America’s opioid epidemic is worsening

I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That&#x27;s roughly .01% of the county&#x27;s total population - so yeah, it&#x27;s getting bad here.<p>There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related.<p>I can&#x27;t help but look around and believe that the needs these folks are trying to satisfy are completely human, and that forcing the users to resort to black markets leads to violence and overdoses. I can&#x27;t help but think this problem in my community could be solved by simply letting people get high.<p>Maybe the answer isn&#x27;t to make heroin available OTC at Walgreens, but supervised injection sites seem to be gaining traction[1]. I think a lot of the dark red spots on the map, like mine, should probably consider this option.<p>It&#x27;s not like anything else is working.<p>[0]<a href="http:&#x2F;&#x2F;www.tribtoday.com&#x2F;news&#x2F;latest-news&#x2F;2017&#x2F;03&#x2F;fri-920-pm-23-overdoses-recorded-in-48-hours-in-trumbull&#x2F;" rel="nofollow">http:&#x2F;&#x2F;www.tribtoday.com&#x2F;news&#x2F;latest-news&#x2F;2017&#x2F;03&#x2F;fri-920-pm...</a> [1]<a href="http:&#x2F;&#x2F;www.seattletimes.com&#x2F;seattle-news&#x2F;health&#x2F;safe-injection-sites-get-ok-from-king-county-health-board&#x2F;" rel="nofollow">http:&#x2F;&#x2F;www.seattletimes.com&#x2F;seattle-news&#x2F;health&#x2F;safe-injecti...</a>

My sister is a heroin addict. To say this has devastated her life is an understatement. Her body is wrecked. She looks way older than she is, she has a pacemaker &#x2F; defibrillator installed in her chest. And doctors keep saying she will die soon if she doesn&#x27;t stop.<p>Here is the most frustrating part. She has wanted to go to rehab a few times, but since she is poor and unemployed, she has no health insurance for rehab. What are her options? My parents have no money to help her.<p>I&#x27;ll never understand the bull-shit US policy towards drugs. Let&#x27;s spend billions upon billions to &quot;fight&quot; drugs coming into the country, but let&#x27;s turn a blind eye to the companies pumping out hundreds of millions of pills.<p>Why the hell don&#x27;t we spend those hundreds of billions on actually treating the disease? If there was no demand, there would be no drug war to fight. Why don&#x27;t we try a new way?

And a potential solution to it:<p><a href="https:&#x2F;&#x2F;arstechnica.com&#x2F;science&#x2F;2017&#x2F;03&#x2F;tweaking-fentanyls-chemical-structure-may-create-safer-opioid&#x2F;" rel="nofollow">https:&#x2F;&#x2F;arstechnica.com&#x2F;science&#x2F;2017&#x2F;03&#x2F;tweaking-fentanyls-c...</a><p><i>For their chemical makeover, the researchers noted that when tissue is damaged and hurting, it becomes inflamed and more acidic. The pH drops from approximately 7.4—what’s seen in normal, healthy tissue—to between 5 and 7. Fentanyl can work regardless of the pH, so it’s active throughout the nervous system no matter what. But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. And with no activity in the central nervous system, it would dodge opioid’s serious side-effects, including addiction and systemic responses that can be lethal during overdoses.</i><p>They&#x27;re testing a modified version of fentanyl that only works in lower pH, restricting its activity to injured areas of the body, eliminating the risk of overdose and dependence:<p><i>In further experiments, the researchers noted that, unlike fentanyl, high doses of NFEPP weren’t lethal to the rats. And rats on the NFEPP didn’t display impaired motor activity or reward-seeking behavior linked to addiction.</i>

Given that this article only touches on the supply of these drugs, is there a tacit assumption that the demand for opioids is driven by unemployment? If so, what can be done about the demand for these drugs in the long term? &quot;Bringing back jobs&quot; to those people whose comparative advantage is no longer manufacturing by taxing robots or imposing tariffs is a temporary stall, and to the degree it does work it amounts to a fat, inefficient handout.<p>Fighting the &quot;epidemic&quot; 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&#x27;t see any possible answers floated.

I&#x27;m going to comment here with a plug for the March For Science, on April 22.<p>Why?<p>Because the opioid epidemic started with a simple matter of scientists not being allowed to science.<p>Purdue Pharmaceuticals marketed oxycontin as a drug that lasts for 12 hours.<p>The evidence indicated it only lasted for 8.<p>If Purdue&#x27;s scientists were allowed to act on the evidence, i.e. to be actual scientists, the whole world would have known this years ago. People prescribed oxycontin would have been told to plan for 8 hours of relief, not 12.<p>Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began.<p>Science is important, yo.

Maintenance treatments with long-acting opioids like methadone tend to come with a withdrawal that lasts for months.<p>Meanwhile, short-acting opiates like heroin have a withdrawal period that lasts about a week. Is it any wonder methadone patients switch back to heroin when they try to quit for good?<p>Mark my words, this isn&#x27;t going away or getting any better. You can prosecute doctors, regulate all you want, burn fields of poppies. None of it will affect the demand nor the supply. You can&#x27;t price or regulate someone out of an addiction.<p>If people get cut off wholesale from their prescriptions because doctors are being prosecuted for prescribing pain medication, they&#x27;ll turn to heroin. Which will be available, regardless of all the opium seized, regardless of cartels dismantled.<p>Just like when Oxycontin went under a formulation change making it resistant to abuse, which also caused the price to spike to a dollar per milligram.<p>People turned to heroin because it was cheaper, more potent, and much more widely available than pharmaceuticals could ever be.<p>If you think pill junkies are bad, wait until you look down an alley to see a heroin junkie injecting another junkie in the jugular because all her veins are blown out. Watch your step, though, lest you get a syringe in your foot.

So what is the answer here? Like another poster said, there&#x27;s a <i>demand</i> problem. How do we as a society address this? I&#x27;ve seen a lot of mumbles about dealing with supply problems, dealing with overdose problems, but it&#x27;d be good to head the problems off at the pass before they descend into major trouble.<p>I should also note, this is a burgeoning problem in the Puget Sound&#x2F;Seattle region. It&#x27;s not just rural people dying.<p>Can someone knowledgeable about drug policy &#x2F; sociology provide some insight in this thread?

We have ~400 overdoses per month here. ~20% of that is fatal overdoses because those ODs are from users doing it by themselves and not inside one of the shooting galleries we have set up. The safe injection sites work as advertised but for many reasons some addicts don&#x27;t go there, mainly because debt collecting gangsters and drug dealers hover all around the front doors, and stigma of standing in an addict lineup that spreads for blocks for all to see.<p>There&#x27;s a few reports here from VANDU a group run by addicts on the effectiveness of peer-run supervised injection sites and needle exchanges, meaning run by other addicts instead of government employees <a href="http:&#x2F;&#x2F;www.vandu.org&#x2F;reports&#x2F;" rel="nofollow">http:&#x2F;&#x2F;www.vandu.org&#x2F;reports&#x2F;</a><p>The problem is synthetic opioid is being used to buff out heroin so street dealers can save money by importing less heroin from India (how it comes into Canada). They keep coming up with new synthetics to bypass precursor prohibition or import laws, plus China has factories pumping this shit out legally which can easily be smuggled since it costs far less than heroin from India&#x2F;Afghanistan.<p>Whenever you talk to a street addict basically the reason they got on heroin was they had some other substance abuse problem, usually cocaine, alcohol or meth, there was a shortage of that substance because either they couldn&#x27;t afford it, busts made it scarce, or they were in jail so through peers they accessed heroin instead and got hooked.<p>Methadone doesn&#x27;t work, they&#x27;ve already abandoned that idea here and moved to just handing out heroin to the worst cases, or hydromorphone which has a proven success rate in weening addicts off drugs.<p>Somewhere in all this is a solution that doesn&#x27;t involve enabling career bums who want free heroin for life and doesn&#x27;t involve 400+ ambulance calls per month draining our resources.

A potential solution:<p>&gt;Legal Heroin Prescriptions: The ‘British System’ You Never Knew Existed<p>Basically prescribe heroin for the addicts so they don&#x27;t need to deal &#x2F; steal and the thing dies out. You could link getting the prescription to doing something useful work wise if you want to be moralistic. Been done since the 1920s - tried and tested.<p><a href="http:&#x2F;&#x2F;www.huffingtonpost.co.uk&#x2F;entry&#x2F;heroin-prescription-diamorphine_uk_57fd2f6ee4b0430f66f67894" rel="nofollow">http:&#x2F;&#x2F;www.huffingtonpost.co.uk&#x2F;entry&#x2F;heroin-prescription-di...</a>

In the UK it appears that there&#x27;s a Spice epidemic. It&#x27;s often called &quot;synthetic cannabis&quot; or &quot;(formerly) legal highs&quot;, but it in reality it&#x27;s all kinds of research chemicals sprayed onto leaves to be smoked. It has some pretty hideous side effects, and seems very addictive (<a href="https:&#x2F;&#x2F;video.vice.com&#x2F;en_uk&#x2F;video&#x2F;the-hard-lives-of-britains-synthetic-marijuana-addicts&#x2F;55ccad2d2b68305332db7128" rel="nofollow">https:&#x2F;&#x2F;video.vice.com&#x2F;en_uk&#x2F;video&#x2F;the-hard-lives-of-britain...</a>)<p>Oh, and the government just handed the whole market over to illegal drug dealers, with fairly predictable results.

If you&#x27;re looking for a go-to book on America&#x27;s opioid crisis- Dreamland by Sam Quinones.<p><a href="http:&#x2F;&#x2F;www.goodreads.com&#x2F;book&#x2F;show&#x2F;22529381-dreamland" rel="nofollow">http:&#x2F;&#x2F;www.goodreads.com&#x2F;book&#x2F;show&#x2F;22529381-dreamland</a><p>The devil is absolutely in the details and it seems like it&#x27;s gonna get a lot worse before it gets better.

I&#x27;m on the gulf coast, and we just had a high-profile prosecution of a doctor running a pill mill.<p>What if this whole mess isn&#x27;t so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don&#x27;t have this problem.<p>In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable. It is not hard to believe that medicine operates similarly.

The first time I saw a TV commercial here in the US for a pill to battle opiod induced constipation, I realized just how many people are taking large doses of the stuff. Pretty staggering to me.

Check <a href="https:&#x2F;&#x2F;morecrows.wordpress.com&#x2F;2016&#x2F;05&#x2F;10&#x2F;unnecessariat&#x2F;" rel="nofollow">https:&#x2F;&#x2F;morecrows.wordpress.com&#x2F;2016&#x2F;05&#x2F;10&#x2F;unnecessariat&#x2F;</a> for some deep reasons and for a feel how bad it is. Don&#x27;t blame this or that pharma for it, that&#x27;s a distraction.

I&#x27;ll never understand locking people up for having an addiction and treating them like criminals. I&#x27;m not too educated on how it&#x27;s handled in America but in Australia you can go to your doctors and get signed up to a methadone program without worrying about any legal repercussions.<p>My fiancé works at a pharmacy in Melbourne, Australia and says some of the most lovely and friendly people who just want to get themselves together come in regularly to get their $5 dose and it&#x27;s saddening to see how badly society judges them.

I know the United States will never do it, but Singapore barely has a drug problem because they execute dealers and have mandatory treatment for users. I&#x27;m not advocating the ridiculous policy that the Phillipines has, but Singapore doesn&#x27;t mess around if they find distribution levels of illegal drugs on you. There also needs to be much stricter control of new prescriptions for opioids, which lead to addiction.

The only thing that is good about this epidemic is that it seems to have moved harm reduction onto the agenda after decades of militarized and&#x2F;or &quot;lock &#x27;em up and throw away the key&quot; responses. Hopefully the result will be a more rational response for <i>all</i> of America&#x27;s drug problems regardless of the color of the users.

&gt;States have since cracked down on prescription opioid abuse, creating drug-monitoring programmes and arresting unscrupulous doctors.<p>So if you look at the chart, when they started doing this, heroin overdoses skyrocketed while pill overdoses stayed about the same. They doubled the deaths with their crackdown solution, as if that has <i>ever</i> worked.

&gt; The opioid epidemic has its roots in the explosive growth of prescription painkillers. Between 1991 and 2011, the number of opioid prescriptions (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied by American retail pharmacies increased from 76m to 219m. As the number of pain pills being doled out by doctors increased, so did their potency. In 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three.<p>I find this absolutely outrageous. I&#x27;m not American, but I stumble upon articles mentioning this, and I do watch enough American TV series and movies to have an idea of how acute the problem is (it&#x27;s crazy how often in TV series doctors seem to give pain killers like it&#x27;s candy).<p>I have the impression that in Europe, painkillers are much less used but I would not be surprised if the American trend were to contaminate medical practice here.<p>Pain is a minor consequence of disease or trauma. Pain won&#x27;t kill you, so why would you risk become addicted to very dangerous drugs just to relieve it?

One of the best books I&#x27;ve ever read on <i>why</i> the war on drugs is a bad idea. It&#x27;s written by a UK cop who was there nearly from the beginning.<p><pre><code> https:&#x2F;&#x2F;www.amazon.com&#x2F;Good-Cop-Bad-War&#x2F;dp&#x2F;1785032690&#x2F; Good Cop, Bad War (Paperback) Publisher: Ebury Press Language: English ISBN-10: 1785032690 ISBN-13: 978-1785032691</code></pre>

I say this mostly tongue-in-cheek because I hate to apply one bad policy to fix another, but I bet if narcotic overprescription could more readily trigger medical malpractice, you&#x27;d see doctors thinking more judiciously about their use.<p>Even if exaggerated by an order of magnitude, stats like this are just indefensible: <a href="http:&#x2F;&#x2F;www.webmd.com&#x2F;mental-health&#x2F;addiction&#x2F;news&#x2F;20160325&#x2F;nearly-all-us-doctors-overprescribe-addictive-narcotic-painkillers-survey#1" rel="nofollow">http:&#x2F;&#x2F;www.webmd.com&#x2F;mental-health&#x2F;addiction&#x2F;news&#x2F;20160325&#x2F;n...</a>

I read that Medicaid is being used to fuel the black market pipeline.<p>$3 copay gets you a $1000 street value opioids...<p>Of course this is corporate welfare for the opioid manufacturers.<p>I also read that one month 11% of Ohio&#x27;s population was prescribed painkillers.

Read Chasing the Scream [1], a fantastic book that documents drug prohibition in the USA, how doctors who viewed it as a health issue got chased out of their desire to help, and suggests many paths to helping people and making the world a better, safer place.<p>I&#x27;ve posted this in enough threads that I probably seem like a bot advertising for it, but seriously, it&#x27;s a book worth reading and that can change someone&#x27;s entire opinion on the drug epidemic and what legislation we should pass.<p>[1] <a href="http:&#x2F;&#x2F;chasingthescream.com&#x2F;" rel="nofollow">http:&#x2F;&#x2F;chasingthescream.com&#x2F;</a>

This article I recently submitted had some interesting stats on the relationship between opiates and the welfare state:<p><a href="https:&#x2F;&#x2F;www.commentarymagazine.com&#x2F;articles&#x2F;our-miserable-21st-century&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.commentarymagazine.com&#x2F;articles&#x2F;our-miserable-21...</a><p>Although the entire article is worth reading, jump down to the paragraph that begins with &quot;The opioid epidemic...&quot; and read for about ~5 paragraphs if that&#x27;s all that interests you.

Is a war on drugs a good response? Hyper-aggressive policing? Lock up even minor participants for decades?<p>Consider why people thought that was a good response when drugs struck other communities.

Could weed slow down the opioid epidemic? It gets you high, it is way cheaper, way healthier (not smoked), it isn&#x27;t addictive, curbs the urge for opioids, easier to make, easier to sell.<p><a href="https:&#x2F;&#x2F;www.theatlantic.com&#x2F;health&#x2F;archive&#x2F;2017&#x2F;02&#x2F;marijuana-cannabinoids-opioids&#x2F;515358&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.theatlantic.com&#x2F;health&#x2F;archive&#x2F;2017&#x2F;02&#x2F;marijuana...</a>

What is causing the variation on the prescription opioid graph do you think? The other two graphs don&#x27;t have similar patterns to such degree.

These stories are so frightening to me that I contemplate just enduring the suffering if I am ever unfortunate enough to be prescribed oxy or dilaudid.

I once read of a 20-year-long study that found that when heroin-addicted UK doctors were given unlimited access to pure heroin they performed slightly better than their non-heroin-addicted colleagues, and they had no negative long-term health consequences. If anyone else has heard of this study, or especially if they have some documentation on it, I would appreciate a link.

There is something obviously wrong or at least strange with the data that backs that map. Look at the contrast across the border between Tennessee and Georgia or between West Virginia and Virginia. I think some states must be under-reporting things or reporting them differently. I would expect such a map to track poverty maps or unemployment maps, but it does not.

Methadone clinics work; Zurich is a good example. Hard to manage; hard on the community; but it eventually kills off the problem.

You know Trump&#x27;s solution? Jail for everyone. No wonder why US has 25% of the world&#x27;s total inmate population...<p>[0]<a href="https:&#x2F;&#x2F;www.thoughtco.com&#x2F;states-spending-money-prisons-not-schools-4068528" rel="nofollow">https:&#x2F;&#x2F;www.thoughtco.com&#x2F;states-spending-money-prisons-not-...</a>

So the Federal Government should Legalize Cannabis and allow research into it&#x27;s painkiller effects?

I watched this BBC documentary a few days ago: <a href="http:&#x2F;&#x2F;www.bbc.com&#x2F;news&#x2F;magazine-37992809" rel="nofollow">http:&#x2F;&#x2F;www.bbc.com&#x2F;news&#x2F;magazine-37992809</a><p>It seems that new painkillers such as oxycodone have something to do with the surge.

John Oliver spoke about this in depth: <a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=5pdPrQFjo2o" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=5pdPrQFjo2o</a><p>Humor aside, he managed to compile an impressive amount of testimonials and facts.

The states with medical cannabis don&#x27;t have anywhere near this problem. They need to cover medical cannabis via medicaid that would seriously put a dent in the crisis or at least keep it from growing bigger.

What is causing this? IS this prescription drug dependence? Because this wasn&#x27;t a problem 10 or 20 years ago!

<a href="https:&#x2F;&#x2F;www.reddit.com&#x2F;r&#x2F;politics&#x2F;comments&#x2F;5v43rj&#x2F;how_mike_pence_used_obamacare_to_halt_indianas&#x2F;ddzapo8&#x2F;?st=izgcbq4v&amp;sh=d07521d3" rel="nofollow">https:&#x2F;&#x2F;www.reddit.com&#x2F;r&#x2F;politics&#x2F;comments&#x2F;5v43rj&#x2F;how_mike_p...</a><p>Also read other comments in the thread about history of needle exchange programs etc.

I _wondered_ what the political &amp; law enforcement community was going to do, with the clear failure of the War on Drugs and growing demands for legal marijuana.<p>Never fear! Here&#x27;s the latest Demon Drug, which we can use to whip up popular support for another round of failed prohibition-mentality policies. No need to worry about budget cuts, reduction in the availability of military weapons, drones, etc. to law enforcement. There will still be a viable career in persecuting some of the most vulnerable members of society.<p>Those in favour of harm minimisation need to fight for legalisation, or at the very least decriminalisation as a strating point. Not just for _their_ favourite drug, but for those causing the most harm right now.

US may need to follow Philippines anti-drug campaign.

Hard to believe there is really an &quot;epidemic&quot; beyond typical fearmongering and political noise. People have always used drugs, this is nothing new. Unfortunately all the hype and noise is having significantly negative consequences to the medical community, doctors, and patients who actually need these things.