Do we have a thread about the opioid epidemic?

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Postby pantsoclock » Thu Feb 01, 2018 1:10 am

my girlfriend asks if you can say who is coming in from boston she might know them.
I pay tax to help pay for things like police..fire..parks..but it goes to Ferguson like people and foreigners who are scamming our stupid government that is full of pasta thieves like this guy
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Postby Fullscreen » Thu Feb 01, 2018 1:12 am

Merciel no joke you're a fucking hero.
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Postby Merciel » Thu Feb 01, 2018 1:14 am

pantsoclock wrote:my girlfriend asks if you can say who is coming in from boston she might know them.


Professor Rebecca Stone from Suffolk University. She's done some interesting research focused specifically on substance-abusing pregnant women, the barriers they face in trying to get treatment for themselves and their future kids, and what policies are most effective in helping them (spoiler: criminalizing substance abuse while pregnant is not one of them!).

The new administration has already expressed its support for the safe injection proposal, so what I'm focusing on is mostly explaining the current research on best policies and combining that with an on-the-ground perspective to convince the current ADAs that this is a good idea and they should get on board, and maybe pre-emptively address some of their concerns and point up some of the ethical dilemmas they might face (e.g., what do you do if a visibly pregnant woman wants to use the safe injection site?).
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Postby pantsoclock » Thu Feb 01, 2018 1:31 am

My girlfriend asked me to share this (she wrote it):
1) RAD. Rad rad rad.
2) Josh Sharfstein and Sean Allen from JHU were very recently involved in the drafting of West Virginia's state opioid response plan, and universal, comprehensive access to contraception was listed as one of the 12 or so explicit goals of the plan, along with other expected things like expanding MAT access, naloxone distribution, etc. I was super impressed, because I've not yet seen a state so overtly, explicitly give reproductive health such an explicit role in the opioid conversation. And, fuck, if West Virginia can get that shit done, there is hope for the rest of us. I thought this worth mentioning only because you said you were entering the capital of the republic of hand-wringing-moral-panic, aka NAS.
3) It's hard to do better than the current DA in Philly if you are looking for allies, but if you ever find yourself in need of some muscle on the law enforcement front, I work closely with Jerry Daley, the director of the HIDTA whose area of responsibility includes the state of PA. We were just in a meeting with him and Kendra Vines from Philly DPH last week. He's a crusty old cop, but he's so astonishingly reasonable, and a team player, and is willing to be proved wrong by data, and law enforcement listens to him. I'm happy to volunteer him to go to bat on your behalf if it would be of any assistance.
4) Oh man I love discovering new harm reductionists whose work/geography overlaps with my own lets pretty please talk shop sometime. Something something about good people and Voltron.
5) Oh man that Steve Erikson avatar what."
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Postby Jefferson Zeppelin » Thu Feb 01, 2018 1:40 am

great thread. I don’t know much about this subject but I’m learning a lot. Thanks for all your contributions.
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Postby average deceiver » Thu Feb 01, 2018 4:21 am

madness and chaos wrote:weird, i was the last one to post

here it is

https://openload.co/f/Ra_V9wX8Vyw


thank you for posting this
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Postby average deceiver » Thu Feb 01, 2018 4:26 am

merciel, it goes without saying that you're rad as fuck and I hope some good comes from all of your effort
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Postby razzle » Fri Feb 02, 2018 1:39 pm

It kind of feels like the damage is already done. Just thinking about how many people Ive known in life who have died or significantly had their lives altered by it. This is not normal and I hate seeing the trope that it is a white person problem.
At least we have Hamilton
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Postby Merciel » Fri Feb 02, 2018 1:47 pm

razzle wrote:It kind of feels like the damage is already done.


It's like any ongoing epidemic, as long as there are new victims then the damage isn't done as to those people, even if others are already dead or beyond help.

People didn't quit working on AIDS just because some of its victims had already died.

I mean I know what you're saying, but fatalism is so pervasive around any big problem that it's worth remembering that we can and do make progress on most of these things in time.
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Postby Merciel » Wed Feb 14, 2018 12:20 am

edit because I'm a wimp

but also because who knows where any of this is headed
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Postby gershon » Wed Feb 21, 2018 10:37 pm

I spoke in the Arizona House of Representatives in support of the syringe access bill HB2389 and outed myself as a volunteer for the unauthorized syringe access program in Phoenix. I loved that the Reps were looking at their cell phones until I mentioned that. I got drilled and loved answering their questions. The bill passed in the Health Committee and moves to a House floor vote soon.

Our exchange program had a front page cover story in AZ’s main newspaper, The Arizona Republic today. Thankfully, my chubby mug pic online wasn’t used:
https://www.azcentral.com/story/news/local/phoenix/2018/02/19/illegal-needle-exchanges-increasingly-popular-arizona/312857002/
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Postby gershon » Wed Feb 21, 2018 10:44 pm

Merciel wrote:
razzle wrote:It kind of feels like the damage is already done.


It's like any ongoing epidemic, as long as there are new victims then the damage isn't done as to those people, even if others are already dead or beyond help.

People didn't quit working on AIDS just because some of its victims had already died.

I mean I know what you're saying, but fatalism is so pervasive around any big problem that it's worth remembering that we can and do make progress on most of these things in time.


The AIDS volunteers and activists in the 80s and 90s are some of syringe access/exchange groups’ inspirations. and underground groups like the Jane collective who performed abortions for women in Chicago when it was illegal to do so.

We handed out 15,000 naloxone (narcan) kits to people who use drugs and their family members doing street outreach just last year and heard reports back that 2,201 lives were saved using them. And those are just the ones we heard from.
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Postby madness and chaos » Wed Feb 21, 2018 10:45 pm

^^^ this is amazing! thank you!
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Postby inspectorhound » Tue Mar 06, 2018 5:52 pm

love using my position as a Serious Academic to troll and endanger people that are addicted to opiates

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Postby pantsoclock » Tue Mar 06, 2018 6:42 pm

holy shit @ publishing the conclusion that "opioid abuse" is something to be curtailed by killing users.
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Postby bear » Tue Mar 06, 2018 7:21 pm

that isn't what they said at all. I don't see the problem with this paper? it's a legitimate question. are people less worried about overdosing when they know there's naloxone available? just like libraries have to ask themselves: should we carry Naloxone? because if they do, people are more likely to use the library to shoot up.
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Postby bear » Tue Mar 06, 2018 7:21 pm

Policymakers have multiple levers available to fight opioid addiction, and broadening
Naloxone access aims to directly address the most dire risk of opioid overdose: death. Naloxone
can save lives and provide a second chance for addicted individuals to seek treatment, but
access to this lifesaving drug may unintentionally increase opioid abuse by providing a safety
net that encourages riskier use. This paper shows that expanding Naloxone access increases
opioid abuse and opioid-related crime, and does not reduce opioid-related mortality. In fact,
in some areas, particularly the Midwest, expanding Naloxone access has increased opioidrelated
mortality. Opioid-related mortality also appears to have increased in the South and
most of the Northeast as a result of expanding Naloxone access.

Our findings do not necessarily imply that we should stop making Naloxone available to
individuals suffering from opioid addiction, or those who are at risk of overdose. They do
imply that the public health community should acknowledge and prepare for the behavioral
effects we find here. Our results show that broad Naloxone access may be limited in its
ability to reduce the epidemic’s death toll because not only does it not address the root
causes of addiction, but it may exacerbate them. Looking forward, our results suggest that
Naloxone’s effects may depend on the availability of local drug treatment: when treatment is
available to people who need help overcoming their addiction, broad Naloxone access results
in more beneficial effects. Increasing access to drug treatment, then, might be a necessary
complement to Naloxone access in curbing the opioid overdose epidemic.
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Postby husbands » Tue Mar 06, 2018 7:32 pm

enjoying this backlash to the Doleac and Mukherjee paper

this is what happens when economists try to colonize other fields
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Postby inspectorhound » Tue Mar 06, 2018 7:47 pm

ok reading the paper

using google trends as proxies and only using data from cities seems very lazy
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Postby def from above » Tue Mar 06, 2018 7:48 pm

bear wrote:
Policymakers have multiple levers available to fight opioid addiction, and broadening
Naloxone access aims to directly address the most dire risk of opioid overdose: death. Naloxone
can save lives and provide a second chance for addicted individuals to seek treatment, but
access to this lifesaving drug may unintentionally increase opioid abuse by providing a safety
net that encourages riskier use. This paper shows that expanding Naloxone access increases
opioid abuse and opioid-related crime, and does not reduce opioid-related mortality. In fact,
in some areas, particularly the Midwest, expanding Naloxone access has increased opioidrelated
mortality. Opioid-related mortality also appears to have increased in the South and
most of the Northeast as a result of expanding Naloxone access.

Our findings do not necessarily imply that we should stop making Naloxone available to
individuals suffering from opioid addiction, or those who are at risk of overdose. They do
imply that the public health community should acknowledge and prepare for the behavioral
effects we find here. Our results show that broad Naloxone access may be limited in its
ability to reduce the epidemic’s death toll because not only does it not address the root
causes of addiction, but it may exacerbate them. Looking forward, our results suggest that
Naloxone’s effects may depend on the availability of local drug treatment: when treatment is
available to people who need help overcoming their addiction, broad Naloxone access results
in more beneficial effects. Increasing access to drug treatment, then, might be a necessary
complement to Naloxone access in curbing the opioid overdose epidemic.


It's great that they clarify that their position isnt one of outright eugenics or Social Darwinism. But at the same time, this attempt at nuance seems to suggest their findings are meaningless (they add nothing of importance to our stock of knowledge). Did any city or organization that promotes harm reduction and naloxone usage ever suggest that this substance could solve the overall problem of drug abuse? Or that it simply reduced risk of overdose deaths so that people can live long enough to have the opportunity to go to treatment and have it stick? So "Increasing access to drug treatment, then, might be a necessary complement to Naloxone access in curbing the opioid overdose epidemic" is a non-finding because it's precisely what all responsible organizations promoting harm reduction are pushing for already. Who exactly do they think their audience is? Let's pray to christ it's not the government...
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Postby pantsoclock » Tue Mar 06, 2018 8:02 pm

These quotes are centering on "opioid abuse" as the variable to be controlled, as in this quote:
access to this lifesaving drug may unintentionally increase opioid abuse

That is as opposed to the *effects* of opioid abuse, of which dying of overdose is the most severe. Engaging with the topic in a way that opposes "directly addressing the most severe effect of opioid usage" with "increased opioid abuse" reveals a moralistic stance toward opioid usage on the part of the authors. It's such an absurdly general and simplistically moralizing perspective on the situation that speaks to their complete lack of engagement with the actual public health community that actively works on this issue. That's most dramatically illustrated by their citation of "narcan parties," an absurd and completely debunked idea.
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Postby inspectorhound » Tue Mar 06, 2018 8:26 pm

it's kind of insane to me that people like this are employed at prestigious universities

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Postby deadbass » Tue Mar 06, 2018 9:33 pm

Linking the general rise in opioid use, presence of fentanyl and overall danger that opioids pose to human life with the increased presence of Naloxone is criminally irresponsible. Shouldn't economists have correlation != causation tattooed on them at this point?
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Postby def from above » Tue Mar 06, 2018 10:08 pm

deadbass wrote:Linking the general rise in opioid use, presence of fentanyl and overall danger that opioids pose to human life with the increased presence of Naloxone is criminally irresponsible. Shouldn't economists have correlation != causation tattooed on them at this point?


precisely

maybe this is what happens to some people working in a publish-or-perish environment. they end up with contrived studies based in questionable research design just to get another notch on their belt.
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Postby husbands » Wed Mar 07, 2018 8:08 am

def from above wrote:
deadbass wrote:Linking the general rise in opioid use, presence of fentanyl and overall danger that opioids pose to human life with the increased presence of Naloxone is criminally irresponsible. Shouldn't economists have correlation != causation tattooed on them at this point?


precisely

maybe this is what happens to some people working in a publish-or-perish environment. they end up with contrived studies based in questionable research design just to get another notch on their belt.



they have an identification strategy. They use differences in differences, which is a way to isolate a causal effect (by controlling for aspects of the data that you assume do not change for just places that expanded access over time):

The DD framework relies on the assumption that places that have not (yet) expanded access to Naloxone are informative counterfactuals for places that have expanded access. The identifying assumption is that, absent the policies, and conditional on a broad set of control variables, our outcome measures of interest would have evolved similarly in treatment and control jurisdictions. (This is commonly referred to as the parallel trends assumption.)

Given these concerns, we pay close attention to the parallel trends assumption. We control for a variety of factors and examine pre-existing trends to ensure as best we can that changes in the outcomes studied are attributable to the causal effects of broadening Naloxone access, rather than to other differences between places that broaden access to this drug. In particular, we will control for other laws that states adopted that might affect opioid use and abuse.


I think that the authors did a very bad job framing the project and interpreting results but they tried reasonably hard to identify the causal effect
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Postby buriedinspace » Wed Mar 07, 2018 10:08 am

Hadn't seen this thread but I've been working with a syringe exchange/harm reduction organization in Greensboro, NC for the last 6-8 months. It's user run and part of a somewhat nascent nationwide network of drug user unions 'Urban Survivor's Union' with others in San Francisco and Seattle. There's only one in Greensboro because the lady who runs it, Louise Vincent, is pretty much a fucking superhero of grant writing and also just general harm reduction knowledge. She did underground syringe exchange in NC for a decade before it was legal and got arrested several times for it, until being part of the coalition that helped pass a legal syringe exchange law about a year and a half ago. She speaks all over the country (occasionally all over the world with orgs like INPUD) at conferences - she just spoke in West Virginia connected the epidemic mentioned upthread.

We handed out thousands of naloxone last year and had something like 350-500 reported successful uses of it. We center users whenever possible into leadership roles (I'm not a user but I'm probably there second most of anyone in the org, so I've gotten a nice role by some level of attrition) and do trainings on proper usage of naloxone, on harm reduction and safe use and other stuff.

Over the next 6-9 months, I have a plan to do a research study looking into intersections and vulnerabilities in the populations that use our services, looking at race, gender etc but also mental health, learning and physical disabilities, incarceration history, chronic pain, insecure housing and homelessness. It's something I'm doing in part to satisfy requirements for my undergrad degree but also I think it's going to be really fucking interesting stuff.

There's little in my life more satisfying than being able to serve people who are so utterly used to being stigmatized and looked down on in a way that provides respect and dignity to them. I've made friends with a decent handful of the participants and was really happy to be able, this past week, to help with a letter that will probably allow one of my fave participants to get off a bullshit charge due to the fact that NC has a syringe exchange law that means there's no reason anyone, especially that's at all associated with us (and carries our card) to be charged with any sort of paraphernalia charge.
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Postby gershon » Thu Mar 08, 2018 5:32 pm

Heyyyy buriedinspace!!! We love Louise Vincent in Phoenix, AZ. We have been operating an unauthorized/illegal syringe access program and use Louise's decades wealth of knowledge in ours and our partner organization's advocacy efforts for legitimacy in Arizona. Sonoran Prevention Works' Executive Director (a harm reduction advocacy and naloxone distributer) used Louise's advocacy as a framework for our own state efforts: first we got lay-person naloxone access approved through the state government, now we are focused on legalizing syringe access/exchange programs. It's been a seven years long project.

I've been a vocal outreach volunteer with the "illegal" syringe program in Maricopa County/Phoenix, AZ and have been taking on advocacy, fundraising, and grant writing work for them, as well. I love the work and the opportunity to be a peer advocate for drug users. I operate a fixed site one night a week and the participants deserve quality health services and I will fight for their right to get it.

buriedinspace, are you going to the harm reduction coalition conference in New Orleans in October? I'll be there:)
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Postby Hal Jordan » Thu Mar 08, 2018 7:51 pm

Inspred by yalls good worj.
well that was intense
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Postby joe » Thu Mar 08, 2018 7:57 pm

husbands wrote:I think that the authors did a very bad job framing the project and interpreting results but they tried reasonably hard to identify the causal effect


that's the economics i know and love
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Postby buriedinspace » Thu Mar 08, 2018 9:58 pm

gershon wrote:
buriedinspace, are you going to the harm reduction coalition conference in New Orleans in October? I'll be there:)


Hoping to! Last year's DPA conference sounded rad af and I missed it. I have a scholarship request in for it and I would imagine I'll get it? Regardless, might try and stow away with some people if not. ;)
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