Do we have a thread about the opioid epidemic?

Health insurance rip off lying FDA big bankers buying
Fake computer crashes dining
Cloning while they're multiplying
Fashion shoots with Beck and Hanson
Courtney Love, and Marilyn Manson
You're all fakes
Run to your mansions
Come around
We'll kick your ass in

Postby WeirdJungle » Fri Jun 09, 2017 11:30 am

In the last week or so I've seen several well intentioned think pieces that really seemed to miss the mark (including the recent one in the New Yorker)

I'd love to see some critical discussion around:
-race and bias in media depictions of opioid use
-the role of pharma companies in creating the crisis
-potential solutions that don't hinge on individuals acting responsibility
ImageImageImageImageImageImageImageImageImageImageImage
User avatar
WeirdJungle
 
Posts: 2136
Joined: Mon Apr 08, 2013 12:39 pm
Location: sludge infinity

Postby Ankh » Fri Jun 09, 2017 11:32 am

my wife is a substance abuse counselor in ohio AMA
User avatar
Ankh
senior fellow
 
Posts: 20823
Joined: Mon Jan 11, 2010 10:01 am
Location: the gracious core

Postby hologram » Fri Jun 09, 2017 11:47 am

4 years off opiates...
why feel chemical warm when love with someone else is such a natural warm? :)
User avatar
hologram
acid casualty
 
Posts: 6799
Joined: Wed Sep 25, 2013 7:51 pm
Location: CORDUROY *COWBOY *

Postby pantsoclock » Fri Jun 09, 2017 11:53 am

This is my girlfriend's main area of research.
International Journal of Drug Policy just published one of her big pieces of research from the last year. Here's the abstract:
Background
Illicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island.

Methods
A mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants.

Results
Study participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n = 61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR) = 4.07, 95% CI: 1.24–13.3, p = 0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs.

Conclusion
Among illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of local users. The rapid scale-up of buprenorphine/naloxone provision may slow the rate of fentanyl-involved overdose deaths.

It's open access so you can read the whole thing if you want:
http://www.ijdp.org/article/S0955-3959(17)30127-5/fulltext
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby WeirdJungle » Fri Jun 09, 2017 11:59 am

I dunno, I guess I just want a gut check because the predominant narrative I've seen seems to be that the "forgotten people" (see also: Trump supporters) lost their jobs during the recession and turned to drugs to escape their situation. But it seems like the more proximal cause might be the unprecedented widespread availability of prescription opioids -- to what extent do you get the sense that this is a disaster that pharmaceutical companies have intentionally created and are continuing to make money from, both by selling the opioids and treatments like naloxone?
ImageImageImageImageImageImageImageImageImageImageImage
User avatar
WeirdJungle
 
Posts: 2136
Joined: Mon Apr 08, 2013 12:39 pm
Location: sludge infinity

Postby south pacific » Fri Jun 09, 2017 12:06 pm

I'd be interested to see a study that investigates whether taking street drugs cut with other chemicals lead to higher rates of cancers for users.
went to the theatre for the tickle contest
User avatar
south pacific
 
Posts: 2604
Joined: Wed May 26, 2010 8:00 pm
Location: honolulu

Postby pantsoclock » Fri Jun 09, 2017 12:07 pm

I don't have the citations in front of me, though I could extract them from my gf if she has the time later. Basically, the evidence isn't really there that prescription opioids are a "gateway" to "street" opioids like heroin in significant numbers.
There's evidence that doctors are not really well educated on opioids in the sense that they have a lot of misperceptions about strength, generally not understanding the differences between different strengths of pills, and hold significant classic biases against drug users, basically presuming that "addiction" is a moral failing on the part of the patient. This leads to prescription regimens from doctors and patient guidance that is not really attuned to the actual impact of the drugs they're providing.
There is evidence out there that drug companies willfully ignored the existence of "pill mills" and other deliberately illegitimate prescription providers, but the idea that the pharma companies are the primary actor in the opioid crisis is, and here I'm really just echoing the opinion of my gf, masking the more urgent responsibility of public health policy makers to provide resources for opioid users to remain safe and to remove stigma from opioids specifically.
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby hologram » Fri Jun 09, 2017 12:10 pm

I used to window shop at the er (some of my ugliest memories) and could tell they knew I was bullshitting with my cry wolf so I always had a guinea pig feeling to it all

I was pushing percs and tramadol hard with Draculina around 2011-12 and made it to the methadone stage where I lowered my freak flag and cold turkey'd that shit

Anyways, whether its Etnies or Dr. Scholls the shoe certainly fits when you're the one running drugs
User avatar
hologram
acid casualty
 
Posts: 6799
Joined: Wed Sep 25, 2013 7:51 pm
Location: CORDUROY *COWBOY *

Postby Ankh » Fri Jun 09, 2017 12:39 pm

pantsoclock wrote:I don't have the citations in front of me, though I could extract them from my gf if she has the time later. Basically, the evidence isn't really there that prescription opioids are a "gateway" to "street" opioids like heroin in significant numbers.


yeah, but it's frequently claimed bc it simplifies the problem and elicits sympathy for the (white) users
User avatar
Ankh
senior fellow
 
Posts: 20823
Joined: Mon Jan 11, 2010 10:01 am
Location: the gracious core

Postby Ankh » Fri Jun 09, 2017 12:41 pm

that sounds harsher than i mean it to. they absolutely deserve sympathy and compassionate treatment, it just sucks that they have to go through this misleading backdoor to get it
User avatar
Ankh
senior fellow
 
Posts: 20823
Joined: Mon Jan 11, 2010 10:01 am
Location: the gracious core

Postby Cone » Fri Jun 09, 2017 12:41 pm

There's some murderous fake Percocet going around Atlanta that's apparently killed a few people.
User avatar
Cone
 
Posts: 13491
Joined: Mon Oct 17, 2011 5:58 am

Postby husbands » Fri Jun 09, 2017 12:44 pm

as long as American life was something to be escaped from, the only solution to the problem is to get millions of ppl on suboxone
ROLL COAL
User avatar
husbands
 
Posts: 11321
Joined: Mon Dec 14, 2009 5:07 pm

Postby wario lopez » Fri Jun 09, 2017 12:44 pm

WeirdJungle wrote:-the role of pharma companies in creating the crisis


the FDA today just recommended to remove opana (oxymorphone) from the market.

this article from last year was really good about Purdue's marketing of oxycontin:
http://www.latimes.com/projects/oxycontin-part1/
http://www.latimes.com/projects/la-me-oxycontin-part2/
http://www.latimes.com/projects/la-me-oxycontin-part3/
✧・゚:*☆*・゜゚・*(っ◕‿◕)っ ᕕ( ᐛ )ᕗლ(๏‿๏ ლ)*・゜゚・*☆*:・゚✧
User avatar
wario lopez
ok
 
Posts: 9865
Joined: Sat Feb 25, 2012 9:15 am
Location: grimace island tiki hut

Postby pantsoclock » Fri Jun 09, 2017 12:57 pm

Potential Boarder wrote:
WeirdJungle wrote:-the role of pharma companies in creating the crisis


the FDA today just recommended to remove opana (oxymorphone) from the market.

this article from last year was really good about Purdue's marketing of oxycontin:
http://www.latimes.com/projects/oxycontin-part1/
http://www.latimes.com/projects/la-me-oxycontin-part2/
http://www.latimes.com/projects/la-me-oxycontin-part3/


The issue with this narrative is that there's a massive issue with *under* prescribing pain medication.
The cited reason for withdrawal of the drug here: http://www.nbcnews.com/storyline/americas-heroin-epidemic/fda-asks-drug-company-pull-its-opioid-opana-because-abuse-n770121 is "potential for abuse," but that's not a well defined concept. Talking about "the risks outweighing the benefits" as the FDA is quoted saying in this story, is ignoring the systemic issues with how drug law treats users in favor of an ineffective intervention. The people who will lose the "benefits" in question are people with pain management needs that are already caught in an arcane and arbitrary system where they face a high likelihood of being shamed by their doctors for being in pain.
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby Peptobysmal » Fri Jun 09, 2017 1:02 pm

husbands wrote:as long as American life was something to be escaped from, the only solution to the problem is to get millions of ppl on suboxone



It saved my life!
User avatar
Peptobysmal
 
Posts: 267
Joined: Fri May 27, 2016 9:59 pm

Postby Peptobysmal » Fri Jun 09, 2017 1:04 pm

I like what you're laying down, Pantsoclock. Interesting stuff.
User avatar
Peptobysmal
 
Posts: 267
Joined: Fri May 27, 2016 9:59 pm

Postby WeirdJungle » Fri Jun 09, 2017 1:08 pm

The issue with this narrative is that there's a massive issue with *under* prescribing pain medication.
The cited reason for withdrawal of the drug here: http://www.nbcnews.com/storyline/americas-heroin-epidemic/fda-asks-drug-company-pull-its-opioid-opana-because-abuse-n770121 is "potential for abuse," but that's not a well defined concept. Talking about "the risks outweighing the benefits" as the FDA is quoted saying in this story, is ignoring the systemic issues with how drug law treats users in favor of an ineffective intervention. The people who will lose the "benefits" in question are people with pain management needs that are already caught in an arcane and arbitrary system where they face a high likelihood of being shamed by their doctors for being in pain.


Can you expand on this a little?

As somebody who doesn't have any first hand knowledge, it sounded from the reports on Opana like there was a documented spike in abuse that was associated with outbreaks in blood borne diseases. I think you're saying the problem is that there aren't any good alternatives for the people who genuinely need the drug, so removing the option to use Opana has a negative effect on them that outweighs the potential positive effect of reducing abuse among a smaller set of people.
ImageImageImageImageImageImageImageImageImageImageImage
User avatar
WeirdJungle
 
Posts: 2136
Joined: Mon Apr 08, 2013 12:39 pm
Location: sludge infinity

Postby Damien Amadeus MetalWind » Fri Jun 09, 2017 1:11 pm

Cone wrote:There's some murderous fake Percocet going around Atlanta that's apparently killed a few people.


Was just talking about this today, my money's on fentanyl or a derivative.
kid8 wrote:women should know when to go fucking home. or at least call it a night. the theatrics aren't helping niña.
User avatar
Damien Amadeus MetalWind
ok
 
Posts: 3602
Joined: Mon Dec 14, 2009 4:07 pm
Location: ABQ

Postby Damien Amadeus MetalWind » Fri Jun 09, 2017 1:14 pm

I'm on my phone so I can't type up a long post but a problem that I see is also the regulation of buprenorphine/suboxone prescriptions. A doctor has to be licensed to prescribe it and has a cap of how many patients they can have. I'm not sure why this is.
kid8 wrote:women should know when to go fucking home. or at least call it a night. the theatrics aren't helping niña.
User avatar
Damien Amadeus MetalWind
ok
 
Posts: 3602
Joined: Mon Dec 14, 2009 4:07 pm
Location: ABQ

Postby pantsoclock » Fri Jun 09, 2017 1:29 pm

increase in injection drug use is going to be associated with an increase in the spread of blood borne diseases, yes. The direct answer to that is clean needle distribution and community education. There's lots and lots of material out there on the effectiveness of clean needle distribution. Here's one summary: https://www.aclu.org/fact-sheet/needle-exchange-programs-promote-public-safety
I'm not familiar with oxymorphone clinically (and I should definitely caveat that basically all my information is second-hand through my gf), but if we're talking about the benefits of pain medication, we're talking about pain management, often of people with chronic conditions. Under-prescription of pain medication is a known and widely discussed issue in disability advocacy circles: https://www.painnewsnetwork.org/stories/2016/10/4/dea-cutting-opioid-supply-in-2017
There's also racial disparity in pain medication prescription: http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0159224
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby pantsoclock » Fri Jun 09, 2017 1:30 pm

Damien Amadeus MetalWind wrote:I'm on my phone so I can't type up a long post but a problem that I see is also the regulation of buprenorphine/suboxone prescriptions. A doctor has to be licensed to prescribe it and has a cap of how many patients they can have. I'm not sure why this is.

Yeah my gf has a bunch of talking points about this as well.
Basically it's a hassle to get licensed, and there's not really a lot of incentive to, especially if this isn't a need you're seeing in your existing patient base.
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby pantsoclock » Fri Jun 09, 2017 2:04 pm

gf is home, tells me:
1. under-prescription is something that was significantly problematic 20 years ago but there *have* been major changes in prescribing guidelines that have improved that situation.
2. There's a good meta-study on the relationship between prescription opioid abuse and heroin use: http://www.nejm.org/doi/full/10.1056/NEJMra1508490#t=article
3. She recommends looking at the CDC guideline, which is in fact a summary of the lack of study of what actually is efficacious wrt prescribing opioids: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. She suggests that the 3rd party summaries of the guideline that have been written up in media significantly simplify what is written in the guideline itself, to the extent that they materially change what it actually says.
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby wario lopez » Fri Jun 09, 2017 2:06 pm

i'm at work right now, so i can't post much, but i work in mental health and substance abuse treatment and deal a lot with prescribing, used to work in an inpatient treatment program. can contribute more thoughts after work.
✧・゚:*☆*・゜゚・*(っ◕‿◕)っ ᕕ( ᐛ )ᕗლ(๏‿๏ ლ)*・゜゚・*☆*:・゚✧
User avatar
wario lopez
ok
 
Posts: 9865
Joined: Sat Feb 25, 2012 9:15 am
Location: grimace island tiki hut

Postby gershon » Fri Jun 09, 2017 2:21 pm

My close friends (all of us ex-heroin addicts) started and run the only harm reduction non-profit in Arizona. They hand out safety kits with naloxone and sharps in three different cities. Public opinion for harm reduction nationwide has become so much more accepting as the opiod epidemic spirals. They met with Arizona's governor who gave them a hug and told them to keep up the good work.
gershon
גֵּרְשׁוֹן
 
Posts: 1842
Joined: Mon Dec 14, 2009 7:46 pm

Postby Thalidomide » Fri Jun 09, 2017 2:25 pm

I'm posting to bookmark this for later. I work for a mental health and substance use crisis center, which has functionally become an opiate and opioid detox program due to the sheer scope of the community need. I'll have a lot to contribute I'm sure.
You are psychic.
You do not masturbate.
You do not know anger. Your patience is infinite.
Snakes are not dangerous to you. There are no snakes in the bottom of your bed.
User avatar
Thalidomide
 
Posts: 2105
Joined: Tue Dec 15, 2009 1:22 am

Postby Merciel » Fri Jun 09, 2017 2:28 pm

WeirdJungle wrote:But it seems like the more proximal cause might be the unprecedented widespread availability of prescription opioids -- to what extent do you get the sense that this is a disaster that pharmaceutical companies have intentionally created and are continuing to make money from, both by selling the opioids and treatments like naloxone?


Yes and no.

Image

is pretty good at tracing that particular strand of history (and charting the rise of Mexican dealers-on-demand using a very different distribution model than what we'd gotten used to here on the East Coast). If you're interested in the pharma companies' complicity, I think that's the best single source on that subject I've seen.
User avatar
Merciel
Hipinion Dog Lady
 
Posts: 24158
Joined: Mon Dec 14, 2009 5:06 pm
Location: dog dog dog

Postby pantsoclock » Fri Jun 09, 2017 2:33 pm

Damien Amadeus MetalWind wrote:
Cone wrote:There's some murderous fake Percocet going around Atlanta that's apparently killed a few people.


Was just talking about this today, my money's on fentanyl or a derivative.


gf forwards this image of one of the counterfeit pills in question:
Image

And that law enforcement has also identified this drug in counterfeit pills in addition to fentanyl: https://en.wikipedia.org/wiki/U-47700

edit: which is to say, they've generally found U-47700 in pills. The labs results for pills involved in the recent incidents has not come through her email yet.
Last edited by pantsoclock on Fri Jun 09, 2017 2:37 pm, edited 1 time in total.
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Postby wario lopez » Fri Jun 09, 2017 2:36 pm

re: complicity, the LA times articles on Purdue that I linked above are really good. purdue definitely knew they were mismarketing the medication, knew who the prescribers and pharmacies dispensing it were.
Purdue had access to a stream of data showing how individual doctors across the nation were prescribing OxyContin. The information came from IMS, a company that buys prescription data from pharmacies and resells it to drugmakers for marketing purposes.

That information was vital to Purdue’s sales department. Representatives working on commission used it to identify doctors writing a small number of OxyContin prescriptions who might be persuaded to write more.

By combing through the data, Purdue also could identify physicians writing large numbers of prescriptions – a potential sign of drug dealing.

Soon after Lake Medical opened, Purdue zeroed in on prescriptions of 80-milligram, maximum-strength OxyContin written by Eleanor Santiago. Once a respected physician, the 70-year-old was in failing health and drowning in debt when she took the job of clinic medical director alongside several other doctors.

The 80-milligram pills Santiago prescribed had the strength of 16 Vicodin tablets. Doctors generally reserved those pills for patients with severe, chronic pain who had built up a tolerance over months or years.

In the illegal drug trade, however, “80s” were the most in demand.

During the years that Lake Medical was in business, the pills could be crushed and smoked or snorted, producing a high similar to the drug’s chemical cousin, heroin. On the street, the pills went for up to $80 apiece.

A physician writing a high volume of 80s was a red flag for anyone trying to detect how OxyContin was getting onto the black market.

The number of prescriptions Santiago was writing wasn’t merely high. It was jaw-dropping. Many doctors would go their entire careers without writing a single 80s prescription. Santiago doled out 26 in a day.

Purdue was tracking her prescriptions.

Michele Ringler, the district sales manager for Los Angeles and a company veteran, went to Lake Medical to investigate. When she and one of her sales reps arrived, they found a building that looked abandoned, according to company emails recounting the visit. Inside, the hallways were strewn with trash and lined with a crowd of men who looked like they’d “just got out of L.A. County jail,” according to the emails. Feeling uncomfortable, Ringler and the rep left without speaking to Santiago.

When a Purdue security committee met in Stamford in December 2008, less than five months after Lake Medical opened, Santiago was under review, according to internal records and interviews. The panel, comprised of three company lawyers, could have reported her to the DEA. Instead it opted to add her name to a confidential roster of physicians suspected of recklessly prescribing to addicts or dealers.
✧・゚:*☆*・゜゚・*(っ◕‿◕)っ ᕕ( ᐛ )ᕗლ(๏‿๏ ლ)*・゜゚・*☆*:・゚✧
User avatar
wario lopez
ok
 
Posts: 9865
Joined: Sat Feb 25, 2012 9:15 am
Location: grimace island tiki hut

Postby wario lopez » Fri Jun 09, 2017 2:37 pm

had a friend recently overdose on u-47700, was in a coma for awhile. awful fucking shit.
✧・゚:*☆*・゜゚・*(っ◕‿◕)っ ᕕ( ᐛ )ᕗლ(๏‿๏ ლ)*・゜゚・*☆*:・゚✧
User avatar
wario lopez
ok
 
Posts: 9865
Joined: Sat Feb 25, 2012 9:15 am
Location: grimace island tiki hut

Postby pantsoclock » Fri Jun 09, 2017 2:44 pm

Damien Amadeus MetalWind wrote:I'm on my phone so I can't type up a long post but a problem that I see is also the regulation of buprenorphine/suboxone prescriptions. A doctor has to be licensed to prescribe it and has a cap of how many patients they can have. I'm not sure why this is.


gf points to this article: http://onlinelibrary.wiley.com/doi/10.1111/maq.12232/full which covers the differentiation in law around buprenorphrine vs methadone.
full text: https://s3-us-west-2.amazonaws.com/my-cool-images/Harris-2015-Medical_Anthropology_Quarterly.pdf
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
User avatar
pantsoclock
 
Posts: 4788
Joined: Mon Dec 14, 2009 4:18 pm

Next

Return to Mamma Mia... Here We Go Again....

Who is online

Users browsing this forum: Adult Contemporary, Alice, bear, belgavin, Big Oil, boatwave, brentwurst, Christmas Ape, Clive, crams, DAT TRILL FRIEND FRITZL, doublethink0, fakename, fester, Flossed Out, folkface, fresh, fuckles, fury, Future, goldmatt, goldsoundz, Google Adsense [Bot], grammatron, hyperbole man, i am rich, incoherent grunting, internethandle, jalapeño ranch, Jefferson Zeppelin, Jerry Lundegaard, king ding-a-ling, lights, marble, matte, mothlight, Mr Squishy, mutism, neely o'hara, office plant, patchperfect, Paul, Peter Dinklage, potentialgetawaydriver, qaanaaq, Rainbow Battle Kid, Robert, seafoam, shoulders technicolor, sideshow raheem, silverapples, Sobieski, speakers, Spooky Jim, sultanpepper, techno beats, That Demon Life, wakeman, wario lopez, WeirdJungle, wildarms, worrywort, yungboi, zach york