Fighting the "epidemic" at the supply level seems like a losing battle, as it is for the hard drugs that plague inner cities. Addressing it at the demand level has to be the answer, but I don't see any possible answers floated.
Fighting the "epidemic" at the supply level seems like a losing battle, as it is for the hard drugs that plague inner cities. Addressing it at the demand level has to be the answer, but I don't see any possible answers floated.
You're probably right about addressing at the demand level. But, I see the problem being more societal - think no one really understands everything. You take away self-reliance of people (whether they realize it or not) at many levels... its cheaper to get some good-enough quality food at 13 places near my home, so why should I learn to cook. I can get any vegetable I want at the store, so I probably don't need to learn how to tend a garden. In both instances as examples I'm losing a little control of my life. And then....
TV gives me entertainment, and the internet even more so, so maybe i'll just sit back and let it entertain me. So maybe I don't need to read anymore. Its easier to have short non-contextual entertainment bits, which rewire my brain further to think differently [wrongly?]... [0]
And, now capitalism has made all margins of businesses so slim that there's no real way to enter a business and still have a safety net in case you fail. You either need to disrupt an industry, create a marketplace, find a niche, or fail hard.
I think we're just starting to see the uglier stuff here. Short of some great awakening I also don't see the correct prescription. Pun intended.
[0]: https://en.wikipedia.org/wiki/Amusing_Ourselves_to_Death
I'm not sure about the Amusing Ourselves To Death stuff or the tut-tutting about cooking and gardening, but overall, though, I think you're on the right track. I'm sure that between automation of both manufacturing and services, big-box retailers and the fact that the covering of the 'long tail' is done very well by web-based business. It's hard to picture what a lot of people are going to be able to do in this circumstance and there seems to be the real potential for a cascading unpleasantness.
If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer.
There may be plenty of spare time for people to have that 'great awakening', whatever that might turn out to be.
two examples of many, admittedly probably too personal. Others: technology obsolescence, and the move toward not actually OWNing anything so nothing to learn to repair.
>>If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer.
Yes... My context is now that as a parent, I'm seeing windows closing for the kids' future that I had. I mean programming (maybe; I hope) and robot repair will be very lucrative. So will professions like plumbing and electricians.
It's not all doom and gloom, of course, and I think it's important to maintain a positive outlook esp. in front of one's kids when talking about this stuff. And of course, the growing helplessness and screen addiction of many of their peers suggests that in competitive terms, finding and holding a good job might be easier and easier (which isn't very encouraging overall, but appeals to the "amoral familism" streak I occasionally get).
While this is true, phrasing it like a critique of capitalism seems very, very weird. As if in a socialist or communist society starting a business is supposed to be easier and margins larger. (Disclaimer: I have founded two failed startups to date, still living on friends' couch after the second one now).
You're phrasing it as if you're comparing it with something. Have you ever lived in a communist country? I have yet to see a "redistribution of wealth" system that actually distributes more wealth than it lives for itself.
Kermit, West Virginia. Population 392. They received over 9 million hydrocodone pills in a two year period.
In a 6 year period, the entire state of WV received 780 million pills. Over 400 pills for every man, woman, and child living in WV.
Seems like attacking the supply is great place to start. WV doesn't need this many pills.
That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of limiting side effects.
Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK.
The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered.
edit to add: http://www.latimes.com/projects/oxycontin-part1/
However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
For people with short term pain, or who are at the end of life, opioids can be a good choice.
For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care.
Most people with long term pain need variations of / combinations of:
1) Access to evidence based pain management specialist clinics
2) Graded strength building exercise (for musculo-skeletal, not for nerve)
3) Medication that isn't opioids
Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction).
Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can.
https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
I learned an important lesson, however. Doctors will frequently use the amount of pain someone is experiencing as a diagnostic aid when determining a patient's diagnosis. I had a ruptured eardrum that I saw a doctor for and that doctor misdiagnosed it because I wasn't showing any signs of pain and that injury is supposed to be excruciating. The doctor explained to me that if it was ruptured, I'd be near tears and screaming for pain medication.
What are you talking about? Everything in medicine is highly regulated. Introducing a new drug is a very expensive process, run in the US by the FDA. It takes all sorts of expensive tests and trials to be allowed to sell a new medicine in the US.
Maybe the process messed up in this case. Sure. Many things are possible. But this was regulated start to finish.
Were they given out without prescription? If not, I feel like MDs have to share some blame on this.
In both cases, mandating a little common sense in how these drugs are used would potentially help a lot of people avoid a life they don't want.
no argument there. :)
The stat though about Kermit, West Virginia example has to be due to fraud and illegal sales, though? Or include vastly more people within the area covered by its pharmacies and/or doctors, which ever the data source used?
Otherwise each person in that town is receiving (on average) 31 pills/day. Maybe I wildly misunderstand hydrocodone prescriptions, but dozens of pills per day seems to be an excess.
Manufacturer seems to have played a role too by sticking to dosing they knew was ineffective and then pushing for higher doses which lead to big bonuses: http://www.latimes.com/projects/oxycontin-part1/
I agree that opioid over-prescription is an issue, but I imagine some of these numbers are being inflated by similar "pill mills" run by unscrupulous doctors.
This EconTalk episode on Narconomics goes into a great deal of detail regarding exactly how structurally broken the supply-side attacks are; I found it quite fascinating!
http://www.econtalk.org/archives/2017/02/tom_wainwright.html
Unfortunately neither of these will happen in the next 4 years; and likely the opposite will happen, so we're in for a worsening.
Tightening the already tightened restrictions would only worsen the issue.
Diversion, etc cannot be stopped and you might just see a sudden uptick in pharmacy truck heists like the one that happened five or so years ago. Corrupt pharmacists unable to resist the temptation of easy money, etc.
Or worse, heroin continues to spread like wildfire. Heroin has no QC, it's being cut with fentanyl across the country and addicts are dropping like flies. Sicker addicts have been seeking out these OD stories and score from those areas looking for the fentanyl cut H. It's bad and only getting worse, as if the government overcorrected its steering and has now spun out of control. The result is going to be a grisly accident.
I can't believe that many more people, especially (and coincidentally?) in the inner cities, need pain meds. This seems like something bigger in my mind. But I also don't have any data to back it up.
https://theweek.com/articles/541564/how-american-opiate-epid...
And now we're heading back in that direction. For some reason we can't seem to stop in the middle somewhere.
After observing this country 20+ years I have concluded that extremes rule. Nothing ever ends up done via a measured and calculated approach, always extremes. You can see that in politics, economic distributions, rules and lack of there of (deregulation). It's not just today; I've been reading a fair amount of history and it's like in the DNA of the country.
I don't think you can stop at drug use and claim "root cause." There's a variety of motivating factors involved in using particular drugs, and ignoring those is what leads to things like Prohibition, The War on Drugs, and other related failures.
If you want to stop people from doing something, you need to look at their motivations for doing it.
So there's likely a pretty big effect of society telling folks that they have to be "disabled" in order for us to support them, and one way to be "disabled" is to have debilitating pain, and so you wind up with a bunch of folks who can't work and have a pain pill prescription.
- Addiction: may or may not be a problem at all, heroin isn't actually very expensive so the government can just keep giving it even to large numbers of people
- Other health risks: the risk of catching Hep C or dying of an overdose.
- Acquisitive crime: largely caused by the drugs being illegal.
- Morality: drug users are "bad people" because they lack moral strength or whatever. (Personally I have no truck with this, but it seems to be very important for a lot of people)
Unemployment seems obvious, but it's not. New Hampshire, for example, if often cited as one of the areas hit the worst by opiate addiction. Yet, it's doing well with unemployment, in relative terms.
1 year old, but relevant: http://www.nationalreview.com/corner/430841/whats-matter-new...
There was a tremendous amount of unemployment during the Great Depression - far worse than now. Sure, opioids weren't as available, so people didn't turn to them. (Alcohol, on the other hand...)
But I think a lot of what people did then was turn to each other. They had deeper relationships with people than (many) people do today. Sure, you've got two hundred Facebook friends. How many of them can you call at 3 AM because your marriage is about to fall apart, or because you're feeling suicidal? Technology has given us more relationships, but I think that in the process, we've lost much of the depth. That leaves a huge hole, because people are wired to connect to people. We crave human contact, and we get tweets. It's not enough.
So my suspicion is that we're turning to opioids to try to fill that void. But as I said, this is just my suspicion.
Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision.
In some cases they can prescribe more suitable drugs and more suitable delivery methods.
For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief.
I'm not a doctor, just speaking from personal knowledge of someone very close to me.
Can you point me to those guidelines please? I'm struggling to find them.
I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example.
Here's the English advice: http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
(easy version) https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a...
(hard version) https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Erowid puts that in the "light" category for users with some tolerance, FWIW:
Despite the evidence showing only short term benefits to opioid treatment physicians fear being sued by patients for refusing to continue prescriptions. I believe the argument is "Pain is the fifth vital sign."