Which feeds into our discussion about police and shootings; law enforcement in the USA is broken, period.
We’ve talked about civil forfeiture before, and I’ve yet to see anyone, anywhere, actually justify it or even explain how it isn’t just flat out theft. The NYDP recently lied, and said they can’t track such forfeitures, because it would crash their computers… despite their computers being a best of breed enterprise database system from SAP.
It was designed to help combat organized crime. I hate slippery slope arguments which are generally weak positions to take. In this case, some groups have taken it too far and way afield from the intention.
Last year, over 52,000 people died from drug overdoses, with almost two-thirds involving prescription or illegal opioids.
In comparison, the number of people who died in car crashes was 37,757, an increase of 12 percent. Gun deaths totaled 36,252, up 7 percent.
The CDC report also included death certificate data for opioid overdoses in 28 states, finding that 16 saw a jump in death rates from synthetic opioids including illicit fentanyl. New York (135.7 percent), Connecticut (125.9 percent) and Illinois (120 percent) were the hardest hit. As for heroin deaths, 11 states had increases, with South Carolina (57.1 percent), North Carolina (46.4 percent) and Tennessee (43.5 percent) seeing the biggest spike.
Some bracing statistics:
[quote]
The federal CDC has lagged in reporting in recent years, but we can get a hint of the nationwide toll by looking at fentanyl deaths state by state. In Maryland, the first six months of 2015 saw 121 fentanyl deaths. In the first six months of 2016, the figure rose to 446.[/quote]
Uncontrolled pain is for the most part one of those things we choose as a society not to acknowledge.
Unfortunately, when this happens to people their productivity is greatly reduced, and as a result their societal influence is almost nil. Their voices are unheard.
The unfortunate factor, which I would like to highlight to those who consider this as an issue of outrage - is that it is human nature to forget our experience of pain when pain is relieved.
If it remains unrelieved and severe it dominates your consciousness - this is the nature of pain. It is a quite real, and terrible, force. It is a simple notion, but one that is very poorly understood. Within the medical profession most of all, as it is either a result of their handiwork or they are inured to it or both. So many of the gutless pricks wash their hands of it.
The response of the medical profession to permanent and severe non-terminal pain today is as enlightened as it was to bacterial infection less than a century ago. In truth, they are incompetent to treat it, and often hostile to incurables as a result. Ultimately it must become a spiritual issue and not a medical one. Unfortunately we tend to impoverish many who suffer it, for no particular reason.
No one really knows to what extent long term opiate use helps or worsens severe ongoing pain that won’t be ended in the near term by death. The science is woeful, and yes I’ve read it. We can’t measure it, can’t evaluate it, can’t treat it. We are in the dark ages. When we discuss it, we should be clear that we are discussing a failure of treatment and little else.
Doctors fall into two camps. I don’t think there’s any doubt the drugs lose their effectiveness, but that is true of all drugs. Some people seem to think they reach stable yet useful doses. Who fucking knows. There is no data, and even if there was, it’s self reported nonsense. Soldiers disease was well documented, but the quality of life of the neuralgia cases no one gave a shit about ascertaining.
The recent round of this media campaign originated to a large degree with the NYT and one of their writers. It is profoundly one-eyed and often ignorant. There is no doubting the ravages of addiction, but any possible appropriate use of these drugs is entirely discounted.
The prescription rates increased since the 1990’s as very little was prescribed. I guess that means that if opiate therapy does increase quality of life in this instance, a great many people were suffering for little reason, and more likely being rendered unemployable due to a lack of function and inability to sleep. If you’re disability was denied, which is pretty common for an unprovable condition, you’re homeless. That’s what we do.
I don’t really like posting re this and I’m probably not interested in your opinion unless it’s been generated through personal experience of permanent disability, but its important to some degree, that is rapidly vanishing or vanished for me now, that there is a counterpoint to the moralism in these campaigns.
Discounting permanent pain and terminal pain, what exactly is your solution?
The only effective solution would be prohibition outside of usage in a hospital setting, and it would have to be of all opioids and their derivatives otherwise one just replaces another.
No one anywhere is seriously considering it.
The idea that it is driven entirely by pharmaceutical companies is also untrue. They have no powers of prescription. Oxycodone has been around since early last century. There are no goodies and baddies. The market for these drugs is large because they work well in the short term relief of nociceptive pain.
So if you take all of that into account, you are left with a complex situation which has no right answer.
If people want to abuse drugs there’s not much that can be done about it. To be honest I find this narrative about the opiate epidemic a bit hard to swallow - as if another drug would not take its place? The ice epidemic is the latest one. There is always some epidemic, some drug of choice.
Perhaps if we make a conscious effort to generate a more inclusive society, some of these issues - where heavy drug use is a choice and not a necessity - will lessen.
Your post makes a lot of sense. Uncontrolled pain is awful, and it absolutely dominates your every conscious moment. I had some significant back issues in early 2016 which took me out of my life for a month. I’m recovered now, and I happily did so without painkillers. But if I had been faced with a lifetime of that… I don’t know how people handle it. I really don’t.
However, we differ on this point:
I’m sure there are people who fit into this category (irresponsible dumbasses), but we’re also concerned with those whose addiction starts with a prescription from their Doctor. I don’t think you can lump them in with the “want to” crowd. As I understand it, you can become addicted to these drugs simply by following the Doctor’s orders.
You’re also right that “another drug would take its place.” For pain management, however, drugs such as cannabis may present less destructive alternatives in some cases.
The vast majority of drug overdoses occur because their prescription runs out, and they are addicted. It is not a choice to “abuse drugs”. They go to the doctor with some ailment, and they prescribe opiates with no intent of counseling or ensuring that the patient’s pain is appropriate for the dose.
Several years ago, my wife had a ruptured disk in her back. She described it as 10x more painful than childbirth, and the doctor prescribed a very powerful pill that she took 10x a day. She was worried and asked the doctor if she would become addicted. The doctor said “this is not to make the pain go away. You should still feel pain - it should be manageable”.
Pain management is hard - but you act like this is a choice to abuse drugs. It is not. It is addiction and until we as a society step back and treat it as such we aren’t going to make any progress. We need to hold doctors accountable for essentially creating addicts through their prescriptions and then yanking the prescription away with no follow up to treat any addiction that may have developed.
Marijuana provides an effective alternative to opiate use in many cases, with none of the addictive side effects.
It also functions via different chemical pathways than opiates, and so has the potential to be combined with opiates to achieve stronger effects with lower opiate doses.
Yeah there are number of people who start to abuse after using a valid prescription.I was given 4 Vicodin when my wisdom teeth were pulled; I didn’t use them. i was surprised by the number of people who asked for them though. I had no idea so many of my family members were on pain meds at any given time. I disposed of them properly rather than listen to all the reasons why they were short before their next prescription. Addition isn’t really about want, not in the traditional use of that word. And all these individuals suffered from pretty severe injuries years ago, crushed discs in the back, broken leg in multiple places, permanent nerve damage in their hands and arms… all obtained while working.
It is always a choice to take a drug. First thing they will teach you in Alcoholics Anonymous or Narc etc. But there is a compulsion and I do not discount for one moment what addiction is. It means good people dying, living on the street, stealing from their parents and losing those who love them. Young kids lives wasted.
I also doubt the received wisdom of this campaign that the addiction occurs due to prescribed use. I admit I haven’t looked for data but I find it unlikely. You need to be prescribed for a certain time to get the addiction going. It’s unlikely to really ramp up over a 4-6 week prescription. I expect some could start there, but it could equally be simple recreational drug abuse and the drugs are mostly sourced from medical channels. The most valid explanation is it’s a lot more socially acceptable to take a pill than inject, so now there’s a lot more use of opiates. There’s no doubt prescription rates rose with the release of oxycontin, and I’ve heard anecdotal remarks of ‘pain management in the 90’s’.
But everything you are saying, it misses the issue. You are asking for some mythological difference between addicts and pain management cases. There is no way to tell in advance if people will become addicted or not.
The only way to stop it is to slam down on the supply in the community, which comes through medical channels. That’s why they’ve gone after the pain management guys so hard, that’s why other doctors are dropping legitimate patients. They don’t need that risk.
Btw what you say about treating addiction, there is no effective treatment. Recividism from rehab is very high, and these are the more motivated people who attend. Same for alcoholism. The only answer there was prohibition, and we didn’t want to give it up. Addiction has no effective treatment. If it did, none of us would worry about it so much.
All we hear in the papers re. prescribing is what a slam dunk it is and yahoo, we’re finally doing something about it. But if we adopt the controversial position that these drugs do indeed help some people, well, these are the people who are getting thrown into the grinder as well.
There is no way, as a doctor, to sit down and accurately assess someones pain, let alone figure out if they are an addict or not. It is impossible. I have yet to hear a doctor admit that, but it is medically undeniable. There is no magic formula. There is no relation between imaging and pain. If that could be done, objectively, this epidemic would disappear overnight as we would actually be able to diagnose pain and the rest are medical cases to be treated as such.
The only way to stop it is to stop prescribing the drugs. That means your wife doesn’t get the pills, and she probably shouldn’t have got them anyway for transient pain from a herniation. I can assure you that all these people taking opiates long term are in quite severe pain. It’s not ‘pain management’ that is hard, it is pain itself which essentially terrorises people depending on how short the short straw is. What I am trying to convey to you is that pain management itself is a joke. Taking opiates is a friggen joke. I don’t know who it helps or who it harms, and I know the doctors don’t either except in hindsight, but these people are compelled by permanent and severe conditions.
Maybe we could have a national database of all patients. If they doctor shop, they’re addicts, right? Of course! But remember doctors cannot diagnose pain. So it’s turkey shoot. Someone who is in severe pain will behave exactly the same as someone who is an addict, and often the lines are a little more blurred than we like to think.
This debate takes on a whole new character, when it is described in terms of ‘my pain’, instead of someone else’s pain. I do not expect a doctor to do that, especially since they have apparently decided they are unhelpful drugs (and will probably change their mind again somewhat in a couple of decades - this has been going on a long time) but the so called 4th estate could try a little harder to present an accurate view. But journos being what they are, it won’t happen. The campaign direction has been set, and every time I have seen them bring in patients view, it’s normally to present them as pitiable why they talk about their circumstances.
So we have an amoral issue being presented as a clear moral choice - a moral choice that cannot be made. You starve the community of these drugs, you starve the addicts and the medical cases alike. There’s no third way.
Pain is a brutal and terrible thing that can and does destroy lives in the same manner addiction does, and often there is nothing to be done except be a compassionate society. Curiously enough, the doctors are generally as inured to the effects of pain in a patient as the pushers are to the effects of addiction. A useful and competent investigative journalist would listen to peoples stories and be able to pick up on this dualism, and present it to you guys who are consuming this media. I know some of them are capable of it, I’ve seen them present some very complex issues in the past, in a manner that demonstrated incisive thought. But this is a media campaign, same as the campaign against Trump (whatever you make of it), and the quality of the journalism is shit.
The most illuminating case was the assistant professor of medicine whose story I read about in an article. She had spent years campaigning against opiates, and now she had a pretty grossly blown out disc and failed surgery and you know what that means. She was talking about watching people going home to die in 3rd world countries in severe pain, with no morphine etc, and she said it with such admiration. Now she was talking about coming off the oxy before her doctors ordered her too. You could almost hear the shock in her voice, when she was saying, she stops taking the drugs and the pain comes back. Obviously this was real pain.
This was someone who had spent a professional career on the matter of pain, and had demonstrated herself incompetent in understanding even the basic nature of it. Pain is a simple thing, not a complex thing. No doubt she would have contributed to the policy make up, and the campaign we see now run by the DEA and the associated media campaign.
But she was absolutely clueless, and I have no reason to think any of her colleagues are any different from my reading of the literature. Science cannot explain to you what pain is in real terms. It is more than that.
‘My pain’, ‘their pain’. It drastically changed her viewpoint, and I expect it would have changed her contribution to the debate. Certainly the moral absolutism would have been replaced by something else.
It’s hard to think of an issue that could be less black and white, but it’s routinely presented in those terms.
TIL the opiate addiction crisis is a fabrication of a Media Campaign and that nobody can really know anything about someone else’s pain, man.
I’m not a doctor and have no experience with painkillers but if these opioids are as potent as people claim then I have no doubt that 4-6 weeks is a perfectly sufficient length of time in which to become dependent. I would guess that the body starts shutting down the production of its own endorphins fairly quickly.
Or prescribe marijuana, which is clinically proven to help treat pain, with none of the physical addictiveness of opiates.
We can’t use marijuana instead of opiates, because Republicans think that marijuana is a gateway drug that could lead to… opiates.
I believe we need to hold doctors accountable for 1-2 months after the prescription runs out. And we need to have counseling services to help those that are having withdrawal symptoms.
Marijuana is a great alternative for some but may not be enough for greater pain management.
What does this mean, exactly? Fines? Jail? I can think of all manner of nasty unintended consequences for this.
Pill mills are one thing. But normal family doctors helping patients they know shouldn’t be at (even more) risk from doing so.
Super potent:
Here I’ll post the photo:
I realize we might be using sightly different meanings for the word potent here, but it’s both, so we’re cool.
I’m not thinking of repercussions, I’m thinking more of setting expectations of when you prescribe, you are also signing up for checking in with the patient and following up to see if they need additional help getting off them. It will also be good for the doctors to get feedback so they can begin to see the whole cycle of patient saying they are in pain to when they no longer need it.
And it gets worse.
"Carfentanil is 50 times more potent than heroin and 100 times more potent than fentanyl, according to the Drug Enforcement Agency. "
http://www.cpr.org/news/story/colorados-opioid-crisis-intensifies-with-new-deadly-drug