Where I live here in Chester County, Pennsylvania, there are no easy refuges from the heroin problem. Even in the county prison some of the correctional officers are dealing H. I swear that I am not shitting you when I tell you that a two month old kitten overdosed on heroin here last year.
Don’t get me wrong, though, because the law enforcement community here is aware of the problem and have been proactive enough to win an award for their diligent work trying to bust up these drug pipelines into the county.
And the legislature, governor, and local social services agencies have been making good strides, too. Most recently, the state passed some reforms that allow police officers and a wider number of emergency responders to carry Narcan (Naloxone) which can reverse the effects of an opioid overdose and save lives. County service workers are training the police how to properly administer the remedy. The legislature also passed a Good Samaritan law that prevents the prosecutors from pressing charges against people who call 911 to help an overdose victim. They can’t charge the victim either.
Another welcome angle of attack has been the introduction of locked depositories at local police stations where you can take your unused pain medication so it won’t be stolen out of your house and put into the local supply.
Even down in Philly, lots of people are getting popped for selling heroin. But the problem isn’t getting better.
And it’s not getting better because the root of the problem is the overprescription of opioid painkillers. The doctors and pharmaceutical companies create the addicts but their pills are expensive when compared to heroin. The drug dealers don’t have to push their product to get people hooked. The people are already hooked when they come seeking out the drug dealers.
I see more and more people writing about this issue. I can no longer accuse the media of neglecting the problem. Local and state governments are trying to mobilize to address it.
But it’s all tinkering around the edges of a problem that keeps growing more and more prevalent and dangerous. There are some people who are trying to focus attention where it belongs, but it seems like howling into the wind. And I’m tired of running into the chronic pain lobby every time I try to discuss this.
The chronic pain lobby should have one of the most prominent seats at the table. But they should be seeking to find solutions, not claim that every grieving parent and proposal is a threat to their supply.
All we need to do is compare how many opioids are prescribed in this country to the rest of the world to know that we’re creating our own crisis.
Yet another reason to legalize marijuana.
The US is truly exceptional. 5% of the world’s population and 25% of the world’s prison population seems horrendous, but practically pales in comparison with the figure that the US consumes 80% of the global supply of opioid drugs. Great going Pharma. (Dare we ask where all the cheap heroin is coming from?)
Apparently religion is not longer the opiate of the masses in the “bible belt;” they’ve switched to the real thing:
Plus:
Is probably more accurate. Fear and consumption. Fear the black President and consume. If all that racial bilge is internalized, the cognitive dissonance must be something fierce. Doc, you got something stronger? Mindlessly buying gold and guns just isn’t doing it for me any longer…
NIH testimony
At the higher estimate of 36 million, the US accounts for 7% of the world’s opioid addicts. A far less alarming statistic than the US 80% consumption figure. (Also note that US opioid addicts are 0.8% of the population.)
This is what’s shocking (imho):
One-third of American are chronic pain sufferers? No wonder Pharma and the pain lobby have captured the debate.
The US has the best health care system in the world.
This is a very difficult problem, along several dimensions. Fifteen or 20 years ago the zeitgeist was in the opposite pendulum swing, with the smart people saying that doctors were too constrained from prescribing opioids and that when people took them for pain relief they seldom became addicted. So people started believing that and we got the current problem. (It doesn’t help that the U.S. invasion of Afghanistan made heroin dirt cheap. The Taliban had banned poppy cultivation.) But . . .
While it is now generally believed that long-term opioid prescribing for chronic non-cancer pain is ineffective and that the harms outweigh any benefits, chronic pain is a horrible burden that ruins lives. It leads to contentious relations between doctors and patients and it makes people desperate. You should not condescend to what you call the “chronic pain lobby,” these are people who are truly suffering many of whom do get relief from opioids, and have no effective alternatives. Also, for shorter term purposes they are effective and are safe for most people. In fact, if used promptly for traumatic pain, they can prevent the development of chronic pain, which is often the result of neural circuits that produce the sensation of pain getting stuck in the open position, to use a slightly crude but not misleading explanation.
It is quite challenging for doctors and patients to manage this decision and to manage treatment when it is prescribed. Opioids are a great boon to humanity and are often the only way to relieve horrible suffering. Rather than casting blame and disparaging people who are looking at the problem from a different perspective, we need to work to figure out how to do this right, and there is not a simple answer.
>>You should not condescend to what you call the “chronic pain lobby,” these are people who are truly suffering
THIS!
Booman’s lack of compassion or respect for chronic pain sufferers undermines his argument. They don’t deserve to be talked about like addicts. For people who really need them it can already be too hard to get pain medications.
Two things on this:
What did I actually say here?
I said that they should have one of the most prominent seats at the table. And I said that they should be helping craft the solutions.
You quoted yourself selectively. This is what you wrote:
“The chronic pain lobby should have one of the most prominent seats at the table. But they should be seeking to find solutions, not claim that every grieving parent and proposal is a threat to their supply.”
That shows condescension and disrespect to people who have an honest stake in this discussion. What is your evidence that there is a “chronic pain lobby” that is not trying to find solutions? Who exactly are you referring to? What have they done and said to justify your contempt? Argument by gratuitous and contentless insult is not helpful.
The problem is that there are very few alternatives to opiods for pain relief. Not every one responds to physical therapy. Non-steroidals are fine for most healthy, younger people, but problematic for older people, people with compromised kidneys, etc. Acetaminophen works for some, but has a short half life and there are concerns about long-term chronic use. That leaves opioids and handful of drugs that only work on specific types of pain. Acupuncture works no better than placebo. Marijuana is a “dirty” drug that offers limited to no pain relief bundled with significant side effects that many people (clearly not “all”!) find extremely unpleasant.
Opioids do present risks, but many people use them without problem. When you look at the places where there appear to be significant health effects from the “narcotic epidemic”, you are mostly looking at a problem that is hugely confounded by economic issues. An unemployed 23 year old in a rural area without any prospect for steady employment or even much opportunity for recreation is a lot more likely to overdose than the mid-level executive who takes a couple of Vicodin every day for his chronic back pain.
A lot of people cope with chronic pain through the use of the OTC drug “ethanol”, but that’s a poor option too.
This is basically wrong. Very wrong.
In talking to paramedics about this issue, probably the most common call they get on opioid overdoses in in nursing homes and inadvertent.
As for who is getting addicted, I can name more than three dozen kids from our school system which is one of the best and most affluent you will find.
You are mistaking how the socio-economic factor plays out in these situations.
Addiction to opioids has little to do with income or even degree of hope and opportunity. However, the mid-level executive probably won’t need to resort to heroin and the seedy lifestyle entailed in getting it because he or she can afford to pay for the pills or doctor-shop to get them prescribed and paid for my their insurance. This executives teen-age daughter, however, will soon discover that her allowance is not sufficient to feel her pill habit, and she will turn to heroin because she can kind of afford it.
When she can no longer afford it, she’ll become a thief, a prostitute, or both. It is repeated in our rich, suburban community over and over and over again.
The top lawyer in our county’s son has been battling this for close to ten years now. More than a handful of sports injuries have felled star athletes in both our district and other nearby districts.
Our community is being decimated and it is not in any sense some kind of Appalachian community.
I am not condescending to anyone.
There is a chronic pain lobby.
They do stand in the way of reducing the overprescription of opioids.
My point is that they can and should be part of the solution, but right now they are just putting up roadblocks. And they have all the power of Big Pharma behind them.
Who exactly are you talking about? Give one example of the behavior you describe — who, what, when and where — and discussion will be possible. You are just arguing by assertion. That is not valid.
I provide links for a reason.
Start with Radley Balko.
Balko is a journalist, not a lobbyist. He provides what I find to be a well-informed and thoughtful discussion (written in 2012 by the way) that may not strike the same balance you want to strike. He is most definitely not claiming “that every grieving parent and proposal is a threat to [his] supply,” (as far as I know he doesn’t have or want a supply) nor does he mention anybody who is doing so.
Sorry, you’ll have to do better than that. You made a gratuitous, insulting, and unsupported claim.
Lol. That’s just funny. Sad funny, but funny.
How do you think this works?
Who do you think pays Balko’s employers’ and for what?
There is an overprescription problem. THe amounts of high-strength opioids which are handed out for routine pain management are staggering. The amounts are not carefully controlled. When I had my rotator cuff, I called on Sun because the pain was quite strong at that point. They gave me a prescription for darvocet or something (can’t remember exactly) immediately. I got 50 pills in 1/2 hour. I took 1. I didn’t need 50 pills.
The pain profile for these repairs is pretty well known. What they should have done is given me enough for 2 days (4-6 pills), and told me to call again if needed. Now, I have a huge number of pills which will have to be dumped (in a proper facility), which is wasteful at the very least.
I just helped a med student with a project looking at the opioide prescription issue. He didn’t do anything interesting, but he is interested in the issue. I am going to look into this further. How many pills prescribed? 2 weeks later, how many are left? Can a more rational policy for prescriptions be devised?
And the street worth of those 49 pills you didn’t use could probably pay your mortgage.
I had a rotator cuff surgery in Nov. 2 days after, the pain level was pretty high. I called and got more meds. I got about 50 pills. I took 1.
This is a key part of the problem. It is not that the pills are prescribed inappropriately but that too many are handed out.
A lot of bad stories start this way. Somebody goes home with several weeks worth of opiate meds for relatively routine surgery pain. Three weeks later, they’re addicted.
A lot of addiction is becoming addicted to the routine associated with the drug. I think part of the reason hospital use doesn’t seem to cause nearly as much addiction is that the routine in the hospital – pushing an on-demand button or getting a pill from a nurse – can’t be duplicated at home. So, I think any substantial home use of opiates should be done with Directly Observed Therapy, where somebody comes out with each pill and watches you take it, as is often used for tuberculosis. It would be expensive, but at 16,000 deaths per year I think it would be worth it.
Oh, and bully for you for handling the situation appropriately.
Thanks for your comment. Honestly, the pain was bad for 1 day. After that, it was easily managed with extra-strength ibuprophen. I needed to have a clear head, as I had a legal deposition to participate in by Friday, and did not want any cloudiness in my thinking.
That’s true, I would say. I have been given a 30 day supply after surgery and taken one or two days. But some people are in pain longer than others, or have a lower threshold. 1 week, renewable with a phone consultation, would make more sense in many cases.
heartbreaking for parents who live with this. and if one takes a look at the locations where more sh*t is legalized it’s clear that isn’t the answer, since the addicts continue to use, steal from friends and family, and be incapable of holding a job. How about we give the young ppl something to live for as well as curb the prescription painkillers? how about not marketing the medicine cabinet as the answer to all problems?
Really glad to see you sticking to this issue, Boo. You’ve certainly influenced me.
Looking at the numbers, opioid use has become one of the biggest public health issues facing this country but it gets relatively little press. Most of what we do get is using the crisis as an excuse for lawnorder nonsense that makes things worse.
I suspect a lot of the “I can’t live without my painkiller” is driven by addiction, not ultimate need. Long-term for most people, opioids don’t help with pain – but that’s because people become habituatated. So, if they stop, the pain will be much worse than it would be if they’d never taken the painkiller, until they de-habituate, which can take a while. If somebody is already dealing with serious chronic pain, it’s easy to see how that could feel unbearable – but the problem is that opioids were used in the first place.
As Marie said above, medical marijuana will help, and it will help a lot more if mainstream doctors start prescribing it. Bluntly, they should, because the death risks for opiates and NSAIDs are so high. Either from the oath of “Do no harm” or from cost-benefit analysis, the doctors should try marijuana first before moving on to these very dangerous pain relievers.
(I do want to point out that long-term NSAIDs, the other main category for chronic pain, are quite risky and cause a lot of deaths too. As is tylenol, which destroyed the mind of my late godfather’s wife.)
See also the massive unethical marketing campaign to promote OxyContin to doctors and the public. http://www.cbc.ca/news/canada/oxycontin-marketing-blamed-for-addiction-epidemic-1.1244871
I was with a group of Purdue senior executives literally the day after 60 Minutes broadcast an early warning about the public health concerns in the late 90s. They were completely dismissive of the the report and the risks… So much so they freely talked about in front of an outsider like me.
Now the new concern also includes Seboxone which is used to treat opiated addiction. I too is addictive and much harder to detox from. I recently met a woman who had been hooked on it for 12 years and took 60 plus days to detox because the. half life in the body long. Imagine having the worst flu of your life combined with insomnia for two months.
The irony is morphine was invented as a supposedly non addictive alternative to opium. Heroin was invented by Bayer as a non addictive version of morphine. Methadone was invented as a non addictive version of heroin. Oxyies were supposed to be non addictive and now we have Seboxone… Each with a more severe withdrawal than the former. You think we’d learn.
I understand the complicated issues with chronic pain, made much more complicated be each individual’s pain tolerance. But I also recently broke six ribs and collapsed a lung. In the hospital they gave me morphine which did absolutely nothing for me. They switched to Percacets which were a bit better (which contain an opiate and acetametaphine). Finally and ironically I was given a healthy dose of Naproxin (Aleve) and I was able to sit up without help and sleep.
Idiosyncratic responses to pain relievers are the norm. My mother isn’t helped at by ibuprofen, which is the only OTC NSAID that works for me, and swears by Naprosyn, which gives me stomach pains. My great-aunt was addicted to Percocet, which makes me nauseous. At least for NSAIDs, the wide variety on the market is a good thing.
Given that the people developing the drugs make money from people using as much as possible, maybe they are learning.
I have known 2 people (personally but not well) that have OD’d in the past 6 months. I don’t know if it was H or prescription drugs, but both were accidental. If anyone talks about it, its like AIDS in the 1980s or cancer in earlier years.
Pain is real and goes untreated a lot more than you think.
People aren’t getting over-prescribed opoids because they’re in pain and then get addicted. They are getting over-prescribed opiods because they’re seeking escape from a dysfunctional society.
Either treat the disease, or the symptoms. One is effective, the other usually causes as much harm as good.
People are getting addicted to opioids because they are overprescribed, which is also the main reason why there is such a massive street supply of pills which are converted to recreational use at nearly every high school party in the country.
Yes, there are people who take a pain pill for the same reason they take a drink, to take the edge off of life for a few hours. But opioids are not friendly to the recreational user and hook them very quickly. People understood this about heroin when I was growing up and most people kept their distance, but we didn’t have their pharmaceutical equivalents in our parents’ medicine cabinets or offered to us at every party.
But recreational users are not the only people getting hooked. If dataguy took the 50 pills he received for his pain instead of the one pill he actually needed, he could well be hooked right now. It’s happening to people in his situation constantly, every day, all throughout the country. But not so much in other countries.