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The Opiate and Heroin Epidemic in America (1 Viewer)
- Thread starter Buckfast 1
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AAABatteries
Footballguy
85??Binky The Doormat said:
Binky The Doormat
Footballguy
so I'm told. One of my other cousins that lives in the same town told me ...so it may be an exaggeration, but she isn't one that typically exaggerates.
ILUVBEER99
Footballguy
i would think that's false for pills. The upper class gets clean opioids like oxycodone. The lower class gets stuck with dirty heroin.Terminalxylem said:
The dosages with pills is known. When someone shoots heroin they have no idea what they are doing.
Make it all legal and far less people die from opioids.
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Terminalxylem
Footballguy
No, it holds true for both prescription and street opioids. The areas hardest hit are predominantly poor and white.
I think decriminalization is part of the solution.
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IC FBGCav
Footballguy
In Switzerland that give addicts heroin and had great results.
https://www.thenation.com/article/switzerland-addiction-prescribed-heroin/
American government just doesn't care about people, only profits.
Fitness freak here, talking....FREAK.
But....back in the day I did smoke some pot, a few LSD trips, smoked hash, snorted a little coke. AND....very curious about just what is it about heroin? Yep, would try it just out of curiousity.
I do nothing now, BUT......if at a party and a joint is passed around, ok cool, If somebody sticks a rolled up 20 in my hand....yep, a snort. But, it ends there for me. Just doesn't fit my life anymore.
Do enjoy a few drinks a week.
But....back in the day I did smoke some pot, a few LSD trips, smoked hash, snorted a little coke. AND....very curious about just what is it about heroin? Yep, would try it just out of curiousity.
I do nothing now, BUT......if at a party and a joint is passed around, ok cool, If somebody sticks a rolled up 20 in my hand....yep, a snort. But, it ends there for me. Just doesn't fit my life anymore.
Do enjoy a few drinks a week.
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Terminalxylem
Footballguy
That's a little different than making it legal. A better example is Portugal, which decriminalized possession of all drugs, with commensurate decrease in their use, IIRC.
Not sure our culture would handle it as well though.
Terminalxylem
Footballguy
Not sure how your exercise habits relate to the topic at hand, but since you seem curious about most drugs, would you try meth?
IC FBGCav
Footballguy
I researched Portugal too. Our culture will end up handling it well when it hits the rich. On the scale problem. I look at that like bs. It might not scale but it works better than what we got. So even if you so status quo. Save some and implement this on a smaller scale.
IC FBGCav
Footballguy
Terminalxylem
Footballguy
Terminalxylem
Footballguy
Yeah, I've encountered him in other threads, and he's a little troll-y at times. But it's not like he said anything inflammatory, and I'm curious what kind of decision making process goes into experimenting with highly addictive drugs.
IC FBGCav
Footballguy
IC FBGCav
Footballguy
https://abcnews.go.com/amp/US/drug-executive-laurence-doud-iii-arrested-opioids/story?id=62575543
I am amazed these people got charged. Must be a scapegoat for others.
I am amazed these people got charged. Must be a scapegoat for others.
Terminalxylem
Footballguy
The part about .gov not caring about anything but profit, and neglecting the problem until if effects the rich.
IC FBGCav
Footballguy
Okay, it is impossible to disprove things. But all ears are showing prove that they care about this over profits.
AAABatteries
Footballguy
That’s crazy if true - I’m the same height and basically weigh twice as much and I’m fairly thin. I don’t see how that’s possible but either way I hope he gets healthy.
Tau837
Footballguy
Yes, but opioid prescribing is at a 10 year low. If there is a lag, it is in the positive direction.Terminalxylem said:
Perhaps so. The American culture is one to seek to cure or fully ease pain. As described in the article I linked, other cultures, including European cultures, focus more on enduring and living with pain. As with most things, it is fair to believe the truth lies somewhere in the middle.Terminalxylem said:
I will point out, however, that European healthcare is also more heavily controlled than US healthcare. By that I mean that it is typically Govt run healthcare, with longer wait times and some form of rationing. The fact that European healthcare systems do not approve as many opioid medications in their formularies or approve as much opioid prescribing does not necessarily equate to that being the best outcome for their patient populations. That may result in fewer opioid addicts and overdose deaths, but at what cost in suffering to the patient populations? Is that a worthy tradeoff? It is a very complex issue.
The issue is more complex for many patients than simply referencing one condition. For example, genetics and comorbid conditions matter. There has been 15 times as much research on cancer pain as other types of pain, so I don't believe that a lack of data to support long term efficacy for any particular non-cancer condition is conclusive.Terminalxylem said:
And my point was that the risk of addiction is low enough that the benefits of opioids to the American pain population outweigh the risks. Especially today, with the risks being so widely known/reported, which means new opioid patients and their prescribers should be prepared for proper monitoring to mitigate those risks.Terminalxylem said:
And a related point, why do we allow alcohol? It has no benefit equivalent to opioids for pain patients, yet spawns a greater percentage of addicts and an order of magnitude more deaths. Same for tobacco. Heck NSAIDs (e.g., aspirin) cause several thousand deaths per year, should we ban those? What about legalized gambling? That ruins lives, why not ban it? And so on.
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Arizona Ron
Footballguy
Just lost a friend I went to high school with. He got injured, prescribed percs then couldn't get off of them. He recently died of kidney failure.
Heroin is bad but it's not as bad on the kidneys as percs because of the amount of acetaminophen (aspirin) in it. A perc has between 2.5 to 10mg of Oxycodone and 325mg of acetaminophen. He was taking about 10 a day.
Heroin is bad but it's not as bad on the kidneys as percs because of the amount of acetaminophen (aspirin) in it. A perc has between 2.5 to 10mg of Oxycodone and 325mg of acetaminophen. He was taking about 10 a day.
rockaction
Footballguy
Getting rid of the acetaminophen would go a long way towards reestablishing the health of the people that take these pills.
Tau837
Footballguy
Well, sure, but there is a reason the acetaminophen is in Percocet. It is a specific combination of medication that is useful for treating certain situations. If acetaminophen is problematic in any given case, there are alternative opioids to prescribe that don't contain it.
Terminalxylem
Footballguy
You initially stated that regulation and decrease in prescriptions at the current levels is enough, and cited increase in opioid deaths despite ten year prescribing lows as evidence that it isn’t working. You went on to suggest we’re at a tipping point, where further restrictions will cause more harm than good. I’m simply pointing out that we don’t know the ideal amount of prescription/regulation, but my guess is we’re likely still net over-prescribing. Moreover, any correlation between prescriptions and deaths will take years, possibly decades to equilibrate, ie. the impact of what we do today might not be evident for a long time.
Prescriptions elsewhere in the developed world are far lower than the US. Maybe some cultures are into suffering, but like just about everything else, perhaps Americans are prone to excess - we are a consumer-driven society seeking a quick fix like no other. As in many other aspects of healthcare, all the fearmongering regarding rationing doesn’t amount to worse objective outcomes. On the contrary, our healthcare system is a bloated, ineffective mess relative to other wealthy nations.
While cancer pain has been more heavily researched, there is plenty of data showing lack of benefit employing opioids in chronic non-cancer pain. For most mechanisms of acute severe pain they work great, but in the long term, side effects, tolerance and physical/psychological dependence make them problematic even if they aren’t abused. So no, the benefit of their rampant use is not offset by their harm, IMO. We’re getting better at regulating prescriptions and starting to identify/punish some of the bad apples who’ve created the epidemic, so at least we’re moving in the right direction.
Lastly, you’ll get no argument from me regarding alcohol or tobacco. They are fairly worthless and cause plenty of harm, but society deemed them approprate long ago. Between financial pressure and normalization of their use, the toothpaste is pretty much out of the tube in curtailing their use through stricter regulation. If it weren’t for vaping, taxing the hell out of tobacco + education was slowly turning the tide wrt cigarette smoking, however. In any event, I’m not advocating banning anything.
rockaction
Footballguy
Indeed. But there are ailments that don't require acetaminophen, yet it is prescribed anyway, often to the detriment of the consumer of the pills. It would be better if the FDA and DEA didn't encourage doctors to not prescribe pure opiates when the situation calls for them.
Terminalxylem
Footballguy
Sorry about your friend, but the acetaminophen (Tylenol) in Percocet isn’t especially kidney toxic. Rather, the liver usually takes a hit if taken in excess. There are many other potential reasons why opioid abuse can contribute to kidney problems, however.
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Terminalxylem
Footballguy
Unlikely. In the doses employed in most combinationation pills, acetaminophen is fairly safe.
Tau837
Footballguy
I assume you meant to say it would be better if the FDA and DEA did not encourage doctors to prescribe pure opiates when the situation does not call for them...?
If that is what you meant to say, rest assured the FDA and DEA are not encouraging doctors to prescribe opioids when they are not appropriate to the situation. Quite the opposite.
Terminalxylem
Footballguy
The FDA and DEA don’t encourage individuals to prescribe anything. The acetaminophen is meant to limit opioid use by providing a second low-toxicity analgesic to help control pain.
Regardless, short term use of opioid-acetaminophen combos as intended isn’t likely to cause any more problems than opioids alone.
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Tau837
Footballguy
Yes, this is why I stated the truth probably lies somewhere in the middle between where we are and where the rest of the developed world is.
However, the way the US Government has been going about its regulation has already been causing significant harm to the pain patient population, while there is no real evidence that it is having any positive effect on reducing the "epidemic" of opioid overdose deaths, which has supposedly been the motivator for their actions. Quite the opposite. I absolutely believe that if the Government continues to impose increasing restrictions on opioid production and prescribing, the net effect will be negative on the American pain patient population.
I am not "fearmongering" about rationing. If my wife and I were suddenly transplanted to Europe, I am pretty certain she would not get the medication she needs to maintain any quality of life, and she would end her life as a result. That is a form of rationing that, fortunately, does not exist here. Or she would not be alive.
My experience in dealing with my wife's situation over the past 21 years has exposed me to hundreds of pain patients, including a large number with very complex cases that goes beyond normal "low back pain," etc. We have experienced pain care in multiple states, from dozens of healthcare providers, in both office/outpatient and hospital settings. That is anecdotal evidence to be sure, but a lot of it, and I trust what I have seen and experienced more than the data you reference.
Agree this is a good thing.
rockaction
Footballguy
No. I'm saying that, for social reasons, the FDA and DEA are encouraging doctors to cut pure opiates with acetaminophen. Terminalxylem disagrees with me. I'm pretty sure that social policy creeps into bureaucratic suggestion and enforcement of regulations and laws.
Terminalxylem
Footballguy
Your wife may be an outlier, as may some of the other individuals experiencing chronic pain you describe. But until we get an objective tool to quantify pain, we’ll never truly know. For every inadequately treated patient you’ve encountered, I can probably point out several more who complain of “10 out of 10” pain with a smile on their face, who’ve never tried physical therapy, weight loss, cognitive behavioral therapy or maximal non-opioid analgesics to address their pain. Are most of those people addicts? No, but that still doesn’t justify the astronomical number of opioids that are prescribed.
rockaction
Footballguy
I actually think this is pretty standard knowledge. From Time.com:
"Although the inclusion of acetaminophen in the combination pain-killers is intended in part to deter abuse of mild opioids, ironically, for some pain patients it’s the ingredient that proves more dangerous."
"Similar attempts to deter alcohol abuse during Prohibition by including poisonous chemicals in industrial alcohol that was being diverted for use by bootleggers resulted in the deaths of roughly 10,000 people; more recently, chemicals added to anti-anxiety and pain medications to prevent injection have instead resulted in limb amputations after the substances caused blood clots or other complications."
"Although the inclusion of acetaminophen in the combination pain-killers is intended in part to deter abuse of mild opioids, ironically, for some pain patients it’s the ingredient that proves more dangerous."
"Similar attempts to deter alcohol abuse during Prohibition by including poisonous chemicals in industrial alcohol that was being diverted for use by bootleggers resulted in the deaths of roughly 10,000 people; more recently, chemicals added to anti-anxiety and pain medications to prevent injection have instead resulted in limb amputations after the substances caused blood clots or other complications."
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Terminalxylem
Footballguy
I don’t follow this whatsoever. Perhaps in their willingness to approve combo drugs, the FDA is implicitly endorsing their use. Or as I’ve already stated, they’re trying to limit opioid use. And OxyContin, oft blamed as the drug which launched the epidemic, contains no Tylenol. Nor does fentanyl.
The DEA doesn’t encourage doctors to prescribe one opiate over the other, or combination tabs, as they are all Schedule II drugs TMK.
rockaction
Footballguy
See my post above yours. There's certainly a bit of social engineering going on in acetaminophen, as Time points out. It's obvious, likely overtly stated in administrative procedural notices, and not difficult to follow at all. If a public health regulatory body proclaims something to be a health epidemic, it takes steps to alleviate it using a balancing calculus. In this case, they can't deny pain medication, so they cut its addictive qualities with another high-dose pain medication that is non-addictive. In this case, acetaminophen cuts the addictive qualities of the opiates which are, for the most part and generally (note the qualifier), fine on their own for the purpose of pain relief.
If I may, an analogy to street drugs: The problems are in the cut. It's what people and businesses do to save money and how nannies and scolds reduce effectiveness of the pure. It hurts the consumer of the drug. If acetaminophen is so effective, it can be prescribed separately. There's no reason it needs to be a combination pill.
And the DEA, through its enforcement body, certainly "encourages" doctors to prescribe medications in a certain way. That's more than obvious and is littered with instances from which to follow.
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Terminalxylem
Footballguy
Sure, if you overdose on the combo pills, the acetaminophen may pickle your liver. But there are only ~500 deaths each year attributed to Tylenol OD in the US, and only 100 or so are unintentional. Opioids kill a lot more people.
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Terminalxylem
Footballguy
Tylenol is also relatively safe. Far safer than opioids, I’d argue. Overdose stats back this up.
Typical combo pills contain 325mg or 500mg of acetaminophen and 5 to 10 mg of an opioid like oxycodone. Anything less than 6 grams of Tylenol is generally considered safe, though most prescribers try to stay under 4 grams. Toxicology data suggest ~12 grams correlates to severe toxicity. Meanwhile Narcan is recommended by the CDC to safeguard individuals who consume more than 50 morphine equivalents daily from overdosing. Oxycodone is roughly 1.5 times as potent as morphine.
You do the math and tell me which is easier to overdose.
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Tau837
Footballguy
at equating inclusion of poison in industrial alcohol to including acetaminophen - an actual pain reliever - in pain medication. Come on, man. Apples and oranges. If the NYT equated the two, they are way off.
rockaction
Footballguy
They're not equating, they're talking about government bureaucracies cutting something pure with something potentially toxic.
Tau837
Footballguy
This is absurd. There are hundreds of pain medications available. In this case, Percocet combines opioid medication with acetaminophen to reduce the amount of opioid dosage in a given pill. No doctor has to use it. It is available to them if they think it appropriate.
Tau837
Footballguy
Acetaminophen is not 'toxic'. It is a medication that can have long term negative effects. That is true of many (most?) medications in one way or another.
rockaction
Footballguy
Acetaminophen is indeed toxic to livers when combined with opiates. I'm wasting my time no longer. It's well-documented that the inclusion of acetaminophen in opiate prescriptions is not only to cut addiction, but potentially harmful. I'm not going back and forth with your certitude on this. Look it up.
Bolded and especially bolded/italicized: No ####. That's my point.
Italicized: Do you not know how regulatory agencies work? If doctors were given carte blanche, there would be little need for the FDA and DEA to be involved.
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Tau837
Footballguy
I'm very familiar. The point of using it is to trade off negatives associated with acetaminophen with negatives associated with opioids. If a doctor prescribes Percocet, he is essentially saying that the negatives of opioids > negatives of acetaminophen for the particular patient. Why are you having such a hard time grasping this?
I have 21 years of experience dealing with pain specialists and opioid prescribing for my wife who has very severe chronic pain with 20+ comorbid conditions after a car accident and 8 major spinal surgeries. How about you? What is your direct experience? Reading the NYT?
My wife's doctors have never forced any particular medication upon her. It has always been a collaborative discussion of pros and cons of various medications. She has been on Percocet, Oxycodone, Hydrocodone, Oxycontin, Fentanyl patches, Fentanyl spray, Fentora, Hydrocodone, Morphine, and many other medications over time. Her doctors have monitored the health of her liver and kidneys throughout to make sure they were okay. She takes Percocet, among others, today. Her liver is fine. Her kidneys are fine. If we asked her doctor to switch to something else he would do it. We've done that to try different meds periodically.
How does that fit with your point?
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rockaction
Footballguy
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
- Prescribing the wrong drug
- Not monitoring
- Pressured to prescribe a cocktail to reduce addiction at the detriment of the patient.
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.
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rockaction
Footballguy
I don't think there's any schtick. I think people are genuinely disagreeing on how to handle what are currently controlled substances, which will elicit a range of responses, from outright decriminalization on through to highly restriced or almost no access to these medications, barring something really pressing.
rockaction
Footballguy
How the CDC's opioid prescription guideline is harming pain patients.
With regulatory overreach.
"The Drug Enforcement Administration and some state medical boards are also using this dosage guidance [the CDC's] in ways that were never intended, such as a proxy or red flag to identify physician “over-prescribers” without considering the medical conditions or needs of these physicians’ patients. As a result, some physicians who specialize in pain management are leaving their practices, while others are tapering their patients off of opioids, solely out of fear of losing their licenses or criminal charges.
The laudable goal of these laws and policies is to stem the tide of unprecedented overdose deaths and addiction in the U.S. But here are three interesting facts: Opioid prescribing is currently at an 18-year low. The rate of prescribing opioids has dropped every year since 2011. Yet drug overdose deaths have skyrocketed since then.
...In [ ] surveys, physicians said that they were prescribing fewer opioids or ceasing treatment of pain patients altogether because of regulatory scrutiny, even in cases where they believed that doing so would harm their patients."
Doctors scared to prescribe opiates for fear of reprisal by regulatory agencies, not because of patient need. Boston Globe and more here
With regulatory overreach.
"The Drug Enforcement Administration and some state medical boards are also using this dosage guidance [the CDC's] in ways that were never intended, such as a proxy or red flag to identify physician “over-prescribers” without considering the medical conditions or needs of these physicians’ patients. As a result, some physicians who specialize in pain management are leaving their practices, while others are tapering their patients off of opioids, solely out of fear of losing their licenses or criminal charges.
The laudable goal of these laws and policies is to stem the tide of unprecedented overdose deaths and addiction in the U.S. But here are three interesting facts: Opioid prescribing is currently at an 18-year low. The rate of prescribing opioids has dropped every year since 2011. Yet drug overdose deaths have skyrocketed since then.
...In [ ] surveys, physicians said that they were prescribing fewer opioids or ceasing treatment of pain patients altogether because of regulatory scrutiny, even in cases where they believed that doing so would harm their patients."
Doctors scared to prescribe opiates for fear of reprisal by regulatory agencies, not because of patient need. Boston Globe and more here
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Tau837
Footballguy
I agree 100% with all of this. The CDC guideline was terrible for multiple reasons. I planned to post about their recent statements about it when I have time.
I don't think the CDC guideline or any other regulatory influence causes a particular doctor to prescribe a particular medication. It may cause a particular doctor to not prescribe a medication he would have otherwise prescribed, but that is two different things.
Tau837
Footballguy
I stand corrected and appreciate your perspective. I don't agree that doctors have been forced to prescribe Percocet or equivalents, but we can agree to disagree on that.
rockaction
Footballguy
I think we're in general agreement, given your past two posts, and I think we will indeed have to agree to disagree on the fine distinction you're making.
Terminalxylem
Footballguy
Both opioids and acetaminophen are potentially toxic. Heck, so is water. The point is opioids are far more likely to cause overdose deaths. They also have more side effects, even when taken correctly.
Have there been a few cases of liver failure because of excess acetaminophen in combination pills? Sure, but the number is small relative to that of opioid ODs, "pure" or not.
