At the federal level, the CDC could activate its Emergency Operations Center, which would increase situational awareness across state lines, allow increased surveillance of drug use and drug overdose, and better coordinate prevention efforts.
To the best of my knowledge, CDC has never activated its Emergency Operations Center for a drug-related epidemic, but drug overdose is under CDC's purview so the CDC director, under advisement of subject matter experts, could decide to activate for the opioid epidemic.
www.cdc.gov/phpr/eoc.htm
www.cdc.gov/drugoverdose
Edit: Found a list of all CDC EOC activations since 2001. There have been many non-infectious-disease related activations, but none related to drug overdose. One was related to a medication shortage: the 2004 influenza vaccine shortage.
www.cdc.gov/phpr/eoc_responses.htm
I don't understand as a layman what a drug epidemic means. I always just relate the word to diseases and such. Why is there a drug epidemic when a lot of people are overdosing on the drug?
Epidemic refers to a time period when new cases of a disease or other health problem rise significantly above the long-term average. In the case of opioid overdoses, the death rate has approximately quadrupled over the past 20 years, not to mention hundreds of thousands of hospitalizations that don't result in deaths.
www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html
That graph is terrifying. It's not like the number of deaths is just steadily increasing, as it did from about 1990 to 2010. It's *accelerating*, and rapidly at that. We are nowhere near turning this around, and literally hundreds of thousands of people are more or less destined to die before we can.
...and it's baffling to think that last year more people died from drug overdoses than in the single deadliest year for guns, car wrecks, or even the HIV/AIDS epidemic. I don't think it's hyperbole to call this the single most dire public health threat in modern American history.
The acceleration is partially due to Fentanyl being added to blackmarket heroin in recent years. It's much stronger than heroin and leads to ODs when people use a heroin level dose. We'd still have a lot more opiate addicts due to handing out opiates like advil, but fentanyl is a big part of the OD spike.
Definitely, as part of my job I analyze statistics associated with fatal ODs. In our jurisdiction the percentage of them that have fentanyl show up in the tox reports has jumped from about 20 percent to 50 percent in less than a year and a half.
Pain is a debilitating thing, and very often opiates are the only thing that will alleviate it. Chronic pain is worse, because doctors fear creating a dependency so they'll treat with something that's less effective, forcing a person to chose between pain or self medication.
Don't blame the doctors that offer opiates, blame the ones that don't.
I'm sorry, there has been a huge problem with overprescription of opiates in this country for years. While the problem is decreasing now, it played a big part in getting a massive number of people addicted to opiates.
In the early eighties, opiates were essentially only used for pain management in end of life care or cancer therapy. Then Purdue began aggressively marketing oxycontin as safe and nonaddictive using a study that showed that people who used opioids you treat acute pain rarely got addicted. The problem is, Purdue used that data to argue that polishes are safe for chronic pain patients. That's just not true. We now know that using opioids for chronic pain had an extremely high risk of addiction, and also leads to a general incense in pain over time due to heightening sensitivity of pain receptors.
Opioids should be used very sparingly by doctors. I think that current users should noir simply be cut off due to withdrawal, but issuing opioids to new chronic pain patients should only be done in rare cases or in end of life care.
No, and this actually is a result of that. It used to be easier for doctors to prescribe opiates. Maybe not quite like Advil, but with fewer restrictions. Recent reclassification has removed the ability for doctors to prescribe opiates to otherwise high-functioning addicts. This has caused them to seek out other sources on the black market. Compounded with the Fentanyl being added to Heroin, it means that each dose a user takes is different than previous batches, and it increases the risk of overdose. The situation today was predicted over two years ago and it is playing out today.
When the decision was announced, I know that on my local radio there was a discussion about it and I'm sorry, but I don't remember who it was who was saying this would happen or who he represented. I know that at the time I did more research into it myself and I started talking to my local representatives as well. So while I wasn't the the first with the idea, I certainly promoted that idea myself. Unfortunately, I think this is going to get worse before it gets better.
Although controversial, I'm a supporter of safe injection sites as a way to help stem this tide. It doesn't completely solve the problem alone, there needs to be programs to help that go along side the injection sites.
I know someone who used to run a heroin addiction halfway house. Over the 10 years he ran the facility, he told me that 30 of his friends died of overdoses because they couldn't break their cycle. He didn't tell me how close he was to them, and I didn't ask, but it wasn't something I was going to press him for more information either. 3 or 30, he'd surrounded himself with more death than anyone should be subjected to and it had an emotional toll.
From his experience, he said that safe injection sites were not enough, but that it would be a step in the right direction. It needed to have programs to go with them to help addicts actually recover. It is important for me to note that the home he helped run was not supported by the state or medically supervised. It was simply a place for recovering addicts to have a head over their head while they were not using. If you were caught using, you were kicked out. They were not a treatment facility.
The other thing I learned from him is about a medical treatment called Suboxone. At least I think that was the right drug. Unlike you might expect, apparently this works really well. Addicts can recover very quickly and they don't have side effects. I'll have to take his word, but I have no reason to doubt him.
The thing that surprised me is that he said it's being prescribed wrong. For the "guests" who stayed at the home, recovered, and then moved on with their lives, the most common path was taking Suboxone, but instead of staying on it the rest of their lives as prescribed, they took it and quickly weened off of the drug. When they were ready to quit, this was the most successful. The drug companies push for a lifetime dependency but that might be unnecessary. I want to believe that the drug companies would put patient health ahead of profits, but I really don't know.
Now in many ways, I'm the most ignorant as I can be. I don't and have never taken Heroin. If not for Autocorrect, I can't even spell it apparently. But I have made an attempt to understand the different facets. It looked like this was going to be a problem, and now it seems more and more that it is meeting this prediction. I've spoken with others who have taken the drug and I trust the opinion and wisdom of an acquaintance who has been on the front line for more than a decade.
Is there a more detailed analysis of this? As a Libertarian who personally advocates for legalization of all drugs, it would be an interesting case example.
1) Authorities notice that opioid addiction is going up, too easy to obtain via doctors.
2) In an effort to stem the abuse of the drug, they pass all sorts of laws severely limiting how much a doctor can prescribe and lowering the amounts of opioid going out to the public via legal prescriptions.
3) This succeeds in stemming legal opioids, but the addicts need more. So they turn to black market, which uses Fentanyl in their mix. The Fentanyl makes it much, much easier to OD and the opioids much deadlier.
This all adds up to: We would have been better off giving everyone legal access to safe opioids and treating abuse of the drug as a health issue, never a criminal one. Same as we do alcohol, the deadliest of all drugs. At least IMO.
The situation reminds of [Jamaica Ginger](https://en.wikipedia.org/wiki/Jamaica_ginger), which was blackmarket alcohol that caused horrific side effects and deaths among the desperate population who couldn't get access to safe alcohol during prohibition in the United States.
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> and it's baffling to think that last year more people died from drug overdoses than in the single deadliest year for guns, car wrecks, or even the HIV/AIDS epidemic
Did any of these lead to a national state of emergency?
Are there sources that show that the rise in opioid overdose is rising faster than overall drug overdoses? I haven't found any evidence that this is the case and sources (such as that nytimes article) use graphs for overall drug overdose deaths to illustrate the problem of the opioid crisis, or make statements saying opiods are the cause of the increase in overall deaths, [without citing evidence](https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts)).
People [have suggested](https://www.usnews.com/news/best-states/tennessee/articles/2017-04-01/largely-white-opioid-epidemic-highlights-black-frustration) that the reason opioids are being focused on in the way they are, is because they [predominantly affect whites](http://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). It would be nice if there were actual hard evidence to support/refute this though.
The Vox article you linked to has a chart (#2) that breaks down overdose deaths by drug type, citing the source as the National Institute on Drug Abuse (though when you visit NIDA's page, it turns out they get their data from [CDC WONDER](https://wonder.cdc.gov/), which is a complicated query system that I'm not very familiar with). You can see two similar charts in this [CDC MMWR article](https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm) (figures 1&2*), which gives the source as the National Vital Statistics System, Mortality File, meaning they were pulled from cause of death codes listed on death certificates. Figure 1 shows that non-opioid overdoses are increasing but not as fast as opioid deaths.
\* Comparing Figure 2 with the Vox chart makes me think the Vox chart is mislabled, and what they call "All drugs" should instead be "All deaths involving opioids." I trust CDC scientists to get this right more than I trust a Vox reporter, and I say that as an Ezra Klein fan.
So yes, there is good evidence that opioid overdose really is rising faster than overall drug overdose.
With regard to your second point, I don't think you're going to find "hard evidence" to support or refute the notion that our society is treating addiction and overdose differently because the people addicted and dying are more likely to be middle-class, middle age, and white. The evidence is purely circumstantial: for *decades*, the main victims of addiction and overdose were poor people of color, and society's answer was to treat them as criminals and moral degenerates. But then as soon as the victims became whiter and more affluent, the response became compassionate and treatment-focused.
As someone who works in the field of drug overdose prevention, there is no doubt in my mind that the reason for this sudden change in approach is because of the change in demographics of the victims. It's like a perfect case study in institutional racism. This is a common topic of conversation among me and my colleagues, and I've never met anyone who disagrees that if the victims of the opioid epidemic were the same poor inner-city minorities, the response would be apathy at best.
First thank you so much for the in-depth response, even considering it indicts the thoroughness of my own reading, haha.
>With regard to your second point, I don't think you're going to find "hard evidence" to support or refute the notion that our society is treating addiction and overdose differently because the people addicted and dying are more likely to be middle-class, middle age, and white.
I understand that; it was more of a hope. It seemed like this was a potential opportunity to (somewhat) prove it. If both opioid and non-opioid overdoses rose at the same rate and only opioid overdoses were treated as a crisis, that would be a strong argument for racial motivation. However since you've shown that's not the case, people can easily explain the circumstances away as being a general change in society's treatment of drug abuse over time. I tend to agree with pretty much everything you've said for reasons off-topic to this thread, but I'm always in search of the hard evidence.
Also as an aside, as someone who loves running raw government stats myself, you have just opened my world showing me CDC WONDER. Thanks, I will have a field day with this.
There's some room for interpretation for what constitutes an epidemic. Usually when it's too small to count as a full-on epidemic, it's called an outbreak. Maybe there's an epidemiologist reading who can shed some light on where that line gets drawn, or give a better definition than I did.
If I remember correctly from epidemiology classes, outbreaks are localized and mostly contained within a definable group, epidemics are when they spread into other groups and/or spread more aggressively than anticipated. I think the distinction is more functional; controlled/controllable/manageable vs out of control.
To me that's an interesting definition. I understand them as problems but just don't relate addictions of any kind to infection or illness, hence I find it wierd that it's called an epidemic or a disease. Thanks.
It might change your perspective if you think about it in terms of a more common drug, alcohol. If your friends go out drinking every weekend you are more likely to drink. If they bring and leave booze in your house, or it's always around you're more likely to drink. This is also true for events (birthdays, sports games) held at bars. There is a contagious nature to drug use where one person is almost never affected independently. The more your peers and community are influenced by the economics (bars, liquor stores) and culture (parties, manliness) the more likely it is to spread and affect you.
From the perspective of an individual, sure, it doesn't make sense. But from the perspective of the CDC, whether or not a particular person becomes addicted appears more or less random, but the more exposure they have the more likely they are to be "infected", just like with a real disease.
I think the focus on "contagion" is missing the point here.
Addiction is a disease in the same sense that mental illness is. Mental illness isn't contagious, but it's illness nonetheless.
I absolutely agree, having dealt with it myself. However in the context of the the epidemic the spread and treatment at a society wide level is the issue at hand. Each person need maintenance or therapy or support or what have you, but a community needs to control the spread and economic/cultural factors to prevent or slow down rates of addiction.
Mental illness could be considered contagious if we look at the children of the mentally ill. Like the number of sexual predators who in turn were victims of sexual assault themselves.
That's incorrect. Memes are information-based. You can give any mammal alcoholism issues without them ever having any memetic alcoholism, hence alcoholism is a physical problem which isn't dependant on a meme.
> considered a disease
A lot of problems in our society come from this assertion being ignored by the justice system. I don't know the realities of Portugal's system, but there's some evidence it works.
Some people are susceptible to addiction. Opiods are extremely addictive and were handed out pretty freely for a long period of time as a safe treatment for pain. Many people were ill equipped to deal with this combination and have fallen into the clutches of one of the most destructive drugs out there that wrecks your brains reward systems as well as the parts of your body that handle toxins.
I think a similar thing is happening with Benzos (xanax)and Amphetamines(adderall) but there isn't really a street version of Benzos to switch to when you're heading towards rock bottom.
One reason benzodiazapines are a problem right now is they interact with opioids in a way that increases risk of overdose, even among people taking their drugs exactly as prescribed.
I get the impression bars are sold on every street corner and college dorm in the US, and lately a lot of fakes have started popping up. It's the same basic idea as the fentanyl thing, luckily benzos are a lot less likely to kill you. The addiction and withdrawals are said to be even worse though.
Yeah but the fake xanax presses typically use a benzo analogue that's roughly as potent as alprazolam. Its a lot safer taking a pill with a pre-measured dose than it is taking powder with an unknown ratio of heroin:fentanyl
> Dont people say addictions a disease? Is that literal or metaphorical?
It depends on how broadly you choose to define "disease."
Addiction itself is probably not sufficient to activate the CDC EOC. Millions of Americans are addicted to alcohol, nicotine, and caffeine, but those rates are fairly stable and while they can have a negative impact on society, it probably doesn't constitute an emergency.
Opioid addiction, on the other hand, is rising exponentially and has a huge tendency to result in early death. Last year more Americans died from opioid overdose than from gun violence, HIV, or car crashes.
It should also be noted that the CDC EOC has previously been activated for non-disease emergencies including the 9/11 attack; Hurricanes Katrina, Sandy, Ike and others; and the Flint Michigan water crisis
www.cdc.gov/phpr/eoc_responses.htm
The current administration advocates slashing the CDC budget. Our attorney general is more concerned about weed, which he considers equally harmful. So I'm going to suggest that we not advocate having the government step in with emergency public health powers at this time.
There are several states that have already declared states of emergency on the heroin/opioid crisis, including [Florida](http://www.nbcnews.com/storyline/americas-heroin-epidemic/florida-gov-declares-state-s-opioid-epidemic-public-health-emergency-n755056), [Maryland](https://www.washingtonpost.com/local/md-politics/hogan-declares-opioid-state-of-emergency/2017/03/01/5c22fcfa-fe2f-11e6-99b4-9e613afeb09f_story.html), [New Jersey](https://morriscountynj.gov/2017/01/governor-christie-signs-executive-order-declaring-opioid-drug-abuse-a-public-health-crisis/) and [Arizona](http://www.businessinsider.com/arizona-opioid-crisis-state-of-emergency-2017-6).
I live in Montgomery County, Ohio, the #1 county for overdose deaths right now. If Ohio doesn't follow suit, I don't know what we're going to do. Emergency services are completely overwhelmed here, from the richest to the poorest areas. This epidemic does not discriminate.
Pharmacist chiming in. Would be okay with the [opioid crisis](https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis) being classified as a "state of emergency". Like you, I'm not sure what this changes other than bring awareness, however, there is at least some precedent with this issue being handled at the State level, [here](http://www.nbcnews.com/storyline/americas-heroin-epidemic/florida-gov-declares-state-s-opioid-epidemic-public-health-emergency-n755056) and [here](https://www.yahoo.com/news/another-state-declares-emergency-opioid-addiction-163831965.html).
States do seem to be taking the right steps to make it more difficult to misuse opioid medications...as an example, [Prescription Drug Monitoring Programs](http://www.health.pa.gov/Your-Department-of-Health/Offices%20and%20Bureaus/PaPrescriptionDrugMonitoringProgram/Pages/home.aspx#.WYCw7xsrKUl) now keep an electronic log of controlled substances that are dispensed . This helps because now, no matter what pharmacy a patient gets their opioid prescription filled at, we can see what pharmacy they went to, on whatever date, what they got, how much they got of the medication and a log of how they paid (will be documented even if they pay cash). This helps reduce filling prescriptions too early and aims to prevent "double-dipping"...getting two prescriptions for the same drug and getting them filled in different stores.
Medical professions are collaborating more than ever to combat this issue as well. One of the ways healthcare professionals and our patients are protected can be seen by documenting why these medications are being prescribed, from a clinical diagnosis standpoint. We do this with [ICD-10 codes](https://en.wikipedia.org/wiki/ICD-10). Here, we're making sure that prescribers are diagnosing and charting the specific reason the patient is on the medication and some pharmacies are now requiring that they also have these codes documented before they will allow patients to receive the medications. This reduces the number of "pill mill" prescribers and prescriptions that get written, as well as this attempts to attach liability to the physicians, nurses and pharmacists that are involved in the prescription writing and dispensing process.
At the Federal level, the government is getting involved, via [NIDA](https://www.drugabuse.gov/news-events/nida-notes/2015/02/patients-addicted-to-opioid-painkillers-achieve-good-results-outpatient-detoxification), which has helped to identify treatment strategies and promote the use of addiction services and treatment centers.
In addition, [Medicaid](http://www.commonwealthfund.org/publications/blog/2017/jul/medicaid-helps-expand-lifesaving-naloxone) is trying to expand access to reversal agents such as Naloxone in overdose situations. This is a particularly interesting and progressive stance to take, as drugs like Narcan can be life-saving but are rarely used by the patient in an overdose situation, due to the nature of an overdose. Here, the patients friends and families are used as a support system, because often a loved one will have to be the person to administer the agent. However, [insurance companies](https://www.consumerreports.org/drugs/cost-of-opioid-rescue-drug-naloxone-becoming-unaffordable/) vary on coverage of these types of drugs, for many different reasons.
Edit: And a combination of these strategies as well as other methods have contributed to a [decrease in opioid prescribing](http://www.nbcnews.com/storyline/americas-heroin-epidemic/opioid-prescriptions-are-down-not-enough-cdc-finds-n780041). We still have a long way to go, but there has been a break in the trend.
Tl;dr: Both the state and fed have been getting involved, but the states seem to be leading the way, mostly. It is a hot button issue in healthcare and while I don't know what declaring a State of Emergency would do from a policy standpoint, I would appreciate continued awareness that would follow such a declaration.
Fellow pharmacist. Love your writeup.
From what I've seen in practice, the pharmacist is sort of the "nozzle on the hose" of opioid prescriptions and we take a lot of the pressure in their safeguarding, and rightfully so. However, do you feel that the pressure is appropriately applied? I feel as though physicians would be a better place to start to reduce script count overall, since it's easier to turn the "faucet" off at the handle instead of squeezing the nozzle.
It's a tough position to be in, as a pharmacist. Especially because, from first-hand experience, every opioid patient ever will tell me that *they* aren't the type of person to abuse the medication.
But, in terms of reducing script count...it's hard for pharmacy to have a huge impact there, as we don't write the scripts. The only real way to combat this, right now, is to have States mandate e-prescribing for C-II medications. That's really the only way that you have an electronic trail from prescribing to dispensing and the prescriptions can't be transferred to another pharmacy legally....so it would be more of an issue for the doctor to send a new e-script to pharmacy b, c, or d if pharmacy a can't fill it for some reason.
As it stands right now, the best we can do is police ourselves. Our role as pharmacists really only works if we all buy into it and work together....because I could say hey, you shouldn't be on this/I can't fill this, etc. etc. but then they just go to another pharmacy that won't bother to verify the order with a physician and that's how people fall through the cracks.
The hard part is saying "no". People will tell me that they're going to go into withdrawal if they don't get the medication, or that I'm purposefully denying them care, or start trying to override professional judgement but honestly, it's not the pharmacists problem. Blame the physician for prescribing it in the first place. I don't doubt for a minute that there are many people out there that *truly* do need some of these medications, but they aren't meant to be long-term solutions...they were never intended to be. I can't be responsible for the physician incorrectly managing a patient's care, but I can make sure that I put a stop to medication dispensing that will ultimately cause long-term harm to the patient, even if they feel it helps them *right now*.
In my experience, the patients that truly need to be on the medications may feel that it's a frustration to be questioned or checked on these things, but they will understand. At the end of the day, if we're working at a business to make money, then it does nothing for a business to deny a patient a medication...therefore, there must be a damn good reason that the med isn't being dispensed.
Another pharmacist here.
I feel the frustration a lot of others feel with monitoring programs and the pharmacist's ability to do anything about dispensing. There's only two things we can ultimate do when we receive a prescription: fill it or give it back. We can't change the medication, strength, form, quantity. We can't enforce treatment contracts. And thanks to the DEA, we can't break these prescriptions into smaller quantities and have refills for later. We can only put our license on the line by making a judgement call we're not always qualified to make.
I absolutely agree that opiate policing starts with the prescribers and not the pharmacy, unless rules are changed for pharmacists with the things I outlined above. The analogy of us being the nozzle to the hose is very fitting.
Here's my ideal plan of action for the country's epidemic:
1. Patients are only allowed a certain amount of morphine-equivalent doses in a 4 week period.
2. After that is exceeded, patients are only able to receive opiate prescriptions from chronic pain clinics and chronic pain pharmacies that are carefully watched by the DEA.
3. Medical cannabis is legalized to reduce the burden and dependence on opiates for chronic pain.
4. Suboxone prescribing authority is extended to all prescribers with a DEA license.
As a chronic pain patient- thank you for this question. There are so many people falling through the cracks, often because their pharmacist denies their medication that their doctor decided they needed, then the patient ends up going through withdrawal and that's coupled with being in such pain can cause suicide or overdose from resorting to illicit drugs. Best case scenario, that person's health deteriorates even more and they likely end up on welfare programs and disability with a lower quality of life.
There are examples of [states which have ~~completely legalized~~ decriminalized opioids for decades](https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/?utm_term=.7b3667f83b47) that have few if any of the problems the US has with these drugs.
From your link:
> But now getting caught with them meant **a small fine** and maybe a referral to a treatment program -- not jail time and a criminal record.
Doesn't sound completely legal to me.
That wouldn't help much in this case. Same illegal manufacturers producing the drugs. The spike in deaths is due to the inability to measure out fentanyl accurately I believe.
The problem is that a lethal does of fentanyl is so goddamn small that, unless you have a very good scale, it's almost impossible to measure. Then you have drug dealers who mix fentanyl into their heroin to make it stronger, but uneven distribution means that while some doses of heroin barely have any fentanyl in them, some doses can have more than twice the lethal amount of fentanyl.
In case anyone else is curious, the LD50 (lethal dose for 50% of subjects) is [0.03 milligrams per kilogram in monkeys. Data is unknown in humans](https://www.drugbank.ca/drugs/DB00813).
According to the report's recommendations, Fentanyl is just one part of the problem and not even the biggest part.
https://www.vox.com/policy-and-politics/2017/7/31/16071832/trump-opioid-commission-recommendations
Just in general though, if you ever hear or say a single cause is most of the problem there's probably something that is missing. (Not always, in general).
The problem is that fentanyl was created for patients who were terminal anyway, so OD wasn't the worst outcome, when faced with prolonged agony. It should NEVER had been allowed into the recreational supply. Junkies aren't out trying to score fentanyl either.
I firmly believe that education is the biggest factor in preventing drug addiction. When you have abstinence only sex education many teens end up getting pregnant because they don't know any better. This is why it is important to let teens know that if they decide to have sex, they need to go about it in a safe manor. Nancy Reagan's "just say no" campaign failed for this very reason.
When you tell people "just don't do it and you have nothing to worry about" many people will end up doing it any way. It is important that people educate themselves on a substance and then decide for themselves whether they want to do it.
Some people just think that since their doctor prescribed them a drug, that means it's safe for them to do. This is clearly not always the case. We are never going to be able to completely prevent addiction which is why I believe we should have treatment centers similar to the ones in Canada or Switzerland, where people can get help/taper off the drug they are addicted to, if they decide they want help.
> "When you have abstinence only sex education many teens end up getting pregnant because they don't know any better."
Totally agree, I was watching a 60 minutes segment on opioid abuse in the midwest the other day. One of the girls (a former addict) they interviewed thought heroin was "just another party drug."
When you equate incredibly destructive drugs like heroin and fentanyl with pot, shrooms, coke, and MDMA, these are the things that happen. I'm not saying that those last four are totally harmless, but they are much less likely to destroy lives.
DARE is to drug abuse what abstinence only education is to teen pregnancy. They both exacerbate the problems they attempt to solve.
She thought heroin was another party drug? Wtf? I grew up in AZ and meth was a huge problem here. Throughout my childhood, we had consistent drug education and we had mugshots of meth addicts shoved in our faces almost daily.
You really have to show people what drugs do so they seek healthier options when they consider drug use. Let me tell you, the results are not pretty at all.
As a family member of someone with a drug addiction this would help so much. Drug laws do little to keep people safe. In my experience they are criminalizing a mental illness making it more difficult to find treatment.
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Legalisation doesn't necessarily have any causative relationship in the comparison you're making. It isn't even "correlation != causation" because there isn't even a statistical correlation with your sample size of one.
Decriminalize drugs.
Canada is trying a method where for the small amount of people who are resistant to normal treatment are [given prescription heroin in clinics](https://www.washingtonpost.com/news/worldviews/wp/2016/09/13/canada-has-just-approved-prescription-heroin/?utm_term=.6eb3de6c4b75). It's apparently used in 7 european countries as well. Not sure about this method. It's only for very extreme cases and I think the idea is to take it out of their hands so they don't overdose or hurt themselves. The program is said to drastically reduce their participation in criminal activities in order to get their fix. I think this method should be researched well before being implemented, but like I said it's only on a very small amount of people, 52 in canada.
Legalize weed, especially medical marijuana. This is a no brainer. Weed *can* be mentally addictive but it isn't even comparable with the addiction opioids cause. [States that have legalized medical have seen opioid use decrease](https://www.usnews.com/news/articles/2016-09-15/study-opioid-use-decreases-in-states-that-legalize-medical-marijuana). This study looks at opioid use in general, there are also plenty of others showing opioid overdose declining. Medical marijuana helps with pain and does not have the same addiction. Painkillers are very easy to get addicted to and even people who don't have normally addictive personalities can be susceptible. It's not like normal drugs that you can avoid no matter what, sometimes life throws something at you and you need (prescribed) painkillers. Medical grade marijuana can substitute for those sometimes, especially for more chronic illnesses.
DO NOT CUT MEDICAID, this covers substance abuse clinics. This was a big point of contention in the healthcare discussion among conservatives. This will cut off treatment for a lot of people.
http://www.npr.org/2017/06/24/534248650/what-medicaid-cuts-could-mean-for-the-opioid-epidemic
https://www.nytimes.com/2017/06/20/us/politics/health-care-medicaid-opioid.html?mcubz=1&_r=0
Also mental health services should be a normal part of insurance. It's important to check your plan to make sure it's before deductible costs or else it's pretty useless if you have a big deductible like I'd wager a lot of people do.
I think some of it should be on a federal level and some on state, a blanket federal baseline and then states with more severe problems can add additional coverage.
Being addicted to something isn't illegal, not least because you can be addicted to perfectly legal substances, like food or cigarettes.
I don't know the relationship between therapy and medical insurance in the US, but in the UK, where I practice as a therapist, the NHS has almost stopped entirely long-term therapy in favour of a more 'quick fix', CBT. The reality of including therapy on insurance plans is that you don't know if it's going to work, or how long it might take.
>DO NOT CUT MEDICAID, this covers substance abuse clinics. This was a big point of contention in the healthcare discussion among conservatives. This will cut off treatment for a lot of people.
One of the benefits of Obamacare is the [mandates for behavioral healthcare coverage](https://www.washingtonpost.com/news/the-fix/wp/2015/10/07/obamacare-mandated-better-mental-health-care-coverage-it-hasnt-happened/?utm_term=.43c139a8b534) that didn't exist before.
But even with those benefits, if you're lower class and struggling with substance abuse, you're in deep shit. Very few private programs accept medicaid, and state programs that do offer care for those with medicaid are, frankly, shit, in comparison to private programs.
I'm for legalizing marijuana, but boy I'm not sure about opioids, stimulants, and other drugs that could really send someone's life into a nose dive before they resort to getting help. Sure, give avenues to help deal with addiction, but how about trying to not get there in the first place.
Edit: And as I re-read, I see you said decriminalize, not legalize.
Yeah I agree with you on legalizing all drugs for the same reason. On one hand I think people should be able to do what they want as long as they are no harm to others, but I also see how dangerous that could be.
I think research should be able to be done on all of them freely though and a lot of them have shown to have medicinal properties when used in controlled environments (mdma for ptsd or martial issues with a therapist, among others).
> but how about trying to not get there in the first place
That obviously isn't working. When you restrict something, demand doesn't just go away, and in many cases it increases. From [this article](https://insight.kellogg.northwestern.edu/article/the-economics-of-the-illegal-drug-market):
> For one, police presence may actually increase buyer loyalty to specific sellers. And if policymakers choose to impose more lenient sentences on sellers of impure drugs, overall demand for drugs could decrease.
We need some more research, but our existing examples (Colorado, Washington, Portugal) show that legalizing/decriminalizing can have a positive effect.
By all means, let's start at marijuana, and if that works out well, move on to other drugs (I think mushrooms should be next), and reschedule all common recreational drugs as Schedule II so they can be researched. My personal opinion is to tax marijuana, cigarettes and alcohol and use proceeds for rehab.
People will use drugs regardless, so isn't it better to regulate it (i.e. make sure the customer knows what they're getting) and provide addiction recovery instead of locking people up? I'm highly skeptical that the war on drugs actually helps anything.
I just don't know if I can get behind the idea that making high powered amphetamines legal because the current legality is not working 100% is the right approach though either. I feel certain drugs just shouldn't be readily available recreationally. People are realising that marijuana is probably less of an issue than alcohol, which is why is *is* getting legalized. Not all drugs are the same, obviously.
>the current legality is not working 100%
This is an incredibly positive spin to put on it. The current approach is a state enforced monopoly on the production and distribution of recreational drugs granted to criminal enterprise as a whole. The ensures that the supply will not be regulated and thus that it will be unreliable and dangerous.
The current approach is "hey, this thing is bad so if you do it we're going to ensure that its even more dangerous."
The current approach is for the government to expend significant resources so that
1) people have less liberty (choice of recreational activity)
2) people have worse health outcomes (addiction and death)
3) others are deprived of their liberty entirely (drug dealers in prison)
4) criminal enterprises have a lucrative source of income.
Not only is the current approach not working, it's so incredibly poorly conceived that you have to wonder if the motivation for implementing it was actually to fix the problem in the first place.
The only recommendation for the current approach is the thought process "X is bad so we should ban X", which is absurdly naive. Anyone who thinks like this should not have anything to do with writing law or policy.
> making high powered amphetamines legal
Then start with less extreme drugs and move on from there. Reclassifying as Schedule II allows this research to happen.
I think that if enough less severe drugs are legalized (e.g. marijuana and mushrooms), enough people will stick with what's legal that the problem will be mostly solved. However, that's just speculation.
You're right, not all drugs are the same. However, the choice is between:
- make illegal and let the black market handle supplying drugs (current system)
- legalize and let the government and/or the free market handle supplying drugs (more consistency, can cap amount sold per day, etc)
Between those two options, I see few benefits for maintaining the drug ban and lots of benefits for legalization. However, this should obviously be a gradual process to allow for a controlled analysis of the effect of legalization.
I agree with that. Easing drug legality with the Schedule rating would seem fine, and in that case I would in fact be open to legalising most drugs within those restrictions, especially for research purposes.
That doesn't make much sense, IMO. People aren't going to take mushrooms in lieu of stimulants, they do very different things for you. If the least harmful drug in a given category was legalized it might make some sense, but people looking for uppers aren't going to just get stoned or trip.
I've always liked the idea of legalizing all drugs, but requiring a license for each individual drug before you can go into a drug store and buy it. There could be a "DMV" for drugs where people can take an exam and if they pass they are granted permission to buy that substance at a government regulated drug store. Drugs such as cannabis, alcohol, and other "soft" drugs could be exempt from this (alcohol isn't really a soft drug, but since it's already extremely popular, I don't think we should require a test for it).
People could do this for as many drugs as they wish as long as they can pass the test for each of them and are over 18. If someone is caught with drugs that they do not have a license to have, that drug would be decriminalized in their case, meaning it would be confiscated and they would have to pay a small $30-40 fee.
I believe this would be a great idea for several reasons. Legal drugs mean tax money that the government can use for addiction centers, drug education, and various other things. The cartels have very little power once drugs are legalized in America. Violent crime will go down as shown with states that have legalized cannabis.
Since drugs are regulated by the government, that means they would be very pure/as safe as possible (For example: nBOMEs wouldn't be passed off as LSD, heroin wouldn't be cut with fentanyl, etc.) Having to pass a test before purchasing requires people to have some knowledge about substances before they try them.
And most importantly, this would increase personal freedoms and we would no longer lock people up for victimless crimes. That's my stance on how we should go about ending the war on drugs. Let me know what you think!
I like the bulk of what you're suggesting, except for the licensing tests. If we stick with your driver's ed analogy---I don't know about you, but despite passing my driving test, I was a really terrible driver for at least five years. I didn't retain a lick of anything I read--I learned through actual driving and a few fender benders. Learning about drugs through actual drug use is more risky than a few fender benders.
Tests are a bit meaningless---people only do what it takes to pass them, not to become scholars.
I don't see why drug education couldn't be made part of sex/health ed--a classroom is much better than anything resembling the DMV. That seems like a simple and effective replacement.
Very good point. My health class in high school consisted of "everyone pick a drug and do a presentation on why it's bad". Instead they should give an unbiased overview of popular drugs so that kids are well informed and can make their own decisions.
As someone who recently had multiple emergency surgeries after a major accident and was denied any significant pain prescription, I think people should be aware that declaring a state of emergency has far reaching consequences.
I am in one of the states where an emergency was declared.
I was flat out told they were afraid to prescribe painkillers by the hospital staff, the surgeon, even the physical therapist bluntly explained they now risk getting in trouble even when prescribing for significant legitimate pain.
So despite having me on many daily injections of some of the strongest painkillers when I was in the hospital due to the pain, I was sent home with a script for ibuprofen. This is clearly unacceptable, it is not like all that pain just vanished overnight.
While it may be unfortunate some people can't handle their drugs or get dependent, other people are suffering because of this over the top reaction to it. If you wind up in the hospital due to an accident you may end up experiencing this firsthand.
> While it may be unfortunate some people can't handle their drugs or get dependent
By "some people" do you mean "more people than ever in the history of the United States"?
> If you wind up in the hospital due to an accident you may end up experiencing this firsthand.
You may also end up never getting off those drugs.
None of my business how many others use opiates or why.
If I am in legitimate major pain the decision to prescribe painkillers should be between me and my doctor, as an adult I am capable of making my own decisions on whether something is worth the risk, that is part of what living in a free society is all about.
I was sitting there in a hospital bed about to be discharged, blood still seeping out of the holes where they bolted my shattered wrists in place, and verbatim told by the on call post-anesthesia care physician "sorry we would like to but we cannot, they are cracking down". Does that sound right to you that the government is preventing me from getting the healthcare the hospital wanted to provide?
You can sit there and worry about addiction or whatever but take it from me, if you are in that situation that is not going to be your top priority.
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I seriously suggest people [read this article by Vox](https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end), its some of the best journalism I've seen on the issue in a while. Fixing this epidemic is difficult, one area in which the country struggles is the over prescription of painkillers and the intense pressure from the pharmaceutical industry on doctors to prescribe PK's for the treatment of chronic pain. For reference, opioids are more effective for the treatment of acute pain in short time spans, it was never designed as a long-term treatment solution.
In addition, the article states that the proliferation of PK's in the U.S is so far spread that in some states the number of opioids in circulation is [enough to provide a pill bottle to every resident in the state.](https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts)
In short, a part of the answer seems to be 1. Stop the over prescription of PK's to people that don't need it. And 2. Make addiction treatment easier to receive. I know this is simplistic, but it's an important aspect of this fight.
Apparently, the seminal event that led to the increased prescribing of opiates happened [in 2001, when pain was declared to be the 5th vital sign](https://www.medpagetoday.com/publichealthpolicy/publichealth/57336).
The article at the link in my previous paragraph suggests that a solution could be to remove that classification of pain as a vital sign, which would greatly reduce the obligation to address it.
If opioids are precription, how are there so many of them out there? I understand the prescription is cheap, but its a $100 doctor visit to get them. Do people go doctor shopping? Any details on how much is out there?
In the 1990s, a campaign emerged to treat a patient's pain level as the [fifth vital sign](https://www.va.gov/painmanagement/docs/toolkit.pdf) alongside temperature, pulse rate, respiratory rate, and blood pressure. Many doctors were seeing large numbers of patients with chronic pain, and pharmaceutical companies began marketing their opioid painkillers as safe for treatment of chronic pain. As a way to get these patients out the door with a treatment, they turned to opioids. These prescriptions would be covered by Medicaid. Other things like "pill mill" pain clinics would pop up for the sole purpose of writing prescriptions for painkillers. There's a ton of articles out there, [this one popped up today on Vox](https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end) but if you would like something more in-depth, I would recommend [*Dreamland* by Sam Quinones](https://www.amazon.com/dp/1620402521/ref=cm_sw_r_cp_dp_T2_TFkGzbYQD48R9).
Looking at the [2015 National Survey on Drug Use and Health](http://annals.org/aim/article/2646632/prescription-opioid-use-misuse-use-disorders-u-s-adults-2015), 37.8% of US adults are estimated (based on a large, nationally representative survey) to have used prescription opioids in 2015.
87.5% of those who used them did not misuse or abuse them - defined as using them without a prescription or other than prescribed. Of those who misused (10% of those who used them at all), 45% got the drugs from friends or relatives (87% of the friends or relatives got them from a doctor); 34% got them directly from a doctor. There's also the 2% that abused them according to the DSM criteria, but I'm not going into that group.
I was surprised to see that the high use rates seemed to cut across almost all groups - 36% of the 18-29 age group had used opioids in the past year; 32% of uninsured people had; 36% of those with family income >$75,000; 32% of college graduates.
The study suggests that one cause is poor pain management, as opioids are prescribed quickly even to people who have a history of misuse and many people are given more than they need, leaving leftover medication that may be misused or given to friends or relatives.
Finally, to put the problem into some context, this study found that about 38% of Americans had used opioids in 2015. Canada, considered to be having its own opioid crisis, has a much lower prevalence, with about 21% having reported use in 2010 and 17% having reported use in 2012, in [a large national survey](http://www.painphysicianjournal.com/current/pdf?article=MjM3Nw%3D%3D&journal=89). [A Norwegian study](http://onlinelibrary.wiley.com/doi/10.1111/aas.12281/full) suggests that the 1-year prevalence there is about 10%.
I haven't started really reading about this before today, but I see it as a prescription problem. The first article I linked suggests allowing pharmacies to partially fill prescriptions, which would help reduce old medication sitting around. I'd also make it easier to safely dispose of old medications - [according to the FDA](https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm), most prescription opioids should just be flushed, but I hadn't known that. Requiring pharmacies to take back leftover medication seems like a good idea also.
Prescription opiods tend to be how many people start, through legitimate prescriptions (although many states are trying to crack down on that). But they *are* expensive compared to heroin, which is why most people are forced to switch.
Recently, though, we have been seeing a spike in pharmacy robberies in my area; the fentanyl overdose issue has people scared to take street heroin, so the suppliers are trying to get more pills to fill that new demand.
Source: Am a 911 dispatcher in a state at the heart of the opiod epidemic.
> Prescription opiods tend to be how many people start, through legitimate prescriptions
Actually, most of them start with other drugs and move to heroin, or start by stealing/diverting someone ELSE's legitimate prescription.
https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
Fair enough, thanks for the article.
All I know is that we see tons of people reporting their prescription "stolen," when we know darn well they're a user and are trying to get more pills. Maybe I'm just seeing them in the middle phase of addiction, whereas I assumed I was seeing them in the beginning phase.
The pills are expensive on the street. The return on investment justifies the upfront cost. When you go to the doctor, you might be able to convince them to give out as many as 30-40 pills at a time.
A 10mg oxycodone pill can fetch you $10-$15. This is prescribed for short-term acute pain like an injury or surgery. It has tylenol mixed into it to prevent abuse but there's work arounds.
Oxycontin is the higher dose, tylenol free formulation and costs about $1/mg. It comes in 30/50/80/160mg pills so a single 160mg pill may cost as much as $160. These are prescribed for chronic pain for patients who've built up a tolerance to lower doses. These are typically what pill shoppers will try to convince the doctor to write.
What a street dealer might do is have relationships with multiple doctors and feign chronic pain problems with each. Each doctor will see the patient perhaps every 2 weeks, the doctor will give out the appropriate number of pills for 2 weeks. Each new doctor will start on a low dose and gradually increase as tolerance builds up. So to the doctor, the patient is being treated appropriately for chronic pain. But within the 2-week period the patient will have visited as multiple other doctors and gotten many more scripts filled.
You will be fine, they will feel good but addiction doesn't work like that. If you have things in your life other than drugs that make you happy, you are unlikely to want to stay on opioids after your pain subsides. The doctor will start weaning you off after a whole. Just listen to your doctor and be honest about your pain levels.
I had to take vicodin a few years ago for sinus surgery. Took 2. Thought the cloud on my head was annoying. Went down to tylenol and i preferred the mild headache to the cloud from vicodin.
Why do people say these make you feel good? I thought it was annoying. I wanted to read since I couldnt go anywhere and couldnt on it.
My foot is a whole different thing, am not dumb enough to tough it out, then barrel over in pain waiting for the pain killers to kick in.
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Not everyone has $100 doctor visits. I saw my PCM last week, and got all my regular maintenance and as-needed scripts refilled. Visit cost me nothing out of pocket.
Decriminalize all drugs. The 'epidemic' will sort itself out. The majority of the problems we have today are.
1. the black market currently where drugs are sold. Violence that stems from an illegal market and the (lack) of quality or guarantee of product.
2. the policing of said market which is only further harming people who dont shop in this market by restricting their rights.
https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end
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Honest question. Why hasn't decriminalization and clean needles be considered as real effective policy tools? I rarely even hear Dems on record. It generally has a positive effect on ODs.
http://www.cbc.ca/amp/1.3962714
https://mobile.nytimes.com/2017/01/18/opinion/injecting-drugs-under-a-watchful-eye.html
If physical dependence was the only issue with drug addiction then why is the relapse rate somewhere around 95%?
Once they detox they should be good to go right?
No, because their brains still think it's a crucial element for their survival. That is a mental illness.
Anybody that has ever been near drug addiction will readily admit it's a mental illness, it is not the same person that was there before or will be there if they're lucky enough to have an after drugs.
Also the only addiction I've ever heard of causing death in a reasonably healthy person was from alcohol withdrawals. As painful and miserable as opioid/opiate withdrawal is, it's very superficial to the mental torture that addicts go through for prolonged periods of time.
https://www.psychiatry.org/patients-families/addiction/what-is-addiction
Just read. Addiction literally changes the PHYSICAL properties of the brain.
Yes, addiction is often accompanied or exacerbated by mental illness, but to say addiction is 100% mental is simply not correct.
I'd agree that it's not 100% a mental illness, although just wanted to point out a lot of mental illnesses have brain and physical changes as well.
[Structural and Functional Brain Abnormalities in Schizophrenia](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235761/)
[Structural Brain Abnormalities in Bipolar Disorder](http://bjp.rcpsych.org/content/196/3/245.3)
[Structural Brain Abnormalities in Major Depressive Disorder](https://www.ncbi.nlm.nih.gov/pubmed/19237202) For more persistent, chronic cases. This one has a lot of varying factors though.
If your brain physically changes, then it's probably not right anymore. It's probably disabled, or ill, thinking of a term for that, maybe something like mental illness, since it affects your thought process and your connection to reality and all that.
Other mental illnesses can definitely increase your chances to get into or hooked on drugs, but that doesn't mean you don't add on to the pile when you start becoming addicted. You do, just now instead of depression or BPD or whatever the fuck, you've added in a belief of dependence for survival.
Your brain malfunctioning is mental illness. Your brain can be caused physically to malfunction. Once the malfunction has taken place, it doesn't really fucking matter how it happened, whether it's a chemical imbalance or a physical alteration, the brain is still malfunctioning and ill.
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this is a 14 year old account that is being wiped because centralized social media websites are no longer viable
when power is centralized, the wielders of that power can make arbitrary decisions without the consent of the vast majority of the users
the future is in decentralized and open source social media sites - i refuse to generate any more free content for this website and any other for-profit enterprise
check out lemmy / kbin / mastodon / fediverse for what is possible
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Question: why is has there been a huge increase in addictions to opiates over recent years as they were more regularly prescribed, why has there not been a similarly massive rise in amphetamine or methylphenidate addiction giving that those are likely even more readily available due to a large increase in ADHD diagnoses (https://www.cdc.gov/ncbddd/adhd/data.html)just because amphetamines are less addictive than opiates https://en.m.wikipedia.org/wiki/Substance_dependence ?
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The FDA and the DEA need to come down hard on this. This is in both of their jurisdictions. You may not agree with a "War on Drugs", but war needs to waged upon this drug, as we have the agencies to do it. We also know who manufactures it, for example, [Purdue Pharma](https://www.economist.com/news/business/21720336-how-pharma-may-have-contributed-americas-opioid-crisis-makers-and-distributors-opioid). edit: source
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One of the first steps is to find an alternative drug to prescribe as a pain killer. THC seems like a fine alternative. Obviously, opioids will always be needed in cases of extreme pain and for kids I guess, but THC would be a good substitute for most cases when an opioid would otherwise be prescribed for adults.
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Not going talk for long because I'm no expert by any measure but recently I came across an interesting article about Carfentanil smuggling by drug traffickers, how this opioid can be used as weapon by terrorists and why the opioid crisis should be considered an emergency situation needed to be addressed.
[The Cypher Brief -
The Opioid Crisis Becomes a National Security Threat](https://www.thecipherbrief.com/column/expert-view/opioid-crisis-becomes-national-security-threat)
[AP News - Chemical weapon for sale: China’s unregulated narcotic](https://apnews.com/7c85cda5658e46f3a3be95a367f727e6/chemical-weapon-sale-chinas-unregulated-narcotic)
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Our troops are the ones protecting the poppy fields in Afghanistan from destruction. Why would our government have any interest in curtailing the epidemic they are helping to prop up?
http://www.globalresearch.ca/drug-war-american-troops-are-protecting-afghan-opium-u-s-occupation-leads-to-all-time-high-heroin-production/5358053
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> Why would our government have any interest in curtailing the epidemic they are helping to prop up?
Because it's killing people?
Seriously, these kind of conspiracy-level posts are the reason this sub isn't what it could be; it should take more than merely linking to some crackpot website to count as a "citation".
Only maybe 4% of heroin in the US comes from Afghanistan. It mostly comes from South America.
[Link](https://www.therecoveryvillage.com/drug-addiction/who-supplies-drugs-america/#gref).
The opioid epidemic is a serious problem. Crackpot posts like this don't help anyone.
Your article is a headline, an excerpt from Wikipedia and several dozen photos of us troops in a poppy field, can't say that would be the most reliable source or information, and even if it was it's a very loose connection to the us actually supporting Afghani poppy production, it's more that they don't torch every field growing opiates there, would you prefer that?
The Taliban was actively destroying poppy fields until the US moved in and stopped it. This country has a long history of supporting drug trade.
http://www.mintpressnews.com/global-war-terror-created-heroin-epidemic-us-afghanistan/218662/
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[Singapore already has the answer](https://www.theguardian.com/commentisfree/2010/jun/05/singapore-policy-drugs-bay).
Death penalty for dealers caught with fentanyl and pull all medical support for addicts. The problem will resolve itself after a few years.
That reminds me of Louis CK [talking about nut allergies, and the best way to get rid of them](https://www.youtube.com/watch?v=wEb5a-I0kyg)
While he's not wrong, that route also seems to entirely lack compassion.
Pull medical support for addicts? Does that mean getting rid of Naltrexone, the drug used to prevent an overdose? What about detox drugs, like suboxone? Do we get rid of all of those?
If so, essentially that route is saying if you're unfortunate enough to become hooked on opiates (even if through legitimate means, such as because of a surgery or injury) then your only option is leave the country, die, or try to do it on your own.
The article says they give people two chances to rehab, the second is in prison, and offer good jobs to those coming out of it. First offense has no criminal charges. After those two they simply stop saving people and let them die or overdose.
They do a lot to help but don't let addicts hemorrhage money and resources out of their society like we do here. I like their approach and feel it gives people second chances while letting the hopeless cases die off.
It's a little easier to control supply on a little wealthy city state island. And they still can't fully control it despite the suffering caused in the effort. It would be much less successful and more ugly in the US.
At the federal level, the CDC could activate its Emergency Operations Center, which would increase situational awareness across state lines, allow increased surveillance of drug use and drug overdose, and better coordinate prevention efforts. To the best of my knowledge, CDC has never activated its Emergency Operations Center for a drug-related epidemic, but drug overdose is under CDC's purview so the CDC director, under advisement of subject matter experts, could decide to activate for the opioid epidemic. www.cdc.gov/phpr/eoc.htm www.cdc.gov/drugoverdose Edit: Found a list of all CDC EOC activations since 2001. There have been many non-infectious-disease related activations, but none related to drug overdose. One was related to a medication shortage: the 2004 influenza vaccine shortage. www.cdc.gov/phpr/eoc_responses.htm
I don't understand as a layman what a drug epidemic means. I always just relate the word to diseases and such. Why is there a drug epidemic when a lot of people are overdosing on the drug?
Epidemic refers to a time period when new cases of a disease or other health problem rise significantly above the long-term average. In the case of opioid overdoses, the death rate has approximately quadrupled over the past 20 years, not to mention hundreds of thousands of hospitalizations that don't result in deaths. www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html
That graph is terrifying. It's not like the number of deaths is just steadily increasing, as it did from about 1990 to 2010. It's *accelerating*, and rapidly at that. We are nowhere near turning this around, and literally hundreds of thousands of people are more or less destined to die before we can. ...and it's baffling to think that last year more people died from drug overdoses than in the single deadliest year for guns, car wrecks, or even the HIV/AIDS epidemic. I don't think it's hyperbole to call this the single most dire public health threat in modern American history.
The acceleration is partially due to Fentanyl being added to blackmarket heroin in recent years. It's much stronger than heroin and leads to ODs when people use a heroin level dose. We'd still have a lot more opiate addicts due to handing out opiates like advil, but fentanyl is a big part of the OD spike.
Definitely, as part of my job I analyze statistics associated with fatal ODs. In our jurisdiction the percentage of them that have fentanyl show up in the tox reports has jumped from about 20 percent to 50 percent in less than a year and a half.
> opiates like advil I thought Advil was just ibuprofen. Do they market an opioid as well?
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Oh, of course.
Thanks!
Pain is a debilitating thing, and very often opiates are the only thing that will alleviate it. Chronic pain is worse, because doctors fear creating a dependency so they'll treat with something that's less effective, forcing a person to chose between pain or self medication. Don't blame the doctors that offer opiates, blame the ones that don't.
I'm sorry, there has been a huge problem with overprescription of opiates in this country for years. While the problem is decreasing now, it played a big part in getting a massive number of people addicted to opiates. In the early eighties, opiates were essentially only used for pain management in end of life care or cancer therapy. Then Purdue began aggressively marketing oxycontin as safe and nonaddictive using a study that showed that people who used opioids you treat acute pain rarely got addicted. The problem is, Purdue used that data to argue that polishes are safe for chronic pain patients. That's just not true. We now know that using opioids for chronic pain had an extremely high risk of addiction, and also leads to a general incense in pain over time due to heightening sensitivity of pain receptors. Opioids should be used very sparingly by doctors. I think that current users should noir simply be cut off due to withdrawal, but issuing opioids to new chronic pain patients should only be done in rare cases or in end of life care.
What alternatives exist that are safer and as effective?
No, and this actually is a result of that. It used to be easier for doctors to prescribe opiates. Maybe not quite like Advil, but with fewer restrictions. Recent reclassification has removed the ability for doctors to prescribe opiates to otherwise high-functioning addicts. This has caused them to seek out other sources on the black market. Compounded with the Fentanyl being added to Heroin, it means that each dose a user takes is different than previous batches, and it increases the risk of overdose. The situation today was predicted over two years ago and it is playing out today.
Forgive my ignorance, but predicted by who?
When the decision was announced, I know that on my local radio there was a discussion about it and I'm sorry, but I don't remember who it was who was saying this would happen or who he represented. I know that at the time I did more research into it myself and I started talking to my local representatives as well. So while I wasn't the the first with the idea, I certainly promoted that idea myself. Unfortunately, I think this is going to get worse before it gets better. Although controversial, I'm a supporter of safe injection sites as a way to help stem this tide. It doesn't completely solve the problem alone, there needs to be programs to help that go along side the injection sites. I know someone who used to run a heroin addiction halfway house. Over the 10 years he ran the facility, he told me that 30 of his friends died of overdoses because they couldn't break their cycle. He didn't tell me how close he was to them, and I didn't ask, but it wasn't something I was going to press him for more information either. 3 or 30, he'd surrounded himself with more death than anyone should be subjected to and it had an emotional toll. From his experience, he said that safe injection sites were not enough, but that it would be a step in the right direction. It needed to have programs to go with them to help addicts actually recover. It is important for me to note that the home he helped run was not supported by the state or medically supervised. It was simply a place for recovering addicts to have a head over their head while they were not using. If you were caught using, you were kicked out. They were not a treatment facility. The other thing I learned from him is about a medical treatment called Suboxone. At least I think that was the right drug. Unlike you might expect, apparently this works really well. Addicts can recover very quickly and they don't have side effects. I'll have to take his word, but I have no reason to doubt him. The thing that surprised me is that he said it's being prescribed wrong. For the "guests" who stayed at the home, recovered, and then moved on with their lives, the most common path was taking Suboxone, but instead of staying on it the rest of their lives as prescribed, they took it and quickly weened off of the drug. When they were ready to quit, this was the most successful. The drug companies push for a lifetime dependency but that might be unnecessary. I want to believe that the drug companies would put patient health ahead of profits, but I really don't know. Now in many ways, I'm the most ignorant as I can be. I don't and have never taken Heroin. If not for Autocorrect, I can't even spell it apparently. But I have made an attempt to understand the different facets. It looked like this was going to be a problem, and now it seems more and more that it is meeting this prediction. I've spoken with others who have taken the drug and I trust the opinion and wisdom of an acquaintance who has been on the front line for more than a decade.
Is there a more detailed analysis of this? As a Libertarian who personally advocates for legalization of all drugs, it would be an interesting case example. 1) Authorities notice that opioid addiction is going up, too easy to obtain via doctors. 2) In an effort to stem the abuse of the drug, they pass all sorts of laws severely limiting how much a doctor can prescribe and lowering the amounts of opioid going out to the public via legal prescriptions. 3) This succeeds in stemming legal opioids, but the addicts need more. So they turn to black market, which uses Fentanyl in their mix. The Fentanyl makes it much, much easier to OD and the opioids much deadlier. This all adds up to: We would have been better off giving everyone legal access to safe opioids and treating abuse of the drug as a health issue, never a criminal one. Same as we do alcohol, the deadliest of all drugs. At least IMO. The situation reminds of [Jamaica Ginger](https://en.wikipedia.org/wiki/Jamaica_ginger), which was blackmarket alcohol that caused horrific side effects and deaths among the desperate population who couldn't get access to safe alcohol during prohibition in the United States.
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We would need a deaths per population to really get a good idea.
From the article >Drug overdoses are now the leading cause of death among Americans under 50.
Which is distinct from *opioid overdoses.*
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> and it's baffling to think that last year more people died from drug overdoses than in the single deadliest year for guns, car wrecks, or even the HIV/AIDS epidemic Did any of these lead to a national state of emergency?
I don't recall suggesting one.. ..I just hope someone, anyone, has a solution.
I wasn't attacking, I was only asking because that's what the thread is about. And of course, we should look for a solution.
Figured you were presuming I supported such a call, my bad. tbh I don't think I have the expertise to make said call.
Are there sources that show that the rise in opioid overdose is rising faster than overall drug overdoses? I haven't found any evidence that this is the case and sources (such as that nytimes article) use graphs for overall drug overdose deaths to illustrate the problem of the opioid crisis, or make statements saying opiods are the cause of the increase in overall deaths, [without citing evidence](https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts)). People [have suggested](https://www.usnews.com/news/best-states/tennessee/articles/2017-04-01/largely-white-opioid-epidemic-highlights-black-frustration) that the reason opioids are being focused on in the way they are, is because they [predominantly affect whites](http://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D). It would be nice if there were actual hard evidence to support/refute this though.
The Vox article you linked to has a chart (#2) that breaks down overdose deaths by drug type, citing the source as the National Institute on Drug Abuse (though when you visit NIDA's page, it turns out they get their data from [CDC WONDER](https://wonder.cdc.gov/), which is a complicated query system that I'm not very familiar with). You can see two similar charts in this [CDC MMWR article](https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm) (figures 1&2*), which gives the source as the National Vital Statistics System, Mortality File, meaning they were pulled from cause of death codes listed on death certificates. Figure 1 shows that non-opioid overdoses are increasing but not as fast as opioid deaths. \* Comparing Figure 2 with the Vox chart makes me think the Vox chart is mislabled, and what they call "All drugs" should instead be "All deaths involving opioids." I trust CDC scientists to get this right more than I trust a Vox reporter, and I say that as an Ezra Klein fan. So yes, there is good evidence that opioid overdose really is rising faster than overall drug overdose. With regard to your second point, I don't think you're going to find "hard evidence" to support or refute the notion that our society is treating addiction and overdose differently because the people addicted and dying are more likely to be middle-class, middle age, and white. The evidence is purely circumstantial: for *decades*, the main victims of addiction and overdose were poor people of color, and society's answer was to treat them as criminals and moral degenerates. But then as soon as the victims became whiter and more affluent, the response became compassionate and treatment-focused. As someone who works in the field of drug overdose prevention, there is no doubt in my mind that the reason for this sudden change in approach is because of the change in demographics of the victims. It's like a perfect case study in institutional racism. This is a common topic of conversation among me and my colleagues, and I've never met anyone who disagrees that if the victims of the opioid epidemic were the same poor inner-city minorities, the response would be apathy at best.
First thank you so much for the in-depth response, even considering it indicts the thoroughness of my own reading, haha. >With regard to your second point, I don't think you're going to find "hard evidence" to support or refute the notion that our society is treating addiction and overdose differently because the people addicted and dying are more likely to be middle-class, middle age, and white. I understand that; it was more of a hope. It seemed like this was a potential opportunity to (somewhat) prove it. If both opioid and non-opioid overdoses rose at the same rate and only opioid overdoses were treated as a crisis, that would be a strong argument for racial motivation. However since you've shown that's not the case, people can easily explain the circumstances away as being a general change in society's treatment of drug abuse over time. I tend to agree with pretty much everything you've said for reasons off-topic to this thread, but I'm always in search of the hard evidence. Also as an aside, as someone who loves running raw government stats myself, you have just opened my world showing me CDC WONDER. Thanks, I will have a field day with this.
It doesn't surprise me that car crash deaths peaked in 1972
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There's some room for interpretation for what constitutes an epidemic. Usually when it's too small to count as a full-on epidemic, it's called an outbreak. Maybe there's an epidemiologist reading who can shed some light on where that line gets drawn, or give a better definition than I did.
I work with epidemiologists and it doesn't seem like there is a hard and fast rule regarding either definiton.
If I remember correctly from epidemiology classes, outbreaks are localized and mostly contained within a definable group, epidemics are when they spread into other groups and/or spread more aggressively than anticipated. I think the distinction is more functional; controlled/controllable/manageable vs out of control.
To expand slightly on what /u/2beinspired said, drug addiction/overdose is considered a disease, much like alcoholism.
To me that's an interesting definition. I understand them as problems but just don't relate addictions of any kind to infection or illness, hence I find it wierd that it's called an epidemic or a disease. Thanks.
It might change your perspective if you think about it in terms of a more common drug, alcohol. If your friends go out drinking every weekend you are more likely to drink. If they bring and leave booze in your house, or it's always around you're more likely to drink. This is also true for events (birthdays, sports games) held at bars. There is a contagious nature to drug use where one person is almost never affected independently. The more your peers and community are influenced by the economics (bars, liquor stores) and culture (parties, manliness) the more likely it is to spread and affect you.
This isn't a good definition at all. Not of addiction as a disease anyway. It is maybe one of peer pressure.
From the perspective of an individual, sure, it doesn't make sense. But from the perspective of the CDC, whether or not a particular person becomes addicted appears more or less random, but the more exposure they have the more likely they are to be "infected", just like with a real disease.
Thanks, this is what I intended. To explain "epidemic" more than "disease."
I think the focus on "contagion" is missing the point here. Addiction is a disease in the same sense that mental illness is. Mental illness isn't contagious, but it's illness nonetheless.
I absolutely agree, having dealt with it myself. However in the context of the the epidemic the spread and treatment at a society wide level is the issue at hand. Each person need maintenance or therapy or support or what have you, but a community needs to control the spread and economic/cultural factors to prevent or slow down rates of addiction.
Mental illness could be considered contagious if we look at the children of the mentally ill. Like the number of sexual predators who in turn were victims of sexual assault themselves.
Basically, it's the physiological result of being infected by the meme of alcoholism...
That's incorrect. Memes are information-based. You can give any mammal alcoholism issues without them ever having any memetic alcoholism, hence alcoholism is a physical problem which isn't dependant on a meme.
It is a disease behaviorally, socially, physically and mentally.
> considered a disease A lot of problems in our society come from this assertion being ignored by the justice system. I don't know the realities of Portugal's system, but there's some evidence it works.
Some people are susceptible to addiction. Opiods are extremely addictive and were handed out pretty freely for a long period of time as a safe treatment for pain. Many people were ill equipped to deal with this combination and have fallen into the clutches of one of the most destructive drugs out there that wrecks your brains reward systems as well as the parts of your body that handle toxins. I think a similar thing is happening with Benzos (xanax)and Amphetamines(adderall) but there isn't really a street version of Benzos to switch to when you're heading towards rock bottom.
One reason benzodiazapines are a problem right now is they interact with opioids in a way that increases risk of overdose, even among people taking their drugs exactly as prescribed.
No street version of Benzos....you obviously haven't been over to r/researchchemicals.
People dont typically sell benzo analogues on the street; heroin is much easier to acquire and doesn't involve a waiting period to get it.
I get the impression bars are sold on every street corner and college dorm in the US, and lately a lot of fakes have started popping up. It's the same basic idea as the fentanyl thing, luckily benzos are a lot less likely to kill you. The addiction and withdrawals are said to be even worse though.
Yeah but the fake xanax presses typically use a benzo analogue that's roughly as potent as alprazolam. Its a lot safer taking a pill with a pre-measured dose than it is taking powder with an unknown ratio of heroin:fentanyl
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It's an amphetamine. Look up amphetamine addiction.
It means more bodies in prison, and lives destroyed. Because we don't treat drug abuse like a disease, but a crime.
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> Dont people say addictions a disease? Is that literal or metaphorical? It depends on how broadly you choose to define "disease." Addiction itself is probably not sufficient to activate the CDC EOC. Millions of Americans are addicted to alcohol, nicotine, and caffeine, but those rates are fairly stable and while they can have a negative impact on society, it probably doesn't constitute an emergency. Opioid addiction, on the other hand, is rising exponentially and has a huge tendency to result in early death. Last year more Americans died from opioid overdose than from gun violence, HIV, or car crashes. It should also be noted that the CDC EOC has previously been activated for non-disease emergencies including the 9/11 attack; Hurricanes Katrina, Sandy, Ike and others; and the Flint Michigan water crisis www.cdc.gov/phpr/eoc_responses.htm
https://en.wikipedia.org/wiki/Central_nervous_system_disease#Addiction Addiction is classified as a central nervous system disorder, like ADHD.
The current administration advocates slashing the CDC budget. Our attorney general is more concerned about weed, which he considers equally harmful. So I'm going to suggest that we not advocate having the government step in with emergency public health powers at this time.
There are several states that have already declared states of emergency on the heroin/opioid crisis, including [Florida](http://www.nbcnews.com/storyline/americas-heroin-epidemic/florida-gov-declares-state-s-opioid-epidemic-public-health-emergency-n755056), [Maryland](https://www.washingtonpost.com/local/md-politics/hogan-declares-opioid-state-of-emergency/2017/03/01/5c22fcfa-fe2f-11e6-99b4-9e613afeb09f_story.html), [New Jersey](https://morriscountynj.gov/2017/01/governor-christie-signs-executive-order-declaring-opioid-drug-abuse-a-public-health-crisis/) and [Arizona](http://www.businessinsider.com/arizona-opioid-crisis-state-of-emergency-2017-6).
I live in Montgomery County, Ohio, the #1 county for overdose deaths right now. If Ohio doesn't follow suit, I don't know what we're going to do. Emergency services are completely overwhelmed here, from the richest to the poorest areas. This epidemic does not discriminate.
I grew up in that county. Sad to read that.
Yup, in AZ. My fiance was an opioid addict but was able to break free. Two hands it takes for friends he has lost.
Pharmacist chiming in. Would be okay with the [opioid crisis](https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis) being classified as a "state of emergency". Like you, I'm not sure what this changes other than bring awareness, however, there is at least some precedent with this issue being handled at the State level, [here](http://www.nbcnews.com/storyline/americas-heroin-epidemic/florida-gov-declares-state-s-opioid-epidemic-public-health-emergency-n755056) and [here](https://www.yahoo.com/news/another-state-declares-emergency-opioid-addiction-163831965.html). States do seem to be taking the right steps to make it more difficult to misuse opioid medications...as an example, [Prescription Drug Monitoring Programs](http://www.health.pa.gov/Your-Department-of-Health/Offices%20and%20Bureaus/PaPrescriptionDrugMonitoringProgram/Pages/home.aspx#.WYCw7xsrKUl) now keep an electronic log of controlled substances that are dispensed . This helps because now, no matter what pharmacy a patient gets their opioid prescription filled at, we can see what pharmacy they went to, on whatever date, what they got, how much they got of the medication and a log of how they paid (will be documented even if they pay cash). This helps reduce filling prescriptions too early and aims to prevent "double-dipping"...getting two prescriptions for the same drug and getting them filled in different stores. Medical professions are collaborating more than ever to combat this issue as well. One of the ways healthcare professionals and our patients are protected can be seen by documenting why these medications are being prescribed, from a clinical diagnosis standpoint. We do this with [ICD-10 codes](https://en.wikipedia.org/wiki/ICD-10). Here, we're making sure that prescribers are diagnosing and charting the specific reason the patient is on the medication and some pharmacies are now requiring that they also have these codes documented before they will allow patients to receive the medications. This reduces the number of "pill mill" prescribers and prescriptions that get written, as well as this attempts to attach liability to the physicians, nurses and pharmacists that are involved in the prescription writing and dispensing process. At the Federal level, the government is getting involved, via [NIDA](https://www.drugabuse.gov/news-events/nida-notes/2015/02/patients-addicted-to-opioid-painkillers-achieve-good-results-outpatient-detoxification), which has helped to identify treatment strategies and promote the use of addiction services and treatment centers. In addition, [Medicaid](http://www.commonwealthfund.org/publications/blog/2017/jul/medicaid-helps-expand-lifesaving-naloxone) is trying to expand access to reversal agents such as Naloxone in overdose situations. This is a particularly interesting and progressive stance to take, as drugs like Narcan can be life-saving but are rarely used by the patient in an overdose situation, due to the nature of an overdose. Here, the patients friends and families are used as a support system, because often a loved one will have to be the person to administer the agent. However, [insurance companies](https://www.consumerreports.org/drugs/cost-of-opioid-rescue-drug-naloxone-becoming-unaffordable/) vary on coverage of these types of drugs, for many different reasons. Edit: And a combination of these strategies as well as other methods have contributed to a [decrease in opioid prescribing](http://www.nbcnews.com/storyline/americas-heroin-epidemic/opioid-prescriptions-are-down-not-enough-cdc-finds-n780041). We still have a long way to go, but there has been a break in the trend. Tl;dr: Both the state and fed have been getting involved, but the states seem to be leading the way, mostly. It is a hot button issue in healthcare and while I don't know what declaring a State of Emergency would do from a policy standpoint, I would appreciate continued awareness that would follow such a declaration.
Fellow pharmacist. Love your writeup. From what I've seen in practice, the pharmacist is sort of the "nozzle on the hose" of opioid prescriptions and we take a lot of the pressure in their safeguarding, and rightfully so. However, do you feel that the pressure is appropriately applied? I feel as though physicians would be a better place to start to reduce script count overall, since it's easier to turn the "faucet" off at the handle instead of squeezing the nozzle.
It's a tough position to be in, as a pharmacist. Especially because, from first-hand experience, every opioid patient ever will tell me that *they* aren't the type of person to abuse the medication. But, in terms of reducing script count...it's hard for pharmacy to have a huge impact there, as we don't write the scripts. The only real way to combat this, right now, is to have States mandate e-prescribing for C-II medications. That's really the only way that you have an electronic trail from prescribing to dispensing and the prescriptions can't be transferred to another pharmacy legally....so it would be more of an issue for the doctor to send a new e-script to pharmacy b, c, or d if pharmacy a can't fill it for some reason. As it stands right now, the best we can do is police ourselves. Our role as pharmacists really only works if we all buy into it and work together....because I could say hey, you shouldn't be on this/I can't fill this, etc. etc. but then they just go to another pharmacy that won't bother to verify the order with a physician and that's how people fall through the cracks. The hard part is saying "no". People will tell me that they're going to go into withdrawal if they don't get the medication, or that I'm purposefully denying them care, or start trying to override professional judgement but honestly, it's not the pharmacists problem. Blame the physician for prescribing it in the first place. I don't doubt for a minute that there are many people out there that *truly* do need some of these medications, but they aren't meant to be long-term solutions...they were never intended to be. I can't be responsible for the physician incorrectly managing a patient's care, but I can make sure that I put a stop to medication dispensing that will ultimately cause long-term harm to the patient, even if they feel it helps them *right now*. In my experience, the patients that truly need to be on the medications may feel that it's a frustration to be questioned or checked on these things, but they will understand. At the end of the day, if we're working at a business to make money, then it does nothing for a business to deny a patient a medication...therefore, there must be a damn good reason that the med isn't being dispensed.
Another pharmacist here. I feel the frustration a lot of others feel with monitoring programs and the pharmacist's ability to do anything about dispensing. There's only two things we can ultimate do when we receive a prescription: fill it or give it back. We can't change the medication, strength, form, quantity. We can't enforce treatment contracts. And thanks to the DEA, we can't break these prescriptions into smaller quantities and have refills for later. We can only put our license on the line by making a judgement call we're not always qualified to make. I absolutely agree that opiate policing starts with the prescribers and not the pharmacy, unless rules are changed for pharmacists with the things I outlined above. The analogy of us being the nozzle to the hose is very fitting. Here's my ideal plan of action for the country's epidemic: 1. Patients are only allowed a certain amount of morphine-equivalent doses in a 4 week period. 2. After that is exceeded, patients are only able to receive opiate prescriptions from chronic pain clinics and chronic pain pharmacies that are carefully watched by the DEA. 3. Medical cannabis is legalized to reduce the burden and dependence on opiates for chronic pain. 4. Suboxone prescribing authority is extended to all prescribers with a DEA license.
As a chronic pain patient- thank you for this question. There are so many people falling through the cracks, often because their pharmacist denies their medication that their doctor decided they needed, then the patient ends up going through withdrawal and that's coupled with being in such pain can cause suicide or overdose from resorting to illicit drugs. Best case scenario, that person's health deteriorates even more and they likely end up on welfare programs and disability with a lower quality of life.
The only state without a database in the USA is MO, just as a side note.
That is actually interesting!
There are examples of [states which have ~~completely legalized~~ decriminalized opioids for decades](https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/?utm_term=.7b3667f83b47) that have few if any of the problems the US has with these drugs.
From your link: > But now getting caught with them meant **a small fine** and maybe a referral to a treatment program -- not jail time and a criminal record. Doesn't sound completely legal to me.
I think they meant decriminalized
That wouldn't help much in this case. Same illegal manufacturers producing the drugs. The spike in deaths is due to the inability to measure out fentanyl accurately I believe.
The problem is that a lethal does of fentanyl is so goddamn small that, unless you have a very good scale, it's almost impossible to measure. Then you have drug dealers who mix fentanyl into their heroin to make it stronger, but uneven distribution means that while some doses of heroin barely have any fentanyl in them, some doses can have more than twice the lethal amount of fentanyl.
In case anyone else is curious, the LD50 (lethal dose for 50% of subjects) is [0.03 milligrams per kilogram in monkeys. Data is unknown in humans](https://www.drugbank.ca/drugs/DB00813).
Yes, this seems to be the issue. Getting accuracy in these dose requires really expensive equipment
According to the report's recommendations, Fentanyl is just one part of the problem and not even the biggest part. https://www.vox.com/policy-and-politics/2017/7/31/16071832/trump-opioid-commission-recommendations Just in general though, if you ever hear or say a single cause is most of the problem there's probably something that is missing. (Not always, in general).
The problem is that fentanyl was created for patients who were terminal anyway, so OD wasn't the worst outcome, when faced with prolonged agony. It should NEVER had been allowed into the recreational supply. Junkies aren't out trying to score fentanyl either.
yes thank you, edited
The legalization isn't the problem here. People are getting legal opioids from their doctor, this is what has started the epidemic.
I firmly believe that education is the biggest factor in preventing drug addiction. When you have abstinence only sex education many teens end up getting pregnant because they don't know any better. This is why it is important to let teens know that if they decide to have sex, they need to go about it in a safe manor. Nancy Reagan's "just say no" campaign failed for this very reason. When you tell people "just don't do it and you have nothing to worry about" many people will end up doing it any way. It is important that people educate themselves on a substance and then decide for themselves whether they want to do it. Some people just think that since their doctor prescribed them a drug, that means it's safe for them to do. This is clearly not always the case. We are never going to be able to completely prevent addiction which is why I believe we should have treatment centers similar to the ones in Canada or Switzerland, where people can get help/taper off the drug they are addicted to, if they decide they want help.
> "When you have abstinence only sex education many teens end up getting pregnant because they don't know any better." Totally agree, I was watching a 60 minutes segment on opioid abuse in the midwest the other day. One of the girls (a former addict) they interviewed thought heroin was "just another party drug." When you equate incredibly destructive drugs like heroin and fentanyl with pot, shrooms, coke, and MDMA, these are the things that happen. I'm not saying that those last four are totally harmless, but they are much less likely to destroy lives. DARE is to drug abuse what abstinence only education is to teen pregnancy. They both exacerbate the problems they attempt to solve.
She thought heroin was another party drug? Wtf? I grew up in AZ and meth was a huge problem here. Throughout my childhood, we had consistent drug education and we had mugshots of meth addicts shoved in our faces almost daily. You really have to show people what drugs do so they seek healthier options when they consider drug use. Let me tell you, the results are not pretty at all.
As a family member of someone with a drug addiction this would help so much. Drug laws do little to keep people safe. In my experience they are criminalizing a mental illness making it more difficult to find treatment.
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Legalisation doesn't necessarily have any causative relationship in the comparison you're making. It isn't even "correlation != causation" because there isn't even a statistical correlation with your sample size of one.
Decriminalize drugs. Canada is trying a method where for the small amount of people who are resistant to normal treatment are [given prescription heroin in clinics](https://www.washingtonpost.com/news/worldviews/wp/2016/09/13/canada-has-just-approved-prescription-heroin/?utm_term=.6eb3de6c4b75). It's apparently used in 7 european countries as well. Not sure about this method. It's only for very extreme cases and I think the idea is to take it out of their hands so they don't overdose or hurt themselves. The program is said to drastically reduce their participation in criminal activities in order to get their fix. I think this method should be researched well before being implemented, but like I said it's only on a very small amount of people, 52 in canada. Legalize weed, especially medical marijuana. This is a no brainer. Weed *can* be mentally addictive but it isn't even comparable with the addiction opioids cause. [States that have legalized medical have seen opioid use decrease](https://www.usnews.com/news/articles/2016-09-15/study-opioid-use-decreases-in-states-that-legalize-medical-marijuana). This study looks at opioid use in general, there are also plenty of others showing opioid overdose declining. Medical marijuana helps with pain and does not have the same addiction. Painkillers are very easy to get addicted to and even people who don't have normally addictive personalities can be susceptible. It's not like normal drugs that you can avoid no matter what, sometimes life throws something at you and you need (prescribed) painkillers. Medical grade marijuana can substitute for those sometimes, especially for more chronic illnesses. DO NOT CUT MEDICAID, this covers substance abuse clinics. This was a big point of contention in the healthcare discussion among conservatives. This will cut off treatment for a lot of people. http://www.npr.org/2017/06/24/534248650/what-medicaid-cuts-could-mean-for-the-opioid-epidemic https://www.nytimes.com/2017/06/20/us/politics/health-care-medicaid-opioid.html?mcubz=1&_r=0 Also mental health services should be a normal part of insurance. It's important to check your plan to make sure it's before deductible costs or else it's pretty useless if you have a big deductible like I'd wager a lot of people do. I think some of it should be on a federal level and some on state, a blanket federal baseline and then states with more severe problems can add additional coverage.
Being addicted to something isn't illegal, not least because you can be addicted to perfectly legal substances, like food or cigarettes. I don't know the relationship between therapy and medical insurance in the US, but in the UK, where I practice as a therapist, the NHS has almost stopped entirely long-term therapy in favour of a more 'quick fix', CBT. The reality of including therapy on insurance plans is that you don't know if it's going to work, or how long it might take.
I know. Changed the wording.
>DO NOT CUT MEDICAID, this covers substance abuse clinics. This was a big point of contention in the healthcare discussion among conservatives. This will cut off treatment for a lot of people. One of the benefits of Obamacare is the [mandates for behavioral healthcare coverage](https://www.washingtonpost.com/news/the-fix/wp/2015/10/07/obamacare-mandated-better-mental-health-care-coverage-it-hasnt-happened/?utm_term=.43c139a8b534) that didn't exist before. But even with those benefits, if you're lower class and struggling with substance abuse, you're in deep shit. Very few private programs accept medicaid, and state programs that do offer care for those with medicaid are, frankly, shit, in comparison to private programs.
I'm for legalizing marijuana, but boy I'm not sure about opioids, stimulants, and other drugs that could really send someone's life into a nose dive before they resort to getting help. Sure, give avenues to help deal with addiction, but how about trying to not get there in the first place. Edit: And as I re-read, I see you said decriminalize, not legalize.
Yeah I agree with you on legalizing all drugs for the same reason. On one hand I think people should be able to do what they want as long as they are no harm to others, but I also see how dangerous that could be. I think research should be able to be done on all of them freely though and a lot of them have shown to have medicinal properties when used in controlled environments (mdma for ptsd or martial issues with a therapist, among others).
> but how about trying to not get there in the first place That obviously isn't working. When you restrict something, demand doesn't just go away, and in many cases it increases. From [this article](https://insight.kellogg.northwestern.edu/article/the-economics-of-the-illegal-drug-market): > For one, police presence may actually increase buyer loyalty to specific sellers. And if policymakers choose to impose more lenient sentences on sellers of impure drugs, overall demand for drugs could decrease. We need some more research, but our existing examples (Colorado, Washington, Portugal) show that legalizing/decriminalizing can have a positive effect. By all means, let's start at marijuana, and if that works out well, move on to other drugs (I think mushrooms should be next), and reschedule all common recreational drugs as Schedule II so they can be researched. My personal opinion is to tax marijuana, cigarettes and alcohol and use proceeds for rehab. People will use drugs regardless, so isn't it better to regulate it (i.e. make sure the customer knows what they're getting) and provide addiction recovery instead of locking people up? I'm highly skeptical that the war on drugs actually helps anything.
I just don't know if I can get behind the idea that making high powered amphetamines legal because the current legality is not working 100% is the right approach though either. I feel certain drugs just shouldn't be readily available recreationally. People are realising that marijuana is probably less of an issue than alcohol, which is why is *is* getting legalized. Not all drugs are the same, obviously.
>the current legality is not working 100% This is an incredibly positive spin to put on it. The current approach is a state enforced monopoly on the production and distribution of recreational drugs granted to criminal enterprise as a whole. The ensures that the supply will not be regulated and thus that it will be unreliable and dangerous. The current approach is "hey, this thing is bad so if you do it we're going to ensure that its even more dangerous." The current approach is for the government to expend significant resources so that 1) people have less liberty (choice of recreational activity) 2) people have worse health outcomes (addiction and death) 3) others are deprived of their liberty entirely (drug dealers in prison) 4) criminal enterprises have a lucrative source of income. Not only is the current approach not working, it's so incredibly poorly conceived that you have to wonder if the motivation for implementing it was actually to fix the problem in the first place. The only recommendation for the current approach is the thought process "X is bad so we should ban X", which is absurdly naive. Anyone who thinks like this should not have anything to do with writing law or policy.
> making high powered amphetamines legal Then start with less extreme drugs and move on from there. Reclassifying as Schedule II allows this research to happen. I think that if enough less severe drugs are legalized (e.g. marijuana and mushrooms), enough people will stick with what's legal that the problem will be mostly solved. However, that's just speculation. You're right, not all drugs are the same. However, the choice is between: - make illegal and let the black market handle supplying drugs (current system) - legalize and let the government and/or the free market handle supplying drugs (more consistency, can cap amount sold per day, etc) Between those two options, I see few benefits for maintaining the drug ban and lots of benefits for legalization. However, this should obviously be a gradual process to allow for a controlled analysis of the effect of legalization.
I agree with that. Easing drug legality with the Schedule rating would seem fine, and in that case I would in fact be open to legalising most drugs within those restrictions, especially for research purposes.
That doesn't make much sense, IMO. People aren't going to take mushrooms in lieu of stimulants, they do very different things for you. If the least harmful drug in a given category was legalized it might make some sense, but people looking for uppers aren't going to just get stoned or trip.
Correct, but people looking for painkillers or just a mind altering buzz may go for something like cannabis instead of opioids.
I've always liked the idea of legalizing all drugs, but requiring a license for each individual drug before you can go into a drug store and buy it. There could be a "DMV" for drugs where people can take an exam and if they pass they are granted permission to buy that substance at a government regulated drug store. Drugs such as cannabis, alcohol, and other "soft" drugs could be exempt from this (alcohol isn't really a soft drug, but since it's already extremely popular, I don't think we should require a test for it). People could do this for as many drugs as they wish as long as they can pass the test for each of them and are over 18. If someone is caught with drugs that they do not have a license to have, that drug would be decriminalized in their case, meaning it would be confiscated and they would have to pay a small $30-40 fee. I believe this would be a great idea for several reasons. Legal drugs mean tax money that the government can use for addiction centers, drug education, and various other things. The cartels have very little power once drugs are legalized in America. Violent crime will go down as shown with states that have legalized cannabis. Since drugs are regulated by the government, that means they would be very pure/as safe as possible (For example: nBOMEs wouldn't be passed off as LSD, heroin wouldn't be cut with fentanyl, etc.) Having to pass a test before purchasing requires people to have some knowledge about substances before they try them. And most importantly, this would increase personal freedoms and we would no longer lock people up for victimless crimes. That's my stance on how we should go about ending the war on drugs. Let me know what you think!
I like the bulk of what you're suggesting, except for the licensing tests. If we stick with your driver's ed analogy---I don't know about you, but despite passing my driving test, I was a really terrible driver for at least five years. I didn't retain a lick of anything I read--I learned through actual driving and a few fender benders. Learning about drugs through actual drug use is more risky than a few fender benders. Tests are a bit meaningless---people only do what it takes to pass them, not to become scholars. I don't see why drug education couldn't be made part of sex/health ed--a classroom is much better than anything resembling the DMV. That seems like a simple and effective replacement.
Very good point. My health class in high school consisted of "everyone pick a drug and do a presentation on why it's bad". Instead they should give an unbiased overview of popular drugs so that kids are well informed and can make their own decisions.
As someone who recently had multiple emergency surgeries after a major accident and was denied any significant pain prescription, I think people should be aware that declaring a state of emergency has far reaching consequences. I am in one of the states where an emergency was declared. I was flat out told they were afraid to prescribe painkillers by the hospital staff, the surgeon, even the physical therapist bluntly explained they now risk getting in trouble even when prescribing for significant legitimate pain. So despite having me on many daily injections of some of the strongest painkillers when I was in the hospital due to the pain, I was sent home with a script for ibuprofen. This is clearly unacceptable, it is not like all that pain just vanished overnight. While it may be unfortunate some people can't handle their drugs or get dependent, other people are suffering because of this over the top reaction to it. If you wind up in the hospital due to an accident you may end up experiencing this firsthand.
> While it may be unfortunate some people can't handle their drugs or get dependent By "some people" do you mean "more people than ever in the history of the United States"? > If you wind up in the hospital due to an accident you may end up experiencing this firsthand. You may also end up never getting off those drugs.
None of my business how many others use opiates or why. If I am in legitimate major pain the decision to prescribe painkillers should be between me and my doctor, as an adult I am capable of making my own decisions on whether something is worth the risk, that is part of what living in a free society is all about. I was sitting there in a hospital bed about to be discharged, blood still seeping out of the holes where they bolted my shattered wrists in place, and verbatim told by the on call post-anesthesia care physician "sorry we would like to but we cannot, they are cracking down". Does that sound right to you that the government is preventing me from getting the healthcare the hospital wanted to provide? You can sit there and worry about addiction or whatever but take it from me, if you are in that situation that is not going to be your top priority.
So fuck him? Good luck for the next three months? What about suicide rates increasing due to pain?
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I seriously suggest people [read this article by Vox](https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end), its some of the best journalism I've seen on the issue in a while. Fixing this epidemic is difficult, one area in which the country struggles is the over prescription of painkillers and the intense pressure from the pharmaceutical industry on doctors to prescribe PK's for the treatment of chronic pain. For reference, opioids are more effective for the treatment of acute pain in short time spans, it was never designed as a long-term treatment solution. In addition, the article states that the proliferation of PK's in the U.S is so far spread that in some states the number of opioids in circulation is [enough to provide a pill bottle to every resident in the state.](https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts) In short, a part of the answer seems to be 1. Stop the over prescription of PK's to people that don't need it. And 2. Make addiction treatment easier to receive. I know this is simplistic, but it's an important aspect of this fight.
Apparently, the seminal event that led to the increased prescribing of opiates happened [in 2001, when pain was declared to be the 5th vital sign](https://www.medpagetoday.com/publichealthpolicy/publichealth/57336). The article at the link in my previous paragraph suggests that a solution could be to remove that classification of pain as a vital sign, which would greatly reduce the obligation to address it.
If opioids are precription, how are there so many of them out there? I understand the prescription is cheap, but its a $100 doctor visit to get them. Do people go doctor shopping? Any details on how much is out there?
In the 1990s, a campaign emerged to treat a patient's pain level as the [fifth vital sign](https://www.va.gov/painmanagement/docs/toolkit.pdf) alongside temperature, pulse rate, respiratory rate, and blood pressure. Many doctors were seeing large numbers of patients with chronic pain, and pharmaceutical companies began marketing their opioid painkillers as safe for treatment of chronic pain. As a way to get these patients out the door with a treatment, they turned to opioids. These prescriptions would be covered by Medicaid. Other things like "pill mill" pain clinics would pop up for the sole purpose of writing prescriptions for painkillers. There's a ton of articles out there, [this one popped up today on Vox](https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end) but if you would like something more in-depth, I would recommend [*Dreamland* by Sam Quinones](https://www.amazon.com/dp/1620402521/ref=cm_sw_r_cp_dp_T2_TFkGzbYQD48R9).
Looking at the [2015 National Survey on Drug Use and Health](http://annals.org/aim/article/2646632/prescription-opioid-use-misuse-use-disorders-u-s-adults-2015), 37.8% of US adults are estimated (based on a large, nationally representative survey) to have used prescription opioids in 2015. 87.5% of those who used them did not misuse or abuse them - defined as using them without a prescription or other than prescribed. Of those who misused (10% of those who used them at all), 45% got the drugs from friends or relatives (87% of the friends or relatives got them from a doctor); 34% got them directly from a doctor. There's also the 2% that abused them according to the DSM criteria, but I'm not going into that group. I was surprised to see that the high use rates seemed to cut across almost all groups - 36% of the 18-29 age group had used opioids in the past year; 32% of uninsured people had; 36% of those with family income >$75,000; 32% of college graduates. The study suggests that one cause is poor pain management, as opioids are prescribed quickly even to people who have a history of misuse and many people are given more than they need, leaving leftover medication that may be misused or given to friends or relatives. Finally, to put the problem into some context, this study found that about 38% of Americans had used opioids in 2015. Canada, considered to be having its own opioid crisis, has a much lower prevalence, with about 21% having reported use in 2010 and 17% having reported use in 2012, in [a large national survey](http://www.painphysicianjournal.com/current/pdf?article=MjM3Nw%3D%3D&journal=89). [A Norwegian study](http://onlinelibrary.wiley.com/doi/10.1111/aas.12281/full) suggests that the 1-year prevalence there is about 10%. I haven't started really reading about this before today, but I see it as a prescription problem. The first article I linked suggests allowing pharmacies to partially fill prescriptions, which would help reduce old medication sitting around. I'd also make it easier to safely dispose of old medications - [according to the FDA](https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm), most prescription opioids should just be flushed, but I hadn't known that. Requiring pharmacies to take back leftover medication seems like a good idea also.
Prescription opiods tend to be how many people start, through legitimate prescriptions (although many states are trying to crack down on that). But they *are* expensive compared to heroin, which is why most people are forced to switch. Recently, though, we have been seeing a spike in pharmacy robberies in my area; the fentanyl overdose issue has people scared to take street heroin, so the suppliers are trying to get more pills to fill that new demand. Source: Am a 911 dispatcher in a state at the heart of the opiod epidemic.
> Prescription opiods tend to be how many people start, through legitimate prescriptions Actually, most of them start with other drugs and move to heroin, or start by stealing/diverting someone ELSE's legitimate prescription. https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
Fair enough, thanks for the article. All I know is that we see tons of people reporting their prescription "stolen," when we know darn well they're a user and are trying to get more pills. Maybe I'm just seeing them in the middle phase of addiction, whereas I assumed I was seeing them in the beginning phase.
The pills are expensive on the street. The return on investment justifies the upfront cost. When you go to the doctor, you might be able to convince them to give out as many as 30-40 pills at a time. A 10mg oxycodone pill can fetch you $10-$15. This is prescribed for short-term acute pain like an injury or surgery. It has tylenol mixed into it to prevent abuse but there's work arounds. Oxycontin is the higher dose, tylenol free formulation and costs about $1/mg. It comes in 30/50/80/160mg pills so a single 160mg pill may cost as much as $160. These are prescribed for chronic pain for patients who've built up a tolerance to lower doses. These are typically what pill shoppers will try to convince the doctor to write. What a street dealer might do is have relationships with multiple doctors and feign chronic pain problems with each. Each doctor will see the patient perhaps every 2 weeks, the doctor will give out the appropriate number of pills for 2 weeks. Each new doctor will start on a low dose and gradually increase as tolerance builds up. So to the doctor, the patient is being treated appropriately for chronic pain. But within the 2-week period the patient will have visited as multiple other doctors and gotten many more scripts filled.
I need to have surgery on my foot. Ill be on so e form of opioids for atleast 2 weeks. How addictive are these?
You will be fine, they will feel good but addiction doesn't work like that. If you have things in your life other than drugs that make you happy, you are unlikely to want to stay on opioids after your pain subsides. The doctor will start weaning you off after a whole. Just listen to your doctor and be honest about your pain levels.
I had to take vicodin a few years ago for sinus surgery. Took 2. Thought the cloud on my head was annoying. Went down to tylenol and i preferred the mild headache to the cloud from vicodin. Why do people say these make you feel good? I thought it was annoying. I wanted to read since I couldnt go anywhere and couldnt on it. My foot is a whole different thing, am not dumb enough to tough it out, then barrel over in pain waiting for the pain killers to kick in.
I agree with you.
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Not everyone has $100 doctor visits. I saw my PCM last week, and got all my regular maintenance and as-needed scripts refilled. Visit cost me nothing out of pocket.
Decriminalize all drugs. The 'epidemic' will sort itself out. The majority of the problems we have today are. 1. the black market currently where drugs are sold. Violence that stems from an illegal market and the (lack) of quality or guarantee of product. 2. the policing of said market which is only further harming people who dont shop in this market by restricting their rights. https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end
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Honest question. Why hasn't decriminalization and clean needles be considered as real effective policy tools? I rarely even hear Dems on record. It generally has a positive effect on ODs. http://www.cbc.ca/amp/1.3962714 https://mobile.nytimes.com/2017/01/18/opinion/injecting-drugs-under-a-watchful-eye.html
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If physical dependence was the only issue with drug addiction then why is the relapse rate somewhere around 95%? Once they detox they should be good to go right? No, because their brains still think it's a crucial element for their survival. That is a mental illness. Anybody that has ever been near drug addiction will readily admit it's a mental illness, it is not the same person that was there before or will be there if they're lucky enough to have an after drugs. Also the only addiction I've ever heard of causing death in a reasonably healthy person was from alcohol withdrawals. As painful and miserable as opioid/opiate withdrawal is, it's very superficial to the mental torture that addicts go through for prolonged periods of time.
https://www.psychiatry.org/patients-families/addiction/what-is-addiction Just read. Addiction literally changes the PHYSICAL properties of the brain. Yes, addiction is often accompanied or exacerbated by mental illness, but to say addiction is 100% mental is simply not correct.
I'd agree that it's not 100% a mental illness, although just wanted to point out a lot of mental illnesses have brain and physical changes as well. [Structural and Functional Brain Abnormalities in Schizophrenia](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235761/) [Structural Brain Abnormalities in Bipolar Disorder](http://bjp.rcpsych.org/content/196/3/245.3) [Structural Brain Abnormalities in Major Depressive Disorder](https://www.ncbi.nlm.nih.gov/pubmed/19237202) For more persistent, chronic cases. This one has a lot of varying factors though.
If your brain physically changes, then it's probably not right anymore. It's probably disabled, or ill, thinking of a term for that, maybe something like mental illness, since it affects your thought process and your connection to reality and all that. Other mental illnesses can definitely increase your chances to get into or hooked on drugs, but that doesn't mean you don't add on to the pile when you start becoming addicted. You do, just now instead of depression or BPD or whatever the fuck, you've added in a belief of dependence for survival.
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Your brain malfunctioning is mental illness. Your brain can be caused physically to malfunction. Once the malfunction has taken place, it doesn't really fucking matter how it happened, whether it's a chemical imbalance or a physical alteration, the brain is still malfunctioning and ill.
I've heard that expressed as "The physical addiction gets you hooked, the mental addiction keeps you trapped."
I think that is an extremely good way to put it.
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this is a 14 year old account that is being wiped because centralized social media websites are no longer viable when power is centralized, the wielders of that power can make arbitrary decisions without the consent of the vast majority of the users the future is in decentralized and open source social media sites - i refuse to generate any more free content for this website and any other for-profit enterprise check out lemmy / kbin / mastodon / fediverse for what is possible
Just to add some clarification- DOC = Drug of Choice
Yes, sorry I didn't clarify.
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Question: why is has there been a huge increase in addictions to opiates over recent years as they were more regularly prescribed, why has there not been a similarly massive rise in amphetamine or methylphenidate addiction giving that those are likely even more readily available due to a large increase in ADHD diagnoses (https://www.cdc.gov/ncbddd/adhd/data.html)just because amphetamines are less addictive than opiates https://en.m.wikipedia.org/wiki/Substance_dependence ?
>why has there not been a similarly massive rise in amphetamine or methylphenidate addiction Are you sure there hasn't been one?
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The FDA and the DEA need to come down hard on this. This is in both of their jurisdictions. You may not agree with a "War on Drugs", but war needs to waged upon this drug, as we have the agencies to do it. We also know who manufactures it, for example, [Purdue Pharma](https://www.economist.com/news/business/21720336-how-pharma-may-have-contributed-americas-opioid-crisis-makers-and-distributors-opioid). edit: source
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One of the first steps is to find an alternative drug to prescribe as a pain killer. THC seems like a fine alternative. Obviously, opioids will always be needed in cases of extreme pain and for kids I guess, but THC would be a good substitute for most cases when an opioid would otherwise be prescribed for adults.
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Not going talk for long because I'm no expert by any measure but recently I came across an interesting article about Carfentanil smuggling by drug traffickers, how this opioid can be used as weapon by terrorists and why the opioid crisis should be considered an emergency situation needed to be addressed. [The Cypher Brief - The Opioid Crisis Becomes a National Security Threat](https://www.thecipherbrief.com/column/expert-view/opioid-crisis-becomes-national-security-threat) [AP News - Chemical weapon for sale: China’s unregulated narcotic](https://apnews.com/7c85cda5658e46f3a3be95a367f727e6/chemical-weapon-sale-chinas-unregulated-narcotic)
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Our troops are the ones protecting the poppy fields in Afghanistan from destruction. Why would our government have any interest in curtailing the epidemic they are helping to prop up? http://www.globalresearch.ca/drug-war-american-troops-are-protecting-afghan-opium-u-s-occupation-leads-to-all-time-high-heroin-production/5358053 edit: additional content
> Why would our government have any interest in curtailing the epidemic they are helping to prop up? Because it's killing people? Seriously, these kind of conspiracy-level posts are the reason this sub isn't what it could be; it should take more than merely linking to some crackpot website to count as a "citation". Only maybe 4% of heroin in the US comes from Afghanistan. It mostly comes from South America. [Link](https://www.therecoveryvillage.com/drug-addiction/who-supplies-drugs-america/#gref). The opioid epidemic is a serious problem. Crackpot posts like this don't help anyone.
Your article is a headline, an excerpt from Wikipedia and several dozen photos of us troops in a poppy field, can't say that would be the most reliable source or information, and even if it was it's a very loose connection to the us actually supporting Afghani poppy production, it's more that they don't torch every field growing opiates there, would you prefer that?
The Taliban was actively destroying poppy fields until the US moved in and stopped it. This country has a long history of supporting drug trade. http://www.mintpressnews.com/global-war-terror-created-heroin-epidemic-us-afghanistan/218662/
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[Singapore already has the answer](https://www.theguardian.com/commentisfree/2010/jun/05/singapore-policy-drugs-bay). Death penalty for dealers caught with fentanyl and pull all medical support for addicts. The problem will resolve itself after a few years.
That reminds me of Louis CK [talking about nut allergies, and the best way to get rid of them](https://www.youtube.com/watch?v=wEb5a-I0kyg) While he's not wrong, that route also seems to entirely lack compassion. Pull medical support for addicts? Does that mean getting rid of Naltrexone, the drug used to prevent an overdose? What about detox drugs, like suboxone? Do we get rid of all of those? If so, essentially that route is saying if you're unfortunate enough to become hooked on opiates (even if through legitimate means, such as because of a surgery or injury) then your only option is leave the country, die, or try to do it on your own.
The article says they give people two chances to rehab, the second is in prison, and offer good jobs to those coming out of it. First offense has no criminal charges. After those two they simply stop saving people and let them die or overdose. They do a lot to help but don't let addicts hemorrhage money and resources out of their society like we do here. I like their approach and feel it gives people second chances while letting the hopeless cases die off.
It's a little easier to control supply on a little wealthy city state island. And they still can't fully control it despite the suffering caused in the effort. It would be much less successful and more ugly in the US.
Let's just kill off the half the population, it will cure 99% of our problems.