Children of the Opioid Epidemic Are Flooding Foster Homes(motherjones.com)
motherjones.com
Children of the Opioid Epidemic Are Flooding Foster Homes
http://www.motherjones.com/politics/2017/07/children-ohio-opioid-epidemic/
94 comments
Have you ever considered that perhaps there are just a lot of people with various levels of chronic pain, and, shockingly, some of them may want to manage their pain and see a doctor and end up with medication?
> "an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain."
https://nccih.nih.gov/news/press/08112015
> "an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain."
https://nccih.nih.gov/news/press/08112015
Yes but opoids has many risks and should only be prescribed to a minority. This is not what is happening.
I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They were complaining that doctors often felt that they couldn't prescribe even when there was legitimate need.
I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now.
As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.
I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now.
As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.
> I don't know what happened in the interim
The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated.
They also said that opioids are not addictive if prescribed for pain.
It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids.
The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mc...
We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/
The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated.
They also said that opioids are not addictive if prescribed for pain.
It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids.
The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mc...
We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/
Actually I agree with asking about pain. If someone's REALLY in pain they'll tell you, but if it's "minor suffering" some are predisposed to tough it out.
I can't remember having ever been in 'real pain', maybe for that the addictive drugs should be considered under a monitored regime.
For lesser pain something lighter should be used.
I can't remember having ever been in 'real pain', maybe for that the addictive drugs should be considered under a monitored regime.
For lesser pain something lighter should be used.
> but if only we had draconian DEA policies aggressively stopping overprescription now.
Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc"
Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him).
What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").
Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc"
Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him).
What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").
Those practices (handing out oxy) are a major contributor to the current epidemic, if not the root cause.
I've gotten opiate prescriptions I had no business having without asking. I get that some people need pain medication or will suffer, but there's a whole lot of suffering that opiate addiction causes and that is not really factored into the 'do no harm' calculation doctors are supposed to be doing.
It really is a great thing to see legitimate restrictions on these prescriptions, as that should cut down on new addicts at the very least.
I've gotten opiate prescriptions I had no business having without asking. I get that some people need pain medication or will suffer, but there's a whole lot of suffering that opiate addiction causes and that is not really factored into the 'do no harm' calculation doctors are supposed to be doing.
It really is a great thing to see legitimate restrictions on these prescriptions, as that should cut down on new addicts at the very least.
I'm hearing on the one side that these legal prescriptions are causing the problems but on the other had others say that these drugs being illegal is causing the problem and if we made them legal that people will use them in a safe manner. If people get addicted them when prescribed legally then how can making them legal have any hope?
Making them legal at least keeps the problem out in the open, where it can be regulated. Notice that the response to the opioid epidemic, as described in this thread, is that clinics have stopped giving out oxycontin. When we had a crack epidemic in the 80s or a heroin epidemic in the 60s and 70s, the response was to send troops into the regions that produced those drugs. This was both expensive and ineffective, and in many ways just made the problem worse: with the whole distribution chain being completely illegal, street prices went up, more money was made by a few outlaw kingpins, and that gave them more resources to buy arms and escalate violence.
These are highly addictive substances. If doctors can't stop the abuse now on prescribed medicines who in the regulatory agencies can do better?
I guess part of this is doctors overprescribing to prevent patient complaints, based on how much patient satisfaction surveys are used to rate their year over year performance.
I don't know if its the AMA to blame for that or not, but everyone in the system seems to think its an upstream problem.
I don't know if its the AMA to blame for that or not, but everyone in the system seems to think its an upstream problem.
If you go into a walk-in (or even GP office) asking for pain meds, that sets off all kinds of alarms.
If you go in with an obvious injury and they offer the painkillers without you asking, they probably feel a lot more confident that you are not drug-seeking.
If you go in with an obvious injury and they offer the painkillers without you asking, they probably feel a lot more confident that you are not drug-seeking.
And so the people that got addicted to those opiates 6 years ago that are now unable to get new ones turn to heroin.
> but around me, I can not go get any prescription for any back pain
Can I check: have you sought treatment for back pain, and not got it?
Have they offered physiotherapy or exercise?
(these might be relevant to your type of pain).
Can I check: have you sought treatment for back pain, and not got it?
Have they offered physiotherapy or exercise?
(these might be relevant to your type of pain).
clarification - my back pain episodes were 2x in ... about 3 years. in both cases this was a sudden onset - like, standing up from a seated position, some sort of switch was flipped, and I had immediate massive pain.
In both cases, talking to a local "urgent care" clinic, "go to your GP for a referral for physical therapy" was the standard line. "we don't treat back pain".
I get it, in some sense, like... yeah, I may be an addict, etc. But in both cases, I'd been to the clinic multiple times before for other things. I had a history with them. Actually, the last time I'd been there I said I had no primary care physician, and wanted to use them as primary (3 miles from house vs 11 miles to previous dr).
In both cases, the back pain episode lasted more than a week, was debilitating to the point of not being able to walk without massive pain or sleep normally for several days. And then, it wore off, and ... 'back to normal'. Historically, I'm learning, we have some back issues in the family, but I can't get much info from anyone on specifics yet.
In both cases, talking to a local "urgent care" clinic, "go to your GP for a referral for physical therapy" was the standard line. "we don't treat back pain".
I get it, in some sense, like... yeah, I may be an addict, etc. But in both cases, I'd been to the clinic multiple times before for other things. I had a history with them. Actually, the last time I'd been there I said I had no primary care physician, and wanted to use them as primary (3 miles from house vs 11 miles to previous dr).
In both cases, the back pain episode lasted more than a week, was debilitating to the point of not being able to walk without massive pain or sleep normally for several days. And then, it wore off, and ... 'back to normal'. Historically, I'm learning, we have some back issues in the family, but I can't get much info from anyone on specifics yet.
> why that's a horrible idea
Making drugs that people want illegal has never worked. Why should it work now?
Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.
Making drugs that people want illegal has never worked. Why should it work now?
Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.
Prohibition worked pretty well from a public health perspective. https://en.wikipedia.org/wiki/Prohibition_in_the_United_Stat... It was the organized crime that was the problem.
Crime is the reaction to prohibition. Its not a separate phenomenon.
Many died being poisoned by ineptly made bootleg liquor.
Organised crime is bad for public health
On balance it's still a win. Alcoholism kills a lot of people.
Depends on what you're measuring. If it's pure death rates sure but throw in quality of life and it's not as clear cut.
I personally wouldn't want to live in a world where I can't enjoy a glass of whiskey.
I personally wouldn't want to live in a world where I can't enjoy a glass of whiskey.
That's not going to offset fetal alcohol syndrome or people raised by drunk parents or recovered alcoholics living with health issues for the rest of their lives.
You can make the same arguments about salty foods (hypertension), fatty foods (heart disease), sugary foods (diabetes), premarital sex (STDs), and just about anything else that people consume or partake in.
If you believe in personal responsibility then you're okay with taking some bad with the good.
If you believe in personal responsibility then you're okay with taking some bad with the good.
What does personal responsibility have to do with fetal alcohol syndrome or kids raised badly? And how can you believe in personal responsibly when public health can change so drastically in response to policy changes?
> What does personal responsibility have to do with fetal alcohol syndrome or kids raised badly?
Both are the result of negligence of their parents. It may not be pleasant to lump that together under personal responsibility but that's the root of the problem and addressing it is the real solution.
A mother that drinks alcohol while pregnant is at fault for the harm that comes to her child. It's not society's fault, it's hers and indirectly her spouse's fault for allowing that to happen.
> And how can you believe in personal responsibly when public health can change so drastically in response to policy changes?
The fundamental disagreement is that I believe people are capable of good on their own and should not be baby sat by a nanny state. I'm willing to accept some of the adverse consequences of people making their own choices in exchange for the freedom and quality of life it brings.
Both are the result of negligence of their parents. It may not be pleasant to lump that together under personal responsibility but that's the root of the problem and addressing it is the real solution.
A mother that drinks alcohol while pregnant is at fault for the harm that comes to her child. It's not society's fault, it's hers and indirectly her spouse's fault for allowing that to happen.
> And how can you believe in personal responsibly when public health can change so drastically in response to policy changes?
The fundamental disagreement is that I believe people are capable of good on their own and should not be baby sat by a nanny state. I'm willing to accept some of the adverse consequences of people making their own choices in exchange for the freedom and quality of life it brings.
But what good is responsibility? The point is this shouldn't happen in the first place. There's no way someone can make up for something bad they did in the past. Assigning blame after the fact seems hollow to me.
It's a tradeoff. "If men were angels no government would be necessary." Personal responsibility might be an ideal but it can't be an absolute. Trading lives for a "glass of whiskey" is morally bankrupt.
It's a tradeoff. "If men were angels no government would be necessary." Personal responsibility might be an ideal but it can't be an absolute. Trading lives for a "glass of whiskey" is morally bankrupt.
Worked fine with Methaqualone.
> As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.
You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that?
Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive.
Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.
You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that?
Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive.
Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.
Don't both alcohol and nicotine have far more dependent users than opioids?
What is the comparison meant to illustrate? That easy availability will increase use and that the effects of the drug are the more important matter?
What is the comparison meant to illustrate? That easy availability will increase use and that the effects of the drug are the more important matter?
> Fentanyl isn't created in the back of a motor home.
But it probably could be, if there's a market for it. There are trained chemists making meth [0]. The sale of the precursors of fentanyl is controlled, but so are the precursors to meth. If fentanyl (or an analog) stays popular we'll have people making their own.
Edit: I'm not saying it would be as obtaining PSE, but if you're a member of a chem lab, the only thing between you and an order to Sigma is ~two signatures? There's too much money involved for it to not happen.
[0] http://news.sky.com/story/inside-the-cartels-cooking-crack-i... (I know, Sky News..)
But it probably could be, if there's a market for it. There are trained chemists making meth [0]. The sale of the precursors of fentanyl is controlled, but so are the precursors to meth. If fentanyl (or an analog) stays popular we'll have people making their own.
Edit: I'm not saying it would be as obtaining PSE, but if you're a member of a chem lab, the only thing between you and an order to Sigma is ~two signatures? There's too much money involved for it to not happen.
[0] http://news.sky.com/story/inside-the-cartels-cooking-crack-i... (I know, Sky News..)
Setting up a lab capable of producing fentanyl has significant up-front costs associated with it. Running the lab and keeping it stocked with precursors is an ongoing risk. For better or worse, the golden age of american clandestine laboratories is probably past: it is far easier to import an uncontrolled, custom-synthesized fentanyl analog, although I would not recommend getting into this business.
Fentanyl isn't popular _at all_ among opioid addicts. The duration of effect is short relative to morphine-like molecules and it absolutely wrecks one's opioid tolerance. Fentanyl is popular among unscrupulous heroin dealers that try to pass off a cheap synthetic opioid as $200/gram diacetylmorphine.
Fentanyl isn't popular _at all_ among opioid addicts. The duration of effect is short relative to morphine-like molecules and it absolutely wrecks one's opioid tolerance. Fentanyl is popular among unscrupulous heroin dealers that try to pass off a cheap synthetic opioid as $200/gram diacetylmorphine.
My brother studies Chemistry. One of the first things they told them was that they could make Meth (I think) with a street value of about 1000 times the cost of the materials, but the police would know where to start looking as soon as they got their hands on some, because it would be too pure, too well made.
Mind you, this was told to incoming (freshmen) students, presumably the professors would be able to make the precursors in such a way that the authorities wouldn't know.
Mind you, this was told to incoming (freshmen) students, presumably the professors would be able to make the precursors in such a way that the authorities wouldn't know.
Yep. In O-chem lab many years ago one of the first things we did was "alkaloid extraction", where we pulled caffeine from tea bags, which was a yellow, clumpy powder, which we then washed out the impurities and it was a clean white crystal. Caffeine is in the same family as meth, and the process is similar.
The teacher joked that she used to teach in San Bernardino and there were a lot of chemicals that the department never had to buy because the police would turn it over after raiding meth labs.
The teacher joked that she used to teach in San Bernardino and there were a lot of chemicals that the department never had to buy because the police would turn it over after raiding meth labs.
> Caffeine is in the same family as meth
If by family you mean CNS stimulant with an amino group, then yes, I guess? They are very different structurally and pharmacologically.
A synthesis of methamphetamine would not look very much at all like an alkaloid extraction, except, possibly, for the final workup and isolation of the salt.
If by family you mean CNS stimulant with an amino group, then yes, I guess? They are very different structurally and pharmacologically.
A synthesis of methamphetamine would not look very much at all like an alkaloid extraction, except, possibly, for the final workup and isolation of the salt.
So is the idea that the school tells them they could totally do this, and they'd get caught, so as to preempt students from coming up with the idea on their own?
Eh, it sounds like the teacher is just trying to get their class excited about the chemistry. Come for the very pure drugs, stay for the molecular orbital theory and the love of the lab.
That, and because some of the more enterprising students would come up with the idea on their own, so better to depress any such tendency ahead of time than end up with two or three people a year finding out via prison sentences that they weren't quite as smart as they thought they were.
"Oh, we could totally synthesize meth and make tons of money, but it would be so good we'd get caught immediately." Talk is cheap. POC or GTFO.
[deleted]
A lot of the fentanyl in Canada comes from china and was ordered over the dark web.
Fentanyl and other opioid synthetics were legal to export in China until very recently, so ordering it was as simple as going on Alibaba or other wholesaler chemical sites and just bringing in enough of it that customs would miss a few shipments. Now that there are regulations involved on the Chinese side the price of Fentanyl smuggling has risen and it's no longer an attractive synthetic to maximize profits for dealers so they are importing other synthetics or Fentanyl from countries who still don't have export laws.
Realistically the only way to stop this problem besides legalization is labs for testing pills and powders like they have in Spain and Netherlands, and mobile Suboxone clinics[1] which were proven here (Vancouver, Canada) to be the best solution for addict recovery as they can pick up the phone and have somebody quietly prescribe them Suboxone treatment without having to queue up at the methodone clinics everyday. Suboxone was described to me as satisfying the 'fiend' cravings while not making you high, so you can function sober and no longer need to chase daily money to satisfy a drug addiction and can actually plan things. It also ensures you won't use again since the antagonist ingredients makes it more difficult or impossible to use other opioids at the same time, making relapse less likely.
The safe injection sites here are a double edged sword. On one hand they are helpful for street addicts but on the other hand they are more likely to take risks, knowing there's a nurse there so aren't afraid of mystery powders like they used to be, according to anecdotes of people I've talked to who frequent them. The city handed out overdose kits to street users who demanded a peer to peer type safe injection network but the junkies stole the needles out of the kits to shoot up with basically rendering them useless and wasting the hundreds of thousands it cost to distribute them.
There's some data here about the Netherlands success in drug use reduction, they put a lot of funds into prevention instead of just treatment. http://www.emcdda.europa.eu/publications/country-drug-report...
[1] https://www.theglobeandmail.com/news/british-columbia/a-bc-c...
Realistically the only way to stop this problem besides legalization is labs for testing pills and powders like they have in Spain and Netherlands, and mobile Suboxone clinics[1] which were proven here (Vancouver, Canada) to be the best solution for addict recovery as they can pick up the phone and have somebody quietly prescribe them Suboxone treatment without having to queue up at the methodone clinics everyday. Suboxone was described to me as satisfying the 'fiend' cravings while not making you high, so you can function sober and no longer need to chase daily money to satisfy a drug addiction and can actually plan things. It also ensures you won't use again since the antagonist ingredients makes it more difficult or impossible to use other opioids at the same time, making relapse less likely.
The safe injection sites here are a double edged sword. On one hand they are helpful for street addicts but on the other hand they are more likely to take risks, knowing there's a nurse there so aren't afraid of mystery powders like they used to be, according to anecdotes of people I've talked to who frequent them. The city handed out overdose kits to street users who demanded a peer to peer type safe injection network but the junkies stole the needles out of the kits to shoot up with basically rendering them useless and wasting the hundreds of thousands it cost to distribute them.
There's some data here about the Netherlands success in drug use reduction, they put a lot of funds into prevention instead of just treatment. http://www.emcdda.europa.eu/publications/country-drug-report...
[1] https://www.theglobeandmail.com/news/british-columbia/a-bc-c...
You're right that doctors can prescribe fentanyl, but I'm not so sure about your (implied) claim that prescribed fentanyl is contributing to the opioid epidemic. To my knowledge, fentanyl is safe to take when done in proper doses (as are most painkillers). The problem with fentanyl is that since it is so much more potent than drugs like heroin, when the two are mixed people can overdose much more easily since they won't know that the fentanyl. And the fentanyl being mixed in with heroin isn't coming from Dilaudid prescriptions, it's coming from China: http://securepackages.org/wp-content/uploads/2017/02/USCC-St...
So unless you can figure out a way to stop the drug trafficking industry, fentanyl+heroin aren't going away. Perhaps we will see fentanyl produced less if China cracks down / increases regulations on their pharmaceutical industry.
Unfortunately the opioid epidemic is going to have to be stopped by moving away from the casual prescription of opioids, which is what creates opioid addiction in the first place. I think your open doctor project is really cool and is a good way to start: shame doctors who are essentially operating as pill mills for their "patients." My hope is that people so obviously abusing the system like the doctors at the top of your list end up losing their license to practice medicine, or behind bars.
So unless you can figure out a way to stop the drug trafficking industry, fentanyl+heroin aren't going away. Perhaps we will see fentanyl produced less if China cracks down / increases regulations on their pharmaceutical industry.
Unfortunately the opioid epidemic is going to have to be stopped by moving away from the casual prescription of opioids, which is what creates opioid addiction in the first place. I think your open doctor project is really cool and is a good way to start: shame doctors who are essentially operating as pill mills for their "patients." My hope is that people so obviously abusing the system like the doctors at the top of your list end up losing their license to practice medicine, or behind bars.
A lot of fentanyl is coming from Mexico, where they easily synthesize it, and it's introduced into the heroin supply as a cutting agent. Whether or not it's "contributing to the opioid epidemic" depends on how you interpret that phrase. In other words, people are getting HOOKED on opioids because of the 12hr dosing of oxy etc that has been discussed on HN in the past. But people are DYING OF OVERDOSES because they cannot afford/lose access to pills and switch to heroin from the street (adulterated with fentanyl).
The source I linked mentions that the primary route fentanyl takes is from labs in China to Mexico, then to the US.
Yes, we are in agreement then. I just don't think the epidemic (or the deaths) is as easy to stop as ransom1538 thinks, because the fentanyl problem by itself stems from trafficking instead of prescriptions. AndYou can't really stop the drug trafficking part of things very efficiently, see the DEA for proof.
Personally I believe that the deaths are secondary to the addiction anyway. Of course, it's very, very bad that people are dying due to adulterated heroin, but the most effective way to lower deaths is probably to prescribe less of those 12hr oxies.
Yes, we are in agreement then. I just don't think the epidemic (or the deaths) is as easy to stop as ransom1538 thinks, because the fentanyl problem by itself stems from trafficking instead of prescriptions. AndYou can't really stop the drug trafficking part of things very efficiently, see the DEA for proof.
Personally I believe that the deaths are secondary to the addiction anyway. Of course, it's very, very bad that people are dying due to adulterated heroin, but the most effective way to lower deaths is probably to prescribe less of those 12hr oxies.
According to most of what I’ve read and seen, opioid prescriptions are contributing to the problem. It’s true that people aren’t overdosing when following their prescribed dosages, but some people are getting addicted.
A common story for opioid addicts starts with, “I was in a car accident, and they prescribed opioids to deal with the pain. Once the prescription ran out, I was in incredible pain, maybe even worse than before I started taking the pills. I started buying pills illegally. Once the pills got too expensive, I switched to heroin.”
I’ve seen far too many stories that follow that basic path. It’s definitely not the only way people get addicted, but it’s too common.
A common story for opioid addicts starts with, “I was in a car accident, and they prescribed opioids to deal with the pain. Once the prescription ran out, I was in incredible pain, maybe even worse than before I started taking the pills. I started buying pills illegally. Once the pills got too expensive, I switched to heroin.”
I’ve seen far too many stories that follow that basic path. It’s definitely not the only way people get addicted, but it’s too common.
Fentanyl even killed Prince
> Given the scale of the crisis, it’s not hard to understand why, when Donald Trump promised Ohioans on the campaign trail to “spend the money” to confront the opioid crisis and build a wall so drugs would stop flowing in,
Have a look at this document with data from 2009. Compare usage rates in Americans for opiates with opioids with prescription opioids:
http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta...
Annual Prevalence of use as a percentage of the population aged 15-64 for the year 2009
Have a look at this document with data from 2009. Compare usage rates in Americans for opiates with opioids with prescription opioids:
http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta...
Annual Prevalence of use as a percentage of the population aged 15-64 for the year 2009
Opioids 5.90%
Opiates 0.57%
Prescription Opioids 5.60%
Also, fentanyl, which is a major illicit opiate source, mainly comes from china. A wall could have no effect at all; and in fact could spur more deaths if people turn to fentanyl.
> it won't do anything about the real problem: people in pain with inadequate treatment for that pain.
Careful, you're sounding awfully reasonable!
Harassing doctors and patients is beyond stupid, I suspect it will result in even more people turning to illegal drugs to self-medicate once their personal doctor gets some external political/media pressure to stop prescribing anything effective.
Careful, you're sounding awfully reasonable!
Harassing doctors and patients is beyond stupid, I suspect it will result in even more people turning to illegal drugs to self-medicate once their personal doctor gets some external political/media pressure to stop prescribing anything effective.
I'm a foster parent, and this is definitely a real thing.
My state recently went into crisis mode for foster care, where they struggled placing kids and filled up the group facility they normal use for short term overflow. They're starting a program specializing in short-term placements.
Opioids have been blamed for the recent increases.
http://fox13now.com/2017/05/12/resources-stretched-thin-as-m...
And this is in a state (Utah) with an already relatively low rate of children in state custody. Surely if we are struggling, other states must be as well.
I don't know what politics to sorry or what macro policy changes will "fix" this, but I know how I can help. Circumstances vary, but if yours permit you to do foster care, I recommend looking seriously at it.
My state recently went into crisis mode for foster care, where they struggled placing kids and filled up the group facility they normal use for short term overflow. They're starting a program specializing in short-term placements.
Opioids have been blamed for the recent increases.
http://fox13now.com/2017/05/12/resources-stretched-thin-as-m...
And this is in a state (Utah) with an already relatively low rate of children in state custody. Surely if we are struggling, other states must be as well.
I don't know what politics to sorry or what macro policy changes will "fix" this, but I know how I can help. Circumstances vary, but if yours permit you to do foster care, I recommend looking seriously at it.
Can you say more here or offer some links on what it's like to be a foster parent? I'm adopted and had to deal with some ACEs, and being a foster parent really does call to me. My dad was an attorney and also volunteered to help with foster kids, so I had exposure to them as a child. I want to look more into it.
Also, if you have biological kids of your own, how did they deal with foster kids? I have a daughter and would like to have another bio child as well.
Also, if you have biological kids of your own, how did they deal with foster kids? I have a daughter and would like to have another bio child as well.
I fostered for nearly 2 years, and ended up adopting my foster daughter who was just a few weeks shy of her 7th birthday. I had a 1 yr old bio son when she joined the family.
I’d say what worked best for me was doing the very hard and frustrating process of building trust between me and her birth mom & family. It was at times maddening but so worth it for her. Especially since the system itself is broken.
My son was actually a plus - she was able to bond with him first and I believe that enabled her to then trust and bond with us.
Now she’s 12 and is amazing. I feel like the luckiest mom in the world to be able to spend my life with her.
I’d say what worked best for me was doing the very hard and frustrating process of building trust between me and her birth mom & family. It was at times maddening but so worth it for her. Especially since the system itself is broken.
My son was actually a plus - she was able to bond with him first and I believe that enabled her to then trust and bond with us.
Now she’s 12 and is amazing. I feel like the luckiest mom in the world to be able to spend my life with her.
A lesbian couple in Oakland I know have two foster girls from a Nepal refugee camp. It's been all uphill with them. They've had them since age 14, and now they're 18. English was a problem, but they're mostly past that. Their schooling is poor; despite Kumon, tutoring, and the Berkeley International School, one of them can't pass the DMV written driving test.
Attitude is an issue. The girls grew up in a refugee camp where they didn't have much, but nobody had to do anything. Now they've been dumped into an complex alien society where they have to become self-supporting. It doesn't help that the girls think their role is to find a man and be supported by him. The girls have strong ideas about the role of women, and despite being fostered by lesbians who do home remodeling and industrial design, they have zero interest in learning those skills.
The people who supervise the foster child program think they're doing a great job. The kids have sort of learned to read, and one of them got a job at an ice cream store. They got high school diplomas, only because California stopped requiring the high school exit exam at the beginning of 2016. This is better than average for the program.
Both girls can use a smartphone for entertainment purposes.
Attitude is an issue. The girls grew up in a refugee camp where they didn't have much, but nobody had to do anything. Now they've been dumped into an complex alien society where they have to become self-supporting. It doesn't help that the girls think their role is to find a man and be supported by him. The girls have strong ideas about the role of women, and despite being fostered by lesbians who do home remodeling and industrial design, they have zero interest in learning those skills.
The people who supervise the foster child program think they're doing a great job. The kids have sort of learned to read, and one of them got a job at an ice cream store. They got high school diplomas, only because California stopped requiring the high school exit exam at the beginning of 2016. This is better than average for the program.
Both girls can use a smartphone for entertainment purposes.
> This is better than average for the program.
I wonder how much of this has to do with Oakland, which has a reputation for having troubled communities.
> They've had them since age 14
Foster care or otherwise, changing someone's habits and worldview starting at fourteen is tough. Kudos for them for trying.
I wonder how much of this has to do with Oakland, which has a reputation for having troubled communities.
> They've had them since age 14
Foster care or otherwise, changing someone's habits and worldview starting at fourteen is tough. Kudos for them for trying.
My mother was in foster care, some good, some bad, and that was a motivator for me to do it.
We don't do foster-to-adopt. We do the other kinds: for situations where the goal is still reunification, or adoption by a family member.
Biologically, we have a two-year-old daughter , three-year-old son, and a son on the way. We have the right to know the history of placements and say yes/no to each one. Our foster care rep knows that we can't (won't) take aggressive children or children over 12, because we gave young kids. We also only do Level 1 care. (There are three levels in our state for rating behavioral and handicapped difficulty. Levels 2 and 3 require extra training.) We do, however, take sibling groups.
Our bio kids LOVE having foster kids. They now think that any friends they make should live at our house, because their other ones do.
I don't have any foster horror stories though I've heard plenty of course. We've been lucky enough to have remarkably well-adjusted kids. I think poor circumstances often demands increased maturity. IMO, the hardest people to deal with are the parents, not the kids.
Getting licensed involved 30 hours of in person training over a few months, a few hours online training, a house inspection (fire extinguisher, escape latter, handrails on stairs), and an interview with very personal questions (e.g. if you're married, "Have you ever considered divorce?").
The hardest parts of parenting are also the hardest parts of foster parenting. So I would expect a biological parent to have a pretty solid idea of what foster parenting would be like.
We don't do foster-to-adopt. We do the other kinds: for situations where the goal is still reunification, or adoption by a family member.
Biologically, we have a two-year-old daughter , three-year-old son, and a son on the way. We have the right to know the history of placements and say yes/no to each one. Our foster care rep knows that we can't (won't) take aggressive children or children over 12, because we gave young kids. We also only do Level 1 care. (There are three levels in our state for rating behavioral and handicapped difficulty. Levels 2 and 3 require extra training.) We do, however, take sibling groups.
Our bio kids LOVE having foster kids. They now think that any friends they make should live at our house, because their other ones do.
I don't have any foster horror stories though I've heard plenty of course. We've been lucky enough to have remarkably well-adjusted kids. I think poor circumstances often demands increased maturity. IMO, the hardest people to deal with are the parents, not the kids.
Getting licensed involved 30 hours of in person training over a few months, a few hours online training, a house inspection (fire extinguisher, escape latter, handrails on stairs), and an interview with very personal questions (e.g. if you're married, "Have you ever considered divorce?").
The hardest parts of parenting are also the hardest parts of foster parenting. So I would expect a biological parent to have a pretty solid idea of what foster parenting would be like.
According to Pew Research: "National data doesn’t identify how many children are removed from their homes because of a parent’s substance abuse. And there’s no one standard for how states report substance abuse and child neglect."
http://www.pewtrusts.org/en/research-and-analysis/blogs/stat...
http://www.pewtrusts.org/en/research-and-analysis/blogs/stat...
[deleted]
I spent the first half of 2016 helping a drug and alcohol addict kick her habit of 20+ years. 6 days inpatient detox. Would have had 30 days rehab if she'd stuck with it.
Had lost her driver's license years ago. So after she checked herself out (admittedly, upon my investigating, for some legitimate reasons vis a vis that program), I spent the next couple of months driving her to meetings, providing childcare to make that possible, helping her get to the job her sister found her, then the second job. Making sure she wasn't alone in the evenings, when she would drink...
My major point. 6 days at one of the area's premier hospitals. Thanks to the ACA expansion of Medicaid. The rehab program would have gone under that, as well. Foodstamps for her and her kids. A social worker and case management for her daughter (living with grandma). Etc. Etc.
I had some warning signs, early on, but I hung in there -- advice from experienced friends and experts advising patience. And thinking not just of her, but of the kids; things seemed to gradually get better with them once I got involved.
Anyway... Not just my support. All this public support. That I don't begrudge: Treat the problem. Take care of the kids.
Come fall, she's back together with her ex-boyfriend, who was a big Cruz supporter. ("The Constitution! La la la, blah blah blah...")
And she -- previously having stated her indifference to politics, except for hating Hillary for whatever gut felt reason -- starts expressing herself as a big Trump supporter.
I'd explained to her, early on, that the ACA is what enabled me to keep insurance. I don't get a tax break. It just gives me the opportunity to participate, whereas before insurance companies would look for any pimple as the basis to exclude me.
She gained sobriety through the support of the State, and someone who depends on the ACA for his own well-being.
None of that seems to matter to her.
This experience has caused me to fundamentally rethink my ideas about how the world works and how we can (or can't) tackle these problems.
Writing about all this makes me feel kind of small. Laying the situation out there and sounding aggrieved.
But I do it, all the same, for the point it impressed upon me: I'm no longer sure some people can be reached, through any level of action and good will.
It's a pretty sobering -- and saddening -- perspective.
P.S. We've been out of touch for months -- her choice. As far as I know, she's still sober. Making plans a year out.
She's doing ok. But there seems to be no connection in her mind with providing that opportunity to others.
I've been forced to realize and acknowledge that some people appear to be in it purely for themselves. They can exhibit charm and engagement in furtherance of this purpose. But real empathy and cooperation?
And, looking around, it's not just the addicts and "miscreants". There's a significant portion of the population who really does believe and follow "I got mine". And that is all they really respect in others.
It is, it turns out, a dog eat dog world. At least when it comes to dealing with these people. Who, en masse, present a formidable problem to a functioning society.
Had lost her driver's license years ago. So after she checked herself out (admittedly, upon my investigating, for some legitimate reasons vis a vis that program), I spent the next couple of months driving her to meetings, providing childcare to make that possible, helping her get to the job her sister found her, then the second job. Making sure she wasn't alone in the evenings, when she would drink...
My major point. 6 days at one of the area's premier hospitals. Thanks to the ACA expansion of Medicaid. The rehab program would have gone under that, as well. Foodstamps for her and her kids. A social worker and case management for her daughter (living with grandma). Etc. Etc.
I had some warning signs, early on, but I hung in there -- advice from experienced friends and experts advising patience. And thinking not just of her, but of the kids; things seemed to gradually get better with them once I got involved.
Anyway... Not just my support. All this public support. That I don't begrudge: Treat the problem. Take care of the kids.
Come fall, she's back together with her ex-boyfriend, who was a big Cruz supporter. ("The Constitution! La la la, blah blah blah...")
And she -- previously having stated her indifference to politics, except for hating Hillary for whatever gut felt reason -- starts expressing herself as a big Trump supporter.
I'd explained to her, early on, that the ACA is what enabled me to keep insurance. I don't get a tax break. It just gives me the opportunity to participate, whereas before insurance companies would look for any pimple as the basis to exclude me.
She gained sobriety through the support of the State, and someone who depends on the ACA for his own well-being.
None of that seems to matter to her.
This experience has caused me to fundamentally rethink my ideas about how the world works and how we can (or can't) tackle these problems.
Writing about all this makes me feel kind of small. Laying the situation out there and sounding aggrieved.
But I do it, all the same, for the point it impressed upon me: I'm no longer sure some people can be reached, through any level of action and good will.
It's a pretty sobering -- and saddening -- perspective.
P.S. We've been out of touch for months -- her choice. As far as I know, she's still sober. Making plans a year out.
She's doing ok. But there seems to be no connection in her mind with providing that opportunity to others.
I've been forced to realize and acknowledge that some people appear to be in it purely for themselves. They can exhibit charm and engagement in furtherance of this purpose. But real empathy and cooperation?
And, looking around, it's not just the addicts and "miscreants". There's a significant portion of the population who really does believe and follow "I got mine". And that is all they really respect in others.
It is, it turns out, a dog eat dog world. At least when it comes to dealing with these people. Who, en masse, present a formidable problem to a functioning society.
Thank you for helping other people! You are making the world a better place, and when you average it out it is working - humanity is more "humane" this century than it was over the last couple of millennia.
Sure, there are those really disappointing frustrations, but I try to just chalk them up to cost of doing business. That way you can focus on the fact that the average is getting better and your efforts are making a difference, even if slowly.
Sure, there are those really disappointing frustrations, but I try to just chalk them up to cost of doing business. That way you can focus on the fact that the average is getting better and your efforts are making a difference, even if slowly.
The "opioid epidemic" is manufactured political and media hysteria. There have always been drug addicts.
The end result to all of this hysteria will be nothing but more political interference in doctor-patient relationships, more annoying obstacles and hoops for patients to jump through, and more suffering for patients.
The end result to all of this hysteria will be nothing but more political interference in doctor-patient relationships, more annoying obstacles and hoops for patients to jump through, and more suffering for patients.
It really, honestly, is not manufactured outrage.
https://www.vox.com/policy-and-politics/2017/6/28/15881246/d...
> America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths
The US uses far more opioids than any other country. Does the US have far more pain than any other country?
> and more suffering for patients.
No.
You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain.
People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.
https://www.vox.com/policy-and-politics/2017/6/28/15881246/d...
> America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths
The US uses far more opioids than any other country. Does the US have far more pain than any other country?
> and more suffering for patients.
No.
You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain.
People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.
> You seem to think that opioids are an effective treatment for long term pain
Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions.
> and is now addicted to opioids
Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant.
> People with long term pain need rapid access to a specialist pain management clinic.
Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.
Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions.
> and is now addicted to opioids
Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant.
> People with long term pain need rapid access to a specialist pain management clinic.
Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.
> In many cases of severe persistent pain, they are the only effective treatment.
I can believe some random person on the internet, or I can believe the Royal College of Anaesthetists.
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
> Given the limited duration of clinical trials, data on efficacy of long term opioid use are available only from case series and open-label extensions of controlled trials. These latter have been systematically reviewed. Open-label extension data suggest that a small proportion of patients may derive continuing benefit from opioids in the long term but the relevance to clinical practice is uncertain as patients with co-morbidities that may predispose to problematic opioid use are generally excluded from clinical trials and evaluation of long term use does not, in these studies, identify potential benefits from placebo effect, benefits of additional therapies or spontaneous resolution of symptoms.
> Analysis of open label data does not enable firm conclusions regarding improvement in function or quality of life with long term opioid treatment. Data from prospective cohort studies suggest that opioids retard return to work after injury and may prolong functional recovery or worsen physical functioning. A Danish cross-sectional study has suggested that when comparing opioid users with non-opioid users, opioid use appears to be associated with poorer self-related quality of life and employment status, increased healthcare use, and worse pain. These studies do not demonstrate causality in relation to opioids and poor function in a number of domains but indicate that the hoped for end points of pain reduction and improvement in function are not being met with long term opioid treatment.
Particularly:
> Important Practice Points
> Patients who do not achieve useful pain relief from opioids within 2-4 weeks are unlikely to gain benefit in the long term.
> Patients who may benefit from opioids in the long term will demonstrate a favourable response within 2-4 weeks.
> Short-term efficacy does not guarantee long-term efficacy.
> Data regarding improvement in quality of life with long-term opioid use are inconclusive.
> There is no good evidence of dose-response with opioids, beyond doses used in clinical trials, usually up to 120mg/day morphine equivalent. There is no evidence for efficacy of high dose opioids in long-term pain.
That "no evidence" bit should worry you. Why doesn't it?
> Those patients and doctors are making the determination that addiction is better than the alternative
Because, as the RCA keep saying: opioids are not treating the pain, and are causing harm to the patient. Patients keep taking the meds not because those meds work, but because they are addicted to those meds.
I can believe some random person on the internet, or I can believe the Royal College of Anaesthetists.
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
> Given the limited duration of clinical trials, data on efficacy of long term opioid use are available only from case series and open-label extensions of controlled trials. These latter have been systematically reviewed. Open-label extension data suggest that a small proportion of patients may derive continuing benefit from opioids in the long term but the relevance to clinical practice is uncertain as patients with co-morbidities that may predispose to problematic opioid use are generally excluded from clinical trials and evaluation of long term use does not, in these studies, identify potential benefits from placebo effect, benefits of additional therapies or spontaneous resolution of symptoms.
> Analysis of open label data does not enable firm conclusions regarding improvement in function or quality of life with long term opioid treatment. Data from prospective cohort studies suggest that opioids retard return to work after injury and may prolong functional recovery or worsen physical functioning. A Danish cross-sectional study has suggested that when comparing opioid users with non-opioid users, opioid use appears to be associated with poorer self-related quality of life and employment status, increased healthcare use, and worse pain. These studies do not demonstrate causality in relation to opioids and poor function in a number of domains but indicate that the hoped for end points of pain reduction and improvement in function are not being met with long term opioid treatment.
Particularly:
> Important Practice Points
> Patients who do not achieve useful pain relief from opioids within 2-4 weeks are unlikely to gain benefit in the long term.
> Patients who may benefit from opioids in the long term will demonstrate a favourable response within 2-4 weeks.
> Short-term efficacy does not guarantee long-term efficacy.
> Data regarding improvement in quality of life with long-term opioid use are inconclusive.
> There is no good evidence of dose-response with opioids, beyond doses used in clinical trials, usually up to 120mg/day morphine equivalent. There is no evidence for efficacy of high dose opioids in long-term pain.
That "no evidence" bit should worry you. Why doesn't it?
> Those patients and doctors are making the determination that addiction is better than the alternative
Because, as the RCA keep saying: opioids are not treating the pain, and are causing harm to the patient. Patients keep taking the meds not because those meds work, but because they are addicted to those meds.
Your comments are best summarized as "I have no experience on this matter but I can spend a few seconds on google and then copy and paste" which may work well for writing a shell script but fortunately it's not how medicine or health care works.
Feel free to provide your own links.
You make it sound like I only just googled these. Even if that's true (and it's not, and that's trivially easy to check) so what? I'm posting government level advice backed by meta analysis.
Your the one posting your opinion. Frankly, I don't care about your personal experience. Look at eg knee arthroscopy for an example of how useless personal experience of both patients and doctors in health care.
You make it sound like I only just googled these. Even if that's true (and it's not, and that's trivially easy to check) so what? I'm posting government level advice backed by meta analysis.
Your the one posting your opinion. Frankly, I don't care about your personal experience. Look at eg knee arthroscopy for an example of how useless personal experience of both patients and doctors in health care.
Bro my old city's opiate overdose death rates have doubled annually for several years now. I have several friends whose lives have been claimed by opiates in that span of time. It's most certainly a thing. No offense but you shouldn't talk completely out of your ass.
Contimplating fostering a computer nerd to do QA. I believe that is how the old apprenticeships worked.
Would also move out with a savings, a marketable skill, and references at 18.
Not a bad start for a Dev.
Would also move out with a savings, a marketable skill, and references at 18.
Not a bad start for a Dev.
Huh, down votes signal it is reasonable to want a pet human, but not an apprentice?
It's interesting we could be developing whole new non addictive classes of pain killer from cannabis extracts but instead we standardize on oxyconton and opiates. With a beat up, aging population of working people with chronic pain of course it's a perfect storm. But in states that have embraced cannabis we don't see this level of crisis .
I think you're seriously downplaying a few variables, to reach a desired conclusion. How many coal mines and textile mills are there in Portland or San Francisco?
[deleted]
And there's definitely no aging physical labor population in Washington, home of Boeing plants and a massive agricultural industry.
Sure, but skilled machinist work in a Boeing plant isn't even remotely comparable to the forms of unskilled manual labor common to Appalachia. While the strawberry pickers of California's agricultural industry tend to be undocumented immigrants, and one's drug of choice is significantly shaped by demographics.
I'm not arguing against the merits of cannabis, mind you. I'm just saying that it's lazy and ridiculous to argue, "We don't have strung-out hillbillies on the Pacific coast. Must be due to the presence of marijuana! (rather than the absence of hillbillies)".
I'm not arguing against the merits of cannabis, mind you. I'm just saying that it's lazy and ridiculous to argue, "We don't have strung-out hillbillies on the Pacific coast. Must be due to the presence of marijuana! (rather than the absence of hillbillies)".
The loggers here might disagree with you.
The barrier to move and change jobs is much lower
> but instead we standardize on oxyconton and opiates
That's because oxycontin and opiates work for relieving pain.
> But in states that have embraced cannabis we don't see this level of crisis .
That's a baseless claim that couldn't be further from the truth. Take a walk around SF, LA, Seattle, Portland, etc, there are tons of strung out junkies laying around on the streets surrounded by needles.
The existence of painkillers are not the reason we have drug addicts.
That's because oxycontin and opiates work for relieving pain.
> But in states that have embraced cannabis we don't see this level of crisis .
That's a baseless claim that couldn't be further from the truth. Take a walk around SF, LA, Seattle, Portland, etc, there are tons of strung out junkies laying around on the streets surrounded by needles.
The existence of painkillers are not the reason we have drug addicts.
> That's because oxycontin and opiates work for relieving pain.
They do not work for relieving long term pain.
https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
> > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain
> > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).
> The existence of painkillers are not the reason we have drug addicts.
This is just untrue. Please provide a valid source.
They do not work for relieving long term pain.
https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
> > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain
> > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).
> The existence of painkillers are not the reason we have drug addicts.
This is just untrue. Please provide a valid source.
It seems that if opioids and opiates did not relieve long term pain the entire pain management industry would implode because health insurance would not pay for the millions of prescription pain management doctors write. I have my own opinions about pain management doctors but that aside' insurance companies are very quick to deny something with no medical benefit or no medical basis for the prescription/procedure.
I know people with debilitating pain that have been on pain melds for over a decade and while the medications do not make the pain disappear it makes it manageable. Some people are not candidates for surgery and have to manage with medications.
Bottom line though, individuals who have been using these drugs for so long whether for a legitimate reason or not suffer from memory issues, fatigue, irritability, impulse control, etc and those factors can certainly have an impact on children.
I know people with debilitating pain that have been on pain melds for over a decade and while the medications do not make the pain disappear it makes it manageable. Some people are not candidates for surgery and have to manage with medications.
Bottom line though, individuals who have been using these drugs for so long whether for a legitimate reason or not suffer from memory issues, fatigue, irritability, impulse control, etc and those factors can certainly have an impact on children.
Your own citation disputes your opinion and claim.
> This is just untrue.
Oh are you saying this from your own research or clinical experience? Do you work directly with persistent pain patients? Are you an anesthesiologist? Or are you just Doctor Google?
> This is just untrue.
Oh are you saying this from your own research or clinical experience? Do you work directly with persistent pain patients? Are you an anesthesiologist? Or are you just Doctor Google?
> Your own citation disputes your opinion and claim.
I'm confused, please can you point out where my citation disputes my claim?
Also, can you provide a citation?
I'm confused, please can you point out where my citation disputes my claim?
Also, can you provide a citation?
Transparently tendentious reasoning of this sort fails to serve your turn, and that's especially regrettable in this case because I agree with you that we would be very well served to look for means of addressing severe and chronic pain that don't involve the most addictive class of drugs known to man.
I would esteem it a kindness of you to find a way of advancing your thesis that does more to support it than, by retreat into intellectually dishonest tactics, to make it look indefensible.
I would esteem it a kindness of you to find a way of advancing your thesis that does more to support it than, by retreat into intellectually dishonest tactics, to make it look indefensible.
It's a myth that heroin and opiate addiction are the result of pain killer prescriptions: "According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. "
That certainly is the result of painkiller prescriptions - just not ones written for the person who starts using.
[deleted]
The initial availability of the drugs was from a prescription. If it weren't for the ready availability of the drugs, far fewer people would be addicted.
People are addicted to pain killers usually because they are dealing with pain, and they are either medicating or self-medicating to manage it.
If mere availability of something addictive was the problem, then we'd have a nation of nothing but alcoholics and cigarette smokers considering you can buy either in an unlimited quantity at any corner store.
If mere availability of something addictive was the problem, then we'd have a nation of nothing but alcoholics and cigarette smokers considering you can buy either in an unlimited quantity at any corner store.
that's from https://blogs.scientificamerican.com/mind-guest-blog/opioid-...
Which says eg
> A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.
Let's have a look at what that Cochrane review says:
http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-tre...
> The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment.
This tells us that the carefully selected patients were not getting pain relief or had too many side effects; (a third dropped out because of these) and we can't say too much about addiction because not all the studies reported it: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome"
It's hard to see that 0.27% (with who knows how many unreported cases of addiction) and that later 8-12% in the same paragraph.
> Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.
I mean, doesn't that tell you there's a massive problem with prescribing?
> recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors.
THat para links to a document called "THE OPIOID CRISIS IN AMERICA'S WORKFORCE" http://www.castlighthealth.com/typ/the-opioid-crisis/
The first para of that report says:
> The use and abuse of prescription opioids continues to be a challenging and costly crisis for the U.S. The facts underscore the severity of this crisis:
> • Nearly 2 million Americans are abusing prescription opioids1
> • 16,000 people die every year from prescription opioid overdoses2
> • Sales of opioid prescriptions in the U.S. nearly quadrupled from 1999 to 20103
> • 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills4
That Scientific American writer has misrepresented every source so far.
For fuck's sake, that last link specifically says:
> One out of every three (32%) opioid prescriptions is being abused.
Which says eg
> A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.
Let's have a look at what that Cochrane review says:
http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-tre...
> The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment.
This tells us that the carefully selected patients were not getting pain relief or had too many side effects; (a third dropped out because of these) and we can't say too much about addiction because not all the studies reported it: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome"
It's hard to see that 0.27% (with who knows how many unreported cases of addiction) and that later 8-12% in the same paragraph.
> Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.
I mean, doesn't that tell you there's a massive problem with prescribing?
> recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors.
THat para links to a document called "THE OPIOID CRISIS IN AMERICA'S WORKFORCE" http://www.castlighthealth.com/typ/the-opioid-crisis/
The first para of that report says:
> The use and abuse of prescription opioids continues to be a challenging and costly crisis for the U.S. The facts underscore the severity of this crisis:
> • Nearly 2 million Americans are abusing prescription opioids1
> • 16,000 people die every year from prescription opioid overdoses2
> • Sales of opioid prescriptions in the U.S. nearly quadrupled from 1999 to 20103
> • 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills4
That Scientific American writer has misrepresented every source so far.
For fuck's sake, that last link specifically says:
> One out of every three (32%) opioid prescriptions is being abused.
Here I have a list of the highest prescribing opioid doctors (sunday with beer project): https://www.opendoctor.io/opioid/highest
(let me know if you want the sql or whatever).