patient satisfaction surveys into reimbursement rates. Pain management is included in those surveys. Doctors and hospitals can see their revenue decrease because patients aren't given opioids they don't need, but demand anyway. Disgruntled, demanding patients who are drug seeking can can cause problems with their complaints. I've had them threaten me with their complaints. Basically, give me what I want or ill complain to everyone I can. My answer is, " Go ahead." Not everyone is willing to take that chance. Also, there isn't a national database for opioid prescriptions to help identify who is abusing opioids and doctor shopping. In Georgia we have PDMP. It is a state wide monitoring program for controlled substances so prescribers can check prescription histories to know who is getting what from the whom in what amounts and when and if they are getting multiple prescriptions from multiple providers filled at multiple locations. We've had it for about 5-6 years and membership and use has been voluntarily. Starting in 2018, the new law requires every provider to check PDMP before writing every prescription for a controlled substance for every patient every time IOT reduce misuse and abuse. But, that's only Georgia. Fill your prescriptions across state lines and I don't have any idea what you're taking if you aren't honest with me. There needs to be a national drug monitoring program. Just that one program would go along way ho cutting down on drug seeking behavior. Before PDMP, if I suspected drug seeking I would have to task a nurse to call all the pharmacies to check on the patient. That's one nurse not taking care of patients and instead doing my detective work for me. I'm not a damn detective. While we are doing that, it slows down the whole patient flow which means less patients which means less revenue for my employer.

That's just some of the BS just related to legal prescriptions.

Thanks for the info.  That is much like what my own family physician says about pain med abusers.  My Othro shared notes with him, during my shoulder surgery rehab, and he saw that I never refilled my pain meds.  He (my family doc) asked why, and I told him.  I don't want to be a statistic, I'd rather feel what's going on with my rehab and deal with it.

 

[oncemoreuntothejimbreech]

(08-10-2017, 12:34 AM)SunsetBengal Wrote: Thanks for the info.  That is much like what my own family physician says about pain med abusers.  My Othro shared notes with him, during my shoulder surgery rehab, and he saw that I never refilled my pain meds.  He (my family doc) asked why, and I told him.  I don't want to be a statistic, I'd rather feel what's going on with my rehab and deal with it.

 

There is appropriate pain management and then there is inappropriate pain management. If you're in legitimate pain, take your pain medication because it will help in your recovery. I don't mean it just makes you feel less pain and more comfortable. I mean appropriate pain management improves wound healing. If your pain is managed your surgically repaired shoulder heals faster than if you try to be a hero and tough it out. It's an interesting topic you might enjoy researching with your background.

[BmorePat87]

(08-09-2017, 10:04 PM)SunsetBengal Wrote: What do you see as the "root cause"?  Why are so many people willing to throw away life in search of a high?

Two major root causes I see:

1. first using prescription opioids 

2. Not having any opportunities


The numbers suggest most addicts in the last few decades started off with prescription opioids. Whether it's finding a better solution (medical marijuana) or providing better access to treatment for those who get addicted to the legal stuff, this will require more than just saying "heroin is bad, kids". 

Most people are willing to throw their life away in search of a high when there's not much they're throwing away. Areas with high rates of problems tend to be blue collar or poor areas where education and good paying jobs aren't as accessible.

[BmorePat87]

(08-10-2017, 12:34 AM)SunsetBengal Wrote: Thanks for the info.  That is much like what my own family physician says about pain med abusers.  My Othro shared notes with him, during my shoulder surgery rehab, and he saw that I never refilled my pain meds.  He (my family doc) asked why, and I told him.  I don't want to be a statistic, I'd rather feel what's going on with my rehab and deal with it.

 

I have chronic shoulder/neck pain, enough where a spinal surgeon said he'd operate on me... if I was older. He gave me a prescription and said, "even though this is a mechanical issue, I'm gonna try a chemical solution". I stopped taking it because I didn't want to be dependent on it. It can't be a long term solution. 

[SunsetBengal]

(08-10-2017, 12:51 AM)oncemoreuntothejimbreech Wrote: There is appropriate pain management and then there is inappropriate pain management. If you're in legitimate pain, take your pain medication because it will help in your recovery. I don't mean it just makes you feel less pain and more comfortable. I mean appropriate pain management improves wound healing. If your pain is managed your surgically repaired shoulder heals faster than if you try to be a hero and tough it out. It's an interesting topic you might enjoy researching with your background.

For me, it's a bit more than a fear of reliance on the pain meds.  I really hate the side effects.  The sweats, nausea, dizziness, and general irritability that come with, are just plain miserable to endure.  

[oncemoreuntothejimbreech]

(08-10-2017, 03:04 PM)SunsetBengal Wrote: For me, it's a bit more than a fear of reliance on the pain meds.  I really hate the side effects.  The sweats, nausea, dizziness, and general irritability that come with, are just plain miserable to endure.  

In which case the adverse effects from side effects outweighs the benefit of the pain medication.

[oncemoreuntothejimbreech]

(08-10-2017, 03:04 PM)BmorePat87 Wrote: I have chronic shoulder/neck pain, enough where a spinal surgeon said he'd operate on me... if I was older. He gave me a prescription and said, "even though this is a mechanical issue, I'm gonna try a chemical solution". I stopped taking it because I didn't want to be dependent on it. It can't be a long term solution. 

If you already understand the difference between physical dependence and addiction bear with me.

Opioids will cause physical dependence if you take them regularly for long enough. Meaning if you aren't weaned off of them you will have withdrawal.

Physical dependence is different than addiction. Addiction involves misuse and/or abuse. Addicts are not using the medication for its intended therapeutic purpose. They are actively seeking the medication in inappropriate ways.

A person who has chronic back pain and is treated appropriately with opioids to manage their pain will eventually become physically dependent on opioids, but that doesn't mean they are an addict. If they begin to lie for more pain medication or they are taking it to "get high" then they have crossed the line from normal physical dependence to addiction.

[SunsetBengal]

(08-10-2017, 07:24 PM)oncemoreuntothejimbreech Wrote: In which case the adverse effects from side effects outweighs the benefit of the pain medication.

Yeah, I gave the opioids an earnest chance, when I was first diagnosed with two herniated discs in my back.  That was torture.  I tried cutting them in half, etc.  Family was telling me that meds were making me "meaner than a snake", I was trying to physically act normal while loopy, and causing my body to seize up.  I was much better off, just feeling what was going on, and moving cautiously. 

Then, with the shoulder surgery, I explained said back adventures to Surgeon.  He prescribed the weakest he was comfortable with.  I took them as prescribed, for almost two days.  I started to actually get used to them.  Then, I decided I wanted to walk to the mailbox and back.  The heat about knocked me on my tail, and I work outdoors.  So, that was the end of that.  I did my rehab, doc said he was amazed at how well and fast I came back to "normal" function.  Presently at 90% of lifting numbers, one year post surgery.  And, I'm 48.

[*TheLeonardLeap*]

(08-10-2017, 10:47 PM)SunsetBengal Wrote: Yeah, I gave the opioids an earnest chance, when I was first diagnosed with two herniated discs in my back.  That was torture.  I tried cutting them in half, etc.  Family was telling me that meds were making me "meaner than a snake", I was trying to physically act normal while loopy, and causing my body to seize up.  I was much better off, just feeling what was going on, and moving cautiously. 

Then, with the shoulder surgery, I explained said back adventures to Surgeon.  He prescribed the weakest he was comfortable with.  I took them as prescribed, for almost two days.  I started to actually get used to them.  Then, I decided I wanted to walk to the mailbox and back.  The heat about knocked me on my tail, and I work outdoors.  So, that was the end of that.  I did my rehab, doc said he was amazed at how well and fast I came back to "normal" function.  Presently at 90% of lifting numbers, one year post surgery.  And, I'm 48.

That's interesting, when I got prescribed them before, I took them for a couple days when the pain was fresh and really bad, but once it just became manageable pain I just stopped. Never noticed any side effects or any desire to continue or anything. Got some when I was in the military when I messed up my knee, but they made it too hard to stay awake during Powerpoints (which were already too hard to stay awake for) so I only ever took like 4.

So maybe I am a bit biased in how I see people who blame them on later drug addictions because the worst effects I ever had from them was being sleepy, and never felt any need or desire to continue them even to completion of the first prescription.

I do find it interesting that they could make someone mean, though.