The Opiate and Heroin Epidemic in America (2 Viewers)

[Terminalxylem]

Bolded, first sentence: And yet deaths due to acetaminophen mixed with opiates were on the rise, according to studies and reports. So the doctors were either

1. Prescribing the wrong drug
   
2. Not monitoring
   
3. Pressured to prescribe a cocktail to reduce addiction at the detriment of the patient.
   

As for the second sentence, I can't figure out how you're having a tough time grasping what I'm saying -- that the regulatory bodies, in concert with the individual doctor's potential for either a paternal view of addiction or a fear of prosecution, are responsible for these potentially harmful cocktails.

As for me, my experience comes from five years of working for a political think tank and having friends who not only covered the business side of the health industry, but also studied the regulatory powers of the FDA and DEA regarding prescription medication and controlled substances. It comes from having ties to close friends who work closely in the drug policy field, especially regarding decriminalization and regulation of controlled substances. It also comes from having a keen interest and following the problem with opiates and its attendant regulation and doctors' prescriptive habits not only on a macro level, but also on a personal one.

You've got a wife with a doctor and one bit of anecdotal evidence that you're extrapolating out to the rest of the population, not only a fallacy of addition, but also generally a tactic that most people don't find convincing.

It's also possible the doctors did most everything right and weren't pressured to prescribe any particular drug by regulatory agencies. You can't always predict who will overdose or prevent all drug diversion.

Opioid deaths are indeed on the rise, and combination pills are some of the more commonly prescribed - both due to marketing and genuine concern to limit opioid use. Not some DEA/FDA conspiracy.

Unless you have data showing significantly higher overdose death rates with the combination tablets, disproportionate to their general availability, it's hard to blame much on acetaminophen.  If roughly a hundred deaths a year are due to unintentional acetaminophen ingestion, only a fraction would be due to combination opioid tabs. Is that really something to be concerned enough about to eliminate the inclusion of acetaminophen in those formulations? Certainly not as you originally stated: “Getting rid of the acetaminophen would go a long way towards reestablishing the health of the people that take these pills.”

Also, even though your anecdotal experience sounds quite impressive, it still isn't scientifically validated.

 

[ZenoRazon]

Not sure how your exercise habits relate to the topic at hand, but since you seem curious about most drugs, would you try meth?

Obviously making it real clear I care about my physical well being so drugs will not work.

I;d try anything once if I felt it was a safe.  That was my point with herion.

 

[Terminalxylem]

Obviously making it real clear I care about my physical well being so drugs will not work.

I;d try anything once if I felt it was a safe.  That was my point with herion.

Safety is in the eye of the beholder. Personally I’d avoid anything highly addictive and subject to adulteration - meth, heroin and cocaine included.

 

[rockaction]

It's also possible the doctors did most everything right and weren't pressured to prescribe any particular drug by regulatory agencies. You can't always predict who will overdose or prevent all drug diversion.

Opioid deaths are indeed on the rise, and combination pills are some of the more commonly prescribed - both due to marketing and genuine concern to limit opioid use. Not some DEA/FDA conspiracy.

Unless you have data showing significantly higher overdose death rates with the combination tablets, disproportionate to their general availability, it's hard to blame much on acetaminophen.  If roughly a hundred deaths a year are due to unintentional acetaminophen ingestion, only a fraction would be due to combination opioid tabs. Is that really something to be concerned enough about to eliminate the inclusion of acetaminophen in those formulations? Certainly not as you originally stated: “Getting rid of the acetaminophen would go a long way towards reestablishing the health of the people that take these pills.”

Also, even though your anecdotal experience sounds quite impressive, it still isn't scientifically validated.

This is just talking past the points I've made and cited. You're just restating your original point differently. I've outlined and linked:

1. Studies showing that doctors feel that they have been pressured to prescribe certain drugs instead of others, which answers your first paragraph
   
2. Studies showing that the acetaminophen milligram requirements needed to be changed and the levels of acetaminophen reduced because of deaths due to liver complications, reductions the FDA adopted in 2011 as part of their new guidelines for acetaminophen levels because of these studies
   
3. Studies and links to articles explaining or showing that most opiate deaths and the subsequent increase in deaths are due to illicit uses of fentanyl and street heroin, not prescription medications
   

You're correct in saying that anecdotal evidence is not scientifically valid. I agree. It is never sound to come to a conclusion from extrapolated anecdotal evidence, nor is anecdotal evidence sufficient to prove a point beyond argument. But I've given you links and materials necessary to prove the predicates of the first three items of this outline, and the links that I've posted prior should cover the scientific aspect and should validate what I'm saying. This is for anyone who wants to take time to do a little digging.

But you don't seem to want to. You seem to want to keep rehashing a particular point and method/mode of argument, which is that there is an opioid crisis regarding prescription medications; yet you've offered no proof, and I've offered studies and articles and proof to rebut that assertion.

 

[Terminalxylem]

This is just talking past the points I've made and cited. You're just restating your original point differently. I've outlined and linked:

1. Studies showing that doctors feel that they have been pressured to prescribe certain drugs instead of others, which answers your first paragraph
   
2. Studies showing that the acetaminophen milligram requirements needed to be changed and the levels of acetaminophen reduced because of deaths due to liver complications, reductions the FDA adopted in 2011 as part of their new guidelines for acetaminophen levels because of these studies
   
3. Studies and links to articles explaining or showing that most opiate deaths and the subsequent increase in deaths are due to illicit uses of fentanyl and street heroin, not prescription medications
   

You're correct in saying that anecdotal evidence is not scientifically valid. I agree. It is never sound to come to a conclusion from extrapolated anecdotal evidence, nor is anecdotal evidence sufficient to prove a point beyond argument. But I've given you links and materials necessary to prove the predicates of the first three items of this outline, and the links that I've posted prior should cover the scientific aspect and should validate what I'm saying. This is for anyone who wants to take time to do a little digging.

But you don't seem to want to. You seem to want to keep rehashing a particular point and method/mode of argument, which is that there is an opioid crisis regarding prescription medications; yet you've offered no proof, and I've offered studies and articles and proof to rebut that assertion.

Sorry you're missing my points, and the absence of links. To restate:

1. While some Dr.s have been influenced to prescribe specific drugs, it wasn't the by the FDA or DEA (as you stated), rather pharmaceutical companies. Regulatory agencies/professional societies like JCAHO and the American Pain Society did promote more aggressive pain management with opioids, by dismissing their addictive potential and creating the 5th vital sign. https://www.physiciansweekly.com/the-opioid-epidemic-what-was-the-joint-commissions-role/ But that still wasn't promoting specific drugs, including combination pills. 

Most doctors prescribe based on clinical indication, considering risk versus benefit and cost. I may have missed the link showing the FDA/DEA's involvement in combination acetaminophen-opioid prescription though. Can you point me in the right direction?

2. The FDA did limit the maximum acetaminophen in combination meds, but the harm caused by acetaminophen toxicity is dwarfed by that caused by the opioid component of the drugs. My initial reply was based on you suggesting eliminating acetaminophen would "go a long way" to re-establishing health among opioid users. You keep ignoring the tens of thousand deaths per year from prescription opioids, instead focussing on a few hundred cases of acetaminophen liver failure/death. Eliminating acetaminophen will do nothing to prevent the vast majority of deaths related to opioid use, period. And the FDA imposed the limit to minimize liver toxicity, not overdose deaths. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-prescription-acetaminophen-products-be-limited-325-mg-dosage-unit

3. I know illicit fentanyl and heroin cause the most deaths, but prescription opioids cause plenty, too: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates But my bigger point was most heroin/street opioid users don't start with those drugs. Nearly 80% of heroin users abuse prescription drugs first, for example: https://www.drugabuse.gov/publications/drugfacts/heroin

In summary, acetaminophen can be harmful, but it is a relatively minor component of our opioid crisis. Doctors who prescribe opioid-acetaminophen combination tabs are by-and-large doing so with their patients' best interest in mind, not some mandate from the FDA or DEA. Unfortunately prescribers were misled by some policy changes in the '90s/2000s, which combined with unscrupulous Pharma/drug distribution practices and poor oversight have created our current mess. And our quick-fix, pill-popping culture compounds the problem.

 

[rockaction]

1. This is patently untrue. In 2014, the FDA changed its guidelines to ask doctors not prescribe acetaminophen in doses greater than 325 mg for combination pills. That's all over the internet, and all over practices. This is a very specific request by a government agency, followed by attendant regulatory pressure.

https://www.medscape.com/viewarticle/820039

2. "overall health" includes liver damage, not just overdoses.

3. One link from one government agency is not enough to convince me about the "gateway" effect of opioid medications. The "gateway" argument has been used a million times before in drug policy arguments by the government, a claim constantly and thoroughly debunked. I am sure this one will be, too. 

 

[Terminalxylem]

1. This is patently untrue. In 2014, the FDA changed its guidelines to ask doctors not prescribe acetaminophen in doses greater than 325 mg for combination pills. That's all over the internet, and all over practices. This is a very specific request by a government agency, followed by attendant regulatory pressure.

https://www.medscape.com/viewarticle/820039

2. "overall health" includes liver damage, not just overdoses.

3. One link from one government agency is not enough to convince me about the "gateway" effect of opioid medications. The "gateway" argument has been used a million times before in drug policy arguments by the government, a claim constantly and thoroughly debunked. I am sure this one will be, too. 

1. Changing the maximal acetaminophen dose in combo tabs is not the same thing as telling doctors to prescribe them. Certainly not this:

 It would be better if the FDA and DEA didn't encourage doctors to not prescribe pure opiates when the situation calls for them.

 If anything, the limits probably deterred prescribers - I can't find a link with actual numbers of prescription after the policy change though.

2. So you still believe this statement:  “Getting rid of the acetaminophen would go a long way towards reestablishing the health of the people that take these pills”? What percentage do you consider "a long way"?

3. Did you see the reference in the government link to the two primary (nongovernment, peer-reviewed) articles? How about this one? https://www.nejm.org/doi/full/10.1056/NEJMra1508490

Trajectory analysis of patterns of nonmedical use of prescription opioids suggests that persons most often start with oral nonmedical use of opioids. They move to more efficient routes of administration, such as insufflation, smoking, or injection, as tolerance to opioids develops and it becomes more costly to maintain their abuse patterns. By the time they initiate heroin use, usually through contact with drug users, sexual partners, or drug dealers, they view heroin as reliably available, more potent, easier to manipulate for nonoral routes, and more cost-effective than prescription opioids.34-36,38-41

In an effort to examine whether the findings from these small studies were consistent with findings in the broader population of nonmedical users, the sequence regarding initiation of use was assessed with the use of both treatment-population data and general-population data. Among heroin users entering substance-abuse treatment programs, Cicero et al. found significant shifts in the pattern of the first opioid used by those with recent onset as compared with those started using opioids 40 to 50 years ago.41 Among persons who began their opioid use in the 1960s, more than 80% reported that their first opioid was heroin; conversely, in the 2000s, a total of 75% of users initiated opioid use with prescription opioids.41

Using national-level, general-population data, Jones found that in the period from 2008 through 2010, among people who used both prescription opioids for nonmedical reasons and heroin during the previous year, 77.4% reported using prescription opioids before initiating heroin use.42 Similarly, Muhuri and colleagues found that 79.5% of persons who recently began using heroin had used prescription opioids nonmedically before initiating heroin use.28 Both studies showed that heroin use was most common among persons who were frequent users of nonmedical opioids.28,42 A recent study with data through 2013 showed that prescription-opioid abuse or dependence was associated with a likelihood of heroin abuse or dependence that was 40 times as great as the likelihood with no prescription-opioid abuse or dependence, even after accounting for sociodemographic, geographic, and other substance abuse or dependence characteristics.43 These studies suggest a clear link between nonmedical use of prescription opioids and heroin use, especially among persons with frequent nonmedical use or those with prescription-opioid abuse or dependence.

Does that article convince you? What about the four studies in bold it references? How many studies do you need to see to change your mind about the "gateway" effect of prescription opioids on subsequent heroin use?

This isn't the same thing as suggesting marijuana users will become hooked to hard drugs. It's a natural progression from drugs with similar effects, but different availability and potency.

 

[rockaction]

3. Did you see the reference in the government link to the two primary (nongovernment, peer-reviewed) articles? How about this one? https://www.nejm.org/doi/full/10.1056/NEJMra1508490

Does that article convince you? What about the four studies in bold it references? How many studies do you need to see to change your mind about the "gateway" effect of prescription opioids on subsequent heroin use?

This isn't the same thing as suggesting marijuana users will become hooked to hard drugs. It's a natural progression from drugs with similar effects, but different availability and potency.

I disagree with your first two points, and I think we're getting hung up on things that can't be said with complete certainty, and then semantics. The third point you make, however, is interesting to me. I'll really have to look at it. This is interesting and I'm willing to give it a fair shake, for sure. This is, at first blush, what I'm looking for out of the debate we're having. I'm intimately familiar with opiate addiction on an anecdotal level, and the people I know that are hooked claim that they started with prescriptions. It's crazy how often I hear it. I am one of the lucky ones who aren't addicted even though I've had Norcos several times in the past three years. I'll have to look, not statistically (as that is not my strength, nor is study design), but at the conclusions of the reports and studies. 

 

[Tau837]

You keep ignoring the tens of thousand deaths per year from prescription opioids

There are not tens of thousands of unintentional overdose deaths per year exclusively from prescription opioids. Consider:

• Population of unintentional prescription opioid overdose deaths:
  
  2016 is the last year for which finalized CDC data exists on overdose death rates. That data shows the following:
  
  
  47,600 opioid deaths
  
• 17,029 prescription opioid deaths
  

[*]However, it also shows:

• 
  5,444 deaths involved both prescription opioids AND other synthetic narcotics
  
• Approximately 2,890 deaths involved cocaine AND opioids other than other synthetic narcotics, most of which were presumably prescription opioids
  
• Approximately 2,657 deaths involved methamphetamine AND opioids other than other synthetic narcotics, most of which were presumably prescription opioids
  

[*]Other factors:

• 
  Approximately 20-24% of the opioid overdose deaths are intentional suicide, intentional homicide, and deaths for which accidental vs. intentional cause could not be determined.
  
• There is double counting that inflates the CDC data, since concurrent heroin and prescription opioid detection by toxicology testing in fatal overdose creates uncertainty over the relative contribution of each agent to death, leading each such overdose death to be recorded as both a prescription opioid overdose and a heroin overdose.
  

Altogether, this data suggests that in 2016, there were approximately 5,000 to 7,000 unintentional overdose deaths exclusively from prescription opioids.

Now consider that the 2016 CDC guideline endorses Nonsteroidal Anti-inflammatory Drug (NSAID) use before considering opioids, but NSAIDs cause 7,000 to 10,000 fatalities annually from gastrointestinal hemorrhage. This suggests that aspirin, ibuprofen, etc. cause more deaths annually than unintentional prescription opioid overdoses, which should put this data into a different perspective than that typically reported in the mass media and that implied by your post.

ETA: Updated to 2017. I had this data from previous research, and CDC added 2017 since I first compiled it. Also note, if you want the actual numbers for the first portion of my post, you have to download the Excel file at the bottom of the page in my first link.

 

[Terminalxylem]

I disagree with your first two points, and I think we're getting hung up on things that can't be said with complete certainty, and then semantics. The third point you make, however, is interesting to me. I'll really have to look at it. This is interesting and I'm willing to give it a fair shake, for sure. This is, at first blush, what I'm looking for out of the debate we're having. I'm intimately familiar with opiate addiction on an anecdotal level, and the people I know that are hooked claim that they started with prescriptions. It's crazy how often I hear it. I am one of the lucky ones who aren't addicted even though I've had Norcos several times in the past three years. I'll have to look, not statistically (as that is not my strength, nor is study design), but at the conclusions of the reports and studies. 

Well, at least I'm convincing you to critically think about the path to heroin addiction. As to the first two points, maybe a bit is semantic, but I can't see how anyone would consider reducing 10,000+ deaths by a hundred or so hugely consequential. But then again, you've admitted stats aren't your strong suit.

 

[rockaction]

Well, at least I'm convincing you to critically think about the path to heroin addiction. As to the first two points, maybe a bit is semantic, but I can't see how anyone would consider reducing 10,000+ deaths by a hundred or so hugely consequential. But then again, you've admitted stats aren't your strong suit.

I would have taken the compliment and run with it. Instead...anyway, I used the phrase "health" and not overdose "deaths" as something that we'd be going a long way towards if we got rid of the pressure to prescribe acetaminophen/opiate combination pills. Indeed, I am aware that the inflated stats of GI "bleeding out" were faulty in the study many people cite. But acute liver damage and long-term liver damage for those in chronic pain is nothing to be sneezed at, and even a government bureaucracy saw this and was fit to move on guidelines, which is significant in result for policy and prescription, a significance which was likely a result of statistical significance within the studies they looked at. So stats are coming into play here. . 

 

[Terminalxylem]

There are not tens of thousands of unintentional overdose deaths per year exclusively from prescription opioids. Consider:

• Population of unintentional prescription opioid overdose deaths:
  
  2016 is the last year for which finalized CDC data exists on overdose death rates. That data shows the following:
  
  
  42,249 opioid deaths
  
• 17,087 prescription opioid deaths
  

[*]However, it also shows:

• 
  4,055 deaths involved both prescription opioids AND other synthetic narcotics
  
• Approximately 3,089 deaths involved cocaine AND opioids other than other synthetic narcotics, most of which were presumably prescription opioids
  
• Approximately 2,374 deaths involved methamphetamine AND opioids other than other synthetic narcotics, most of which were presumably prescription opioids
  

[*]Other factors:

• 
  Approximately 20-24% of the opioid overdose deaths are intentional suicide, intentional homicide, and deaths for which accidental vs. intentional cause could not be determined.
  
• There is double counting that inflates the CDC data, since concurrent heroin and prescription opioid detection by toxicology testing in fatal overdose creates uncertainty over the relative contribution of each agent to death, leading each such overdose death to be recorded as both a prescription opioid overdose and a heroin overdose.
  

Altogether, this data suggests that in 2016, there were approximately 5,000 to 7,000 unintentional overdose deaths exclusively from prescription opioids.

Now consider that the 2016 CDC guideline endorses Nonsteroidal Anti-inflammatory Drug (NSAID) use before considering opioids, but NSAIDs cause 7,000 to 10,000 fatalities annually from gastrointestinal hemorrhage. This suggests that aspirin, ibuprofen, etc. cause more deaths annually than unintentional prescription opioid overdoses, which should put this data into a different perspective than that typically reported in the mass media and that implied by your post.

I'm well aware there are confounders like multi substance use and limits in toxicology analysis. The point remains though: acetaminophen ain't all that bed, in no way similar to adulterated whiskey during prohibition.

And you need to know the denominator for those death stats, ie. total users, to know how dangerous a given class of medications is.

 

[Tau837]

I'm well aware there are confounders like multi substance use and limits in toxicology analysis. The point remains though: acetaminophen ain't all that bed, in no way similar to adulterated whiskey during prohibition.

Agree 100% about acetaminophen, which is a bit of a strange tangent this thread has taken.

But the point of my post you quoted wasn't about acetaminophen. It was about prescription opioid deaths, the driver of the Government "war" on this opioid "epidemic". The numbers on those deaths are typically significantly overstated by ignoring context. As you did in your post that I quoted.

 

[Terminalxylem]

I would have taken the compliment and run with it. Instead...anyway, I used the phrase "health" and not overdose "deaths" as something that we'd be going a long way towards if we got rid of the pressure to prescribe acetaminophen/opiate combination pills. Indeed, I am aware that the inflated stats of GI "bleeding out" were faulty in the study many people cite. But acute liver damage and long-term liver damage for those in chronic pain is nothing to be sneezed at, and even a government bureaucracy saw this and was fit to move on guidelines, which is significant in result for policy and prescription, a significance which was likely a result of statistical significance within the studies they looked at. So stats are coming into play here. . 

Right, I was being generous including liver failure with Tylenol OD deaths in the ~100 annual estimate. It's a small number relative to prescription opioid deaths, even if you whittle them down as JWB suggests above.

Long term liver failure in opioid abusers is almost never due to acetaminophen. That's viral hepatitis' job. 

 

[rockaction]

Agree 100% about acetaminophen, which is a bit of a strange...

It's strange that FDA guidelines were altered to not only conform with studies but also to address exactly what I was addressing. 

The tangent is not strange. It's a real health concern for a lot of people.

 

[Terminalxylem]

Agree 100% about acetaminophen, which is a bit of a strange tangent this thread has taken.

But the point of my post you quoted wasn't about acetaminophen. It was about prescription opioid deaths, the driver of the Government "war" on this opioid "epidemic". The numbers on those deaths are typically significantly overstated by ignoring context. As you did in your post that I quoted.

People have an irrational fear of Tylenol, even though it is arguably one of the safest analgesics.

I appreciate you parsing the stats, but I maintain prescription drugs still play a big part in the overall deaths, either directly or as stepping stones to heroin and street fentanyl derivatives.

 

[Terminalxylem]

It's strange that FDA guidelines were altered to not only conform with studies but also to address exactly what I was addressing. 

The tangent is not strange. It's a real health concern for a lot of people.

No one is denying acetaminophen can be harmful. We differ in our perception of the relative threat it poses in comparison to opioids.

 

[rockaction]

No one is denying acetaminophen can be harmful. We differ in our perception of the relative threat it poses in comparison to opioids.

I don't think it's a zero sum game. Opiate overdoses are always something to be concerned about. Clearly. 

 

[Tau837]

It's strange that FDA guidelines were altered to not only conform with studies but also to address exactly what I was addressing. 

The tangent is not strange. It's a real health concern for a lot of people.

The thread is about the opiate and heroin "epidemic" in America. Acetaminophen is not an opiate and is not heroin. Hence why I called this a tangent of discussion. I didn't comment about acetaminophen as a health concern.

 

[rockaction]

The thread is about the opiate and heroin "epidemic" in America. Acetaminophen is not an opiate and is not heroin. Hence why I called this a tangent of discussion. I didn't comment about acetaminophen as a health concern.

Thanks. Point taken. That is all very true. 

 

[ZenoRazon]

Safety is in the eye of the beholder. Personally I’d avoid anything highly addictive and subject to adulteration - meth, heroin and cocaine included.

I cannot get addicted to anything and I know this. My self discipline is actually freaky.

 

[AAABatteries]

I cannot get addicted to anything and I know this. My self discipline is actually freaky.

 

 

[ZenoRazon]

 

You act as if you know me.

 

[Apple Jack]

I cannot get addicted to anything and I know this. My self discipline is actually freaky.

 if you only knew how many smack junkies have thought the same.

 

[ZenoRazon]

 if you only knew how many smack junkies have thought the same.

If you only knew me you wouldn't be posting that. X track/footballer current bodybuilder, TOTALLY disciplined.

 

[Terminalxylem]

I cannot get addicted to anything and I know this. My self discipline is actually freaky.

That’s beyond arrogant - everyone has potential for addiction.

 

[ZenoRazon]

That’s beyond arrogant - everyone had potential for addiction.

That's not true at all.

 

[rockaction]

That's not true at all.

God, everything about you annoys me. 

 

[ZenoRazon]

God, everything about you annoys me. 

I have no idea why.

 

[Terminalxylem]

That's not true at all.

Well, at least you answered my question - the tried and true “it can never happen to me” belief isn’t just applicable in youth I see.

 

[ZenoRazon]

Well, at least you answered my question - the tried and true “it can never happen to me” belief isn’t just applicable in youth I see.

I graduated HS in 1968, so right in the middle of all that drugs thing back then. Spent 4 years in the Navy yep, drugs everywhere. 

Smoked pot, dropped acid, snorted coke, smoked hash, opium, did reds and whites and stuff where it was....what?  Here I sit 6-2 275 pounds of twisted railroad steel, in the best shape of my life, there is NOTHING that I can't do without, no drug stands a chance, ok?

 

[Terminalxylem]

I graduated HS in 1968, so right in the middle of all that drugs thing back then. Spent 4 years in the Navy yep, drugs everywhere. 

Smoked pot, dropped acid, snorted coke, smoked hash, opium, did reds and whites and stuff where it was....what?  Here I sit 6-2 275 pounds of twisted railroad steel, in the best shape of my life, there is NOTHING that I can't do without, no drug stands a chance, ok?

Whatever dude. Congrats on your bench press, I guess.

 

[ZenoRazon]

Whatever dude. Congrats on your bench press, I guess.

Not really....whatever dude....it's more.....ok now I can see it, you're freaky about fitness, ok cool.

 

[Shawnky]

You act as if you know me.

The irony of this statement.

 

[wikkidpissah]

God, everything about you annoys me. 

i have him blocked and, with our need for new blood, that's pretty bad.

i partially understand his assertion though. i have taken everything & quit everything but food in my time and never needed a program (12step or anything) or had to avoid getting high since "beating" sumn for fear of restarting a cycle. and was high on coke for 3/4 of my waking life (and that's a LOT more waking than most folks) for over a decade, recycling bindles and licking questionable surfaces for the odd crumb of stimulant in that time and even smoked it on occasion (my Mary looooved base/crack), but never considered myself addicted to it. When a change in Nevada law lowered quality & raised cost and i switched to meth, though...........boyhowdy.

 

[rockaction]

i have him blocked and, with our need for new blood, that's pretty bad.

i partially understand his assertion though. i have taken everything & quit everything but food in my time and never needed a program (12step or anything) and was high on coke for 3/4 of my waking life (and that's a LOT more waking than most folks) for over a decade, recycling bindles and licking questionable surfaces for the odd crumb of stimulant in that time and even smoked it on occasion (my Mary looooved base/crack), but never considered myself addicted to it. When a change in Nevada law lowered quality & raised cost and i switched to meth, though...........boyhowdy.

Yeah, I generally don't block people. I'm just tired of the act. People have put up with me, though, so...

Regarding the point, I can see what he's saying, but I have a different story. Cocaine is a hell of a drug, and my downfall. I can remember crawling around looking for intoxicants that might have fallen from me or the desk or whatever and onto the carpet. A crumb, a dropped piece, anything would suffice, I thought. I think I've spent two waking days of my life looking for stuff hidden in fibrous material.

I never want to go back to that. It's always fun at first, always the saddest moment of life when it's gone.

 

[Tau837]

That's not true at all.

Dude, please stop hijacking this thread.

 

[wikkidpissah]

Yeah, I generally don't block people. I'm just tired of the act. People have put up with me, though, so...

Regarding the point, I can see what he's saying, but I have a different story. Cocaine is a hell of a drug, and my downfall. I can remember crawling around looking for intoxicants that might have fallen from me or the desk or whatever and onto the carpet. A crumb, a dropped piece, anything would suffice, I thought. I think I've spent two waking days of my life looking for stuff hidden in fibrous material.

I never want to go back to that. It's always fun at first, always the saddest moment of life when it's gone.

know that feeling all too well, but that's more abject need than addiction. it's what you do next determines that.

it's a spectrum, like everything else. my Mary was addicted to everything always because molestation and subsequent bad life choices gave her sumn to drown. my supplier would call to tell me she showed up at his place w a TV @ 3am when all she had to do was put it on my tab, but NO MAN would itch the twitch in her switch when she'd flash back to her old man or being beaten by a trick. in the 12 years we were together, she had to be high the way she wanted to be high virtually every idle moment, but was never substance-addicted.

ETA: Even when she was dying and undermedicated and i had to buy her smack to deal with the half-month after her morphine-allotment ran out, it never locked her into junkie mode

 

[Spin]

Does opioid addiction impact the lower class/less educated at a higher rate?

I have a pretty broad network and Dont know a single person struggling with opioid issues. 

I became pretty close friends with someone over the last 6 years, and you would swear he had a perfect life.  Good high paying job, a picture perfect family, wife and 3 kids.  Bought a nice house, always posting pictures from various vacations they were taking.  Our families got together often throughout the years for various events.  I was someone he would usually confide in when something was going on with his wife/family/job etc and his wife and my wife became pretty close, too.  

Last week he checked himself into rehab and apparently has been taking a staggering amount of pain pills over the last 3+ years.  I had no clue. Never noticed a change in his demeanor, attitude.  Caught my wife and me completely by surprise.  You would have won quite a bit of money off me if you bet me he was dealing with an addiction to opioids.

 

[Terminalxylem]

I graduated HS in 1968, so right in the middle of all that drugs thing back then. Spent 4 years in the Navy yep, drugs everywhere. 

Smoked pot, dropped acid, snorted coke, smoked hash, opium, did reds and whites and stuff where it was....what?  Here I sit 6-2 275 pounds of twisted railroad steel, in the best shape of my life, there is NOTHING that I can't do without, no drug stands a chance, ok?

Wait a second - you graduated high school in 1968? At nearly 70, that twisted steel has to be pretty rusty. Do you know Frank Thomas?

 

[Terminalxylem]

i have him blocked and, with our need for new blood, that's pretty bad.

i partially understand his assertion though. i have taken everything & quit everything but food in my time and never needed a program (12step or anything) or had to avoid getting high since "beating" sumn for fear of restarting a cycle. and was high on coke for 3/4 of my waking life (and that's a LOT more waking than most folks) for over a decade, recycling bindles and licking questionable surfaces for the odd crumb of stimulant in that time and even smoked it on occasion (my Mary looooved base/crack), but never considered myself addicted to it. When a change in Nevada law lowered quality & raised cost and i switched to meth, though...........boyhowdy.

Nothing is 100% certain to create an addict, but I’m fascinated at the ways people rationalize it won’t happen to them before indulging in the hard stuff. In your case, did you think your will was too strong, didn’t care about rolling the dice or weren’t aware of the danger? Or were you under the influence of something else that lowered your inhibitions?

 

[wikkidpissah]

Nothing is 100% certain to create an addict, but I’m fascinated at the ways people rationalize it won’t happen to them before indulging in the hard stuff. In your case, did you think your will was too strong, didn’t care about rolling the dice or weren’t aware of the danger? Or were you under the influence of something else that lowered your inhibitions?

i don't understand what you are asking about

 

[Terminalxylem]

i don't understand what you are asking about

At the time you did all those potentially addictive substances, what were you thinking about your chances of addiction? The troll guy believes his will is too strong to overcome basic neurobiology, for example.

I've seen far too many people end up destroyed by meth, heroin and to a lesser extent, cocaine, to even consider trying them. There is no reward great enough to justify the potential consequences IMO. But I've probably done a lot of other activities you'd consider too risky - mostly involving high places than state of mind.

I guess its a question of your perception of the risk and how you expected to mitigate it?

 

[wikkidpissah]

At the time you did all those potentially addictive substances, what were you thinking about your chances of addiction? The troll guy believes his will is too strong to overcome basic neurobiology, for example.

I've seen far too many people end up destroyed by meth, heroin and to a lesser extent, cocaine, to even consider trying them. There is no reward great enough to justify the potential consequences IMO. But I've probably done a lot of other activities you'd consider too risky - mostly involving high places than state of mind.

I guess its a question of your perception of the risk and how you expected to mitigate it?

i can tell you're likely spoiling to tell me precisely who i am, but i know who i am better than you know anything in this world. nonetheless i will respond.

i had actually already been a non-using tour pharmacist for several 70s rock&roll bands AND a drug & alcohol counselor, - trained @ a Fort Lyon, CO V.A. facility - before i started using drugs heavily (altho i did a lot of LSD as a teenager). when i started playing poker for a living in 1984, i found cocaine use conducive to the work & hours and averaged a little less than a gram a day for the next decade. i went off the rails now & then cuz my wife was a stone druggie (when she wasn't being the best psych nurse i ever seen) and i loved snorting speedballs and enjoyed every ounce of arrogance in the gamblin' life, but i never took drugs when i shouldn't nor had maintenance issues. when the quality of coke declined, due to a change in NV law, and the hours i kept increased - mostly due to the care of a wife dying of cancer and raising the extra funds to medicate her off the books - i switched to meth (similar dosage). the result of that was a physical dependence, which i overcame by spending 6 months in my uncle's hunting cabin in NH after my wife died. after that, i led a typical life - partying w friends a few times a year, drinking the odd beer watching football, observing my beloved's b'day & death anniversary by desTROYing 8balls of coke without any other use, smoking the odd doob if that's what my female company wound down with, without ever losing a grain of self-control. now retired, i can still work a buzz when i want - tho my heart won't abide stimulants anymore - without any desire for continuance and do so a couple times a yr. i'm an open book if you have further curiosity.

ETA: my only regret - even though who wouldnt like that quarter mil back, but i considered it a business expense - was making evil guys rich

 

[Terminalxylem]

i can tell you're likely spoiling to tell me precisely who i am, but i know who i am better than you know anything in this world. nonetheless i will respond.

i had actually already been a non-using tour pharmacist for several 70s rock&roll bands AND a drug & alcohol counselor, - trained @ a Fort Lyon, CO V.A. facility - before i started using drugs heavily (altho i did a lot of LSD as a teenager). when i started playing poker for a living in 1984, i found cocaine use conducive to the work & hours and averaged a little less than a gram a day for the next decade. i went off the rails now & then cuz my wife was a stone druggie (when she wasn't being the best psych nurse i ever seen) and i loved snorting speedballs and enjoyed every ounce of arrogance in the gamblin' life, but i never took drugs when i shouldn't nor had maintenance issues. when the quality of coke declined, due to a change in NV law, and the hours i kept increased - mostly due to the care of a wife dying of cancer and raising the extra funds to medicate her off the books - i switched to meth (similar dosage). the result of that was a physical dependence, which i overcame by spending 6 months in my uncle's hunting cabin in NH after my wife died. after that, i led a typical life - partying w friends a few times a year, drinking the odd beer watching football, observing my beloved's b'day & death anniversary by desTROYing 8balls of coke without any other use, smoking the odd doob if that's what my female company wound down with, without ever losing a grain of self-control. now retired, i can still work a buzz when i want - tho my heart won't abide stimulants anymore - without any desire for continuance and do so a couple times a yr. i'm an open book if you have further curiosity.

ETA: my only regret - even though who wouldnt like that quarter mil back, but i considered it a business expense - was making evil guys rich

Thanks for the interesting response. It’s something I hadn’t really thought of, but makes a lot of sense. Especially for stimulants. 

I’ve always been more of a my body is a temple kind of guy, rather than a tool for abuse a la Hunter S Thompson. But once physical debility sets in, I’m open to mind-altering substances. For the drug-naive septuagenarian or older, what do you recommend?

 

[wikkidpissah]

Thanks for the interesting response. It’s something I hadn’t really thought of, but makes a lot of sense. Especially for stimulants. 

I’ve always been more of a my body is a temple kind of guy, rather than a tool for abuse a la Hunter S Thompson. But once physical debility sets in, I’m open to mind-altering substances. For the drug-naive septuagenarian or older, what do you recommend?

natural hallucinogenics - peyote or psilocybin mushrooms. no real physical tax, other than eventing one may be emboldened to attempt (and peyote makes one briefly nauseous before it kicks in). i've never done them as a senior, would not recommend hallucinogens to a truly repressed individual and strongly recommend an experienced guide for initial attempts. we are beautiful organisms - the culmination of earthly progress, God's divine plan or both - inclined to drown our beauty in desire and excuses and i'm with Abraham Maslow that we each owe ourselves some peak experiences before all is said and done. now, can i have your DEA badge #, just for my records....

 

[Terminalxylem]

natural hallucinogenics - peyote or psilocybin mushrooms. no real physical tax, other than eventing one may be emboldened to attempt (and peyote makes one briefly nauseous before it kicks in). i've never done them as a senior, would not recommend hallucinogens to a truly repressed individual and strongly recommend an experienced guide for initial attempts. we are beautiful organisms - the culmination of earthly progress, God's divine plan or both - inclined to drown our beauty in desire and excuses and i'm with Abraham Maslow that we each owe ourselves some peak experiences before all is said and done. now, can i have your DEA badge #, just for my records....

Yeah, I was thinking hallucinogens too. Seem a lot more interesting than other drugs, and I’ve already seen psilocybin ‘shrooms in the wild. Interestingly enough, they were growing in cow #### right next to castor beans, should I choose to check out after my mind is sufficiently altered.

 

[wikkidpissah]

Yeah, I was thinking hallucinogens too. Seem a lot more interesting than other drugs, and I’ve already seen psilocybin ‘shrooms in the wild. Interestingly enough, they were growing in cow #### right next to castor beans, should I choose to check out after my mind is sufficiently altered.

outdoor music concert - even if its classical - is a real safe starting point w shrooms. guides recommended. GL -

 

[Terminalxylem]

outdoor music concert - even if its classical - is a real safe starting point w shrooms. guides recommended. GL -

Thx. I’ve still got several decades before I anticipate my body failing to do the things I enjoy. By that time, virtual reality may be able recreate any drug experience, minus the risk involved.

 

[ZenoRazon]

Dude, please stop hijacking this thread.

How many others are hijacking this thread?