The opioid crisis


Because opioids are a white people problem.


It’s easy to parse. It’s harder to cop a bundle of heroin on the street, especially for clean cut white guys, than it is to get a script from a doctor. In those years.

You have no idea what it’s like to cop a few bags for a clean cut white guy. Are you a cop? You look like a narc. Eventually you’d find one dude that would bring you uptown, you pay for the taxi. You end up in the lobby of a building. Dude calls someone. He comes down. Same questions. You a fucking cop? Fucking white boy. So you buy the number of bags you need plus two for your guide.

If you’re not in a hurry, you try to get a cab. This may take a bit of time. Or you sniff a couple bags on the steps. Then, somehow, you have taken a dollar cab to your original place.

Oops. TMI. Bye.


On the one hand, the pharma industry and various other elements of the health care industry are out of control, seeking profits for oxycodone and similar prescription drugs without the least concern for people’s lives.

On the other hand, fentanyl and fentanyl analogues are replacing heroin on the street. Heroin is a relatively safe drug if its purity meets user expectations and it’s not cut with poison. Fentanyl and some even worse forms of the same basic molecule are a million times more potent and if cut into heroin or other drugs may make establishing a safe dosage almost impossible.


Well yeah but… maybe the Democrats and those with, knowledge, research… experts should start leading these conversations instead of being led by them. It’s infuriating to see the panic over drugs… now, after decades of it ravaging various parts of the country. Meth has been a rising problem for years. I don’t know how many of them die though… it seems to be a slow poisoning that rots their brain, teeth and skin… but they’re still alive.


I can’t remember what I took when I had my wisdom teeth removed. I don’t remember being high though.


They gave me Vicodin for that, and I did not take it. I assumed the pain would be horrific once the numbness ended, but it was more of a minor ache, for me. They didn’t really ask either, just gave me a prescription which I filled assuming I would need it.


So many of the deaths attributed to heroin in this chart would also be due to fentanyl and related types?

I mean, everything in the opioid category is going nuts, but cocaine and meth are also ramping up. I’m happy to lay a bunch of deaths at the door of the pharma companies and fentanyl, but it seems like it’s not the whole story.

Is it the case that there were this many drug addicts all along, and ODs are just spiking, or is something driving more and more to addiction?


Who knows whether any given coroner decides to call an OD a heroin death if heroin is present or other-opioid if fentanyl is also present.

Deaths related to fentanyl and related analogues are not due to pharma industry malice but drug labs, primarily Chinese, selling through the usual criminal networks. Apparently it’s been easy recently to order fentanyl shipments through USPS direct from China. Lucky none of the bags broke open in shipping or postal workers could easily have been killed.


If I had to guess, and this is just a guess, I’d suspect that folks who lost their jobs in 2008 and couldn’t find new ones for years, started turning to drugs.



It does seem to be a coastal or maybe West vs rest of America issue. Hawaii as severe Meth/Ice problem but not much of an opioid problem. I was surprised that OK had such a big meth problem.

I’ve known several ice addicts, but no one that I know is hooked on opioids. One of my best friends sons got hooked in high school. He’d be dead if his mom didn’t go to extraordinary length to save him.


The opiod one can be hard to spot. I think I said it before, I had no idea we had that many people on pain meds in my family until several years ago I was give Vicodin with my wisdom teeth extraction and just got rid of it because I didn’t need it. More than one person was pissed at me… as if I would have given it to them anyway.

Meth… there is no way to really hide that. It destroys your body and brain long before death, and that’s very visible, noticeable. And if you can get someone off it, they’re almost unemployable in the light of day;they have no teeth, their skin is shot and they look like they aged ten or twenty years over a short period of time. It’s everywhere here.


I tossed my Vicodin from my dental surgery also. I remember seeing lots of heroin addicts in California,most of them were pretty strung out, looked like awful. But ya long time meth heads look like Walking Dead zombies.


I would like us to continue to fight the opioid problem, but the way it’s being approached, it’s as if we’re saying to all those addicts they’re somehow better than these other addicts, simply because they can hide it better and they get a blanket pass that says it’s the fault of the physicians and pharmaceutical companies… meanwhile we have these other people who fell into the same patters, who will probably never recovery physically, and there are no real resources to help make these living zombies look like normal people again because most the resources available will consider it just… cosmetic… as if anyone is going to get employed like that.


More abuses by companies - testing companies this time:

But doctors and experts say that test was unnecessary, the price “outrageous,” and the case just the latest in a new, alarming trend.

“This just blows my mind,” Jennifer Bolen, a former federal prosecutor and lab and pain management consultant told KHN. “It’s very high and incredibly out of the norm.”

The testing lab, Sunset Labs, was considered out of network for Moreno’s insurance. But that may be the least of the problem. Sunset also has an “F” rating from the Houston Better Business Bureau for charging thousands of dollars for tests that cost a few hundred dollars—tops. And Sunset Labs is part of a network of pain clinics owned by Houston anesthesiologist Phillip C. Phan, which is facing lawsuits and complaints related to forced, unnecessary testing and improper billing.

Moreno’s insurance company valued her $17,850 urine test at $100.92.

In an emailed statement to KHN, an attorney for Sunset said the lab’s billings “are in line with the charges of competing out-of-network labs in the geographical area.”

The bill’s breakdown shows Sunset charged Moreno $4,675 to screen for a variety of opioids, $2,975 for psychiatric benzodiazepine drugs, $1,700 for amphetamines, $1,275 for a host of illicit drugs, and $850 for buprenorphine, a drug to treat opioid addiction. Sunset added another $850 fee to verify that the urine hadn’t been adulterated, among other charges.


This doesn’t make a lot of sense to me. How can the doctor say the test is unnecessary but somehow they got an order to perform the test anyway? Someone should have to order a test. Like if our system winds up with a test and there’s no order, one the lab should not have performed the test and two, if they did we eat the cost. Unless this some sort of different set-up, you have to have a signed order. And their claim that the cost is on par with out of network, that doesn’t make sense either. You don’t typically charge more for out of network, the billed amount remains the same, but there is a contract that says the insurance will only pay so much and the patient only pays so much. There is no reasonable way to think a 100 dollar test is being charged that much, routinely.


If you read the article, her Doctor said it was unecessary, but her surgeon requested it. a bit more info from the article:

In an apparent effort to catch opioid abuse, some doctors have turned to routine urine drug testing, which lacks standardized pricing. In a November report from KHN, an investigation into Medicare and private insurance billing conducted with Mayo Clinic found that spending on drug-related tests quadrupled between 2011 and 2014 to an estimated $8.5 billion dollars a year. KHN noted the annual spending on drug testing is now more than the whole budget for the Environmental Protection Agency.

Moreno’s doctor, Dr. Stephen Esses, reportedly said that he ordered drug testing on patients out of fear of getting in trouble with the state’s medical licensing board. But a spokesperson for the Texas Medical Board told KHN that it doesn’t require testing for short-term opioid prescriptions like Moreno’s.


Well then the first statement makes no sense. A surgeon is a doctor, so to say doctors and experts say the tests are unnecessary is not actually true. By saying the surgeon’s office ordered it, they make it sound like there is no doctor behind it. That surgeon would need to request the test… they’re making it sound like it was done against clinician’s will, that’s not how it works.

There are a lot of tests that are ordered that seem unnecessary until, you know, they reveal it was necessary via the results. So the problem here shouldn’t be he ordered a test so much as which lab performed the test and why their billing is so out of whack.


Actually, that’s not true. Out-of-network simply means that the provider has no contract with the insurer. In-network prices are negotiated prices between the provider and the insurance company. The benefit being that the provider is guaranteed payment at that price. Downside is that the price is lower. If a provider is out-of-network, he/she can charge a higher price, with the risk being that the insurance company will only pay a portion and the provider will have to get the rest from the patient.


They are using the word “doctor” to mean internist, as opposed to the surgeon. This is a fairly common shorthand. The conflict they are describing is between the surgeon who performs a procedure for which pain medications are prescribed, and the physician who ends up managing medications in the longer term for the problem the surgery was supposed to address. Significant conflicts can arise.