
Orphaned by America's opioid epidemic - pmcpinto
http://www.washingtonpost.com/sf/national/2016/12/17/orphaned-by-americas-opioid-epidemic/
======
Sanddancer
Opioid addiction is a symptom, not the disease. The disease is a generation of
people who are left behind, who don't have the mobility to go where the jobs
are, who can't go back to school because there are no schools in the area. The
disease is the minimum wage job at dollar general which keeps their employees
at 28.5 hours to keep from having to provide all the social and economic
obligations of maintaining a full time employee. The disease is a lack of
psychologists who can treat the underlying despair and hopelessness caused by
living in a dying county. The disease is a lack of physical therapists that
can teach exercises to help keep the pain away. The disease is a complete lack
of infrastructure that entraps people in these small towns. The disease is an
employment system that ensure that a drug conviction from ten years ago
precludes them from having any sort of decent job. The disease is stigma and
stagnation. We won't stop this epidemic until we fix the broken system that
let it happen in the first place, and that's going to take a lot more help and
a lot more money than just blaming the doctors and drug companies.

~~~
sdenton4
When drugs are a problem in black communities, and the pushers are people of
color, it's a criminal problem. And when it's a white problem, with corporate
pushers, it's a problem of Big Systems which need fixing...

By all means, let's work on fixing unemployment and hopelessness in these
United States. But let's feel free to shut down a couple brazenly unethical
corporate outfits along the way.

~~~
Sanddancer
I talk about the same thing when inner city drug problems are brought up to.
The article isn't about the greater problem of the war on drugs, it's about
the problem as it pertains to a very poor part of West Virginia. If you aren't
going to fix the underlying problems, then bringing down the exploiters isn't
going to do a damn thing, because more will just take their place.

------
Scaevolus
Treating opiate addiction with suboxone (one of the most effective methods) is
largely blocked by bureaucracy:
[http://slatestarcodex.com/2015/02/02/practically-a-book-
revi...](http://slatestarcodex.com/2015/02/02/practically-a-book-review-dying-
to-be-free/)

"They are worried that suboxone, being an opiate, might be addictive, and so
doctors might turn into drug pushers. So suboxone is possibly the most highly
regulated drug in the United States. If I want to give out OxyContin like
candy, I have no limits but the number of pages on my prescription pad. If I
want to prescribe you Walter-White-level quantities of methamphetamine for
weight loss, nothing is stopping me but common sense. But if I want to give
even a single suboxone prescription to a single patient, I have to take a
special course on suboxone prescribing, and even then I am limited to only
being able to give it to thirty patients a year (eventually rising to one
hundred patients when I get more experience with it). The (generally safe)
treatment for addiction is more highly regulated than the (very dangerous)
addictive drugs it is supposed to replace. Only 3% of doctors bother to jump
through all the regulatory hoops, and their hundred-patient limits get
saturated almost immediately."

~~~
bryondowd
Those are some great points and it probably should be more readily available.
But I still have some issues with Suboxone and the way it is being used. It
seems to be pushed as a lifetime substitution for illegal opiates, rather than
a tool for tapering off opiate dependence. When I was involved with someone in
this situation, I couldn't even find anything official about how to go off the
Suboxone, just anecdotes from people who had done it themselves. The doctors
seemed perfectly happy to prescribe whatever dose you wanted, as long as they
got their fees. And the smallest dose available was 2mg, which is apparently
too much to drop off from, meaning that to taper you have to manually cut
doses into small fragments. All together, it just seemed extremely sketchy to
me.

~~~
girvo
The smallest dose of buprenorphine is 0.4mg.

I was a heroin addict from 16yo, until just before my 22nd birthday. I've been
clean ever since, 4 years this past August. This is entirely down to my state
government's excellent opiate replacement therapy program, and buprenorphine.
It literally saved my life.

The clinic builds a plan for you specifically, and adjusts it every few
months. They provide counseling, advice and medical help. We don't pay them,
the government does. The doses themselves cost $5 per day.

~~~
bryondowd
I'm impressed, it sounds like your state has a system that is almost
incomparably better than mine. Grats on staying clean.

------
bopcrane
I can not understate how much of my little West Virginia town has been
destroyed by opioid addiction. There doesn't seem to be a perfect solution to
fix the problem, but I hope this will shed some light on the situation and at
least bring it to the forefront so hopefully real changes can be made to
combat this

~~~
wmeredith
I think you meant to say, "I cannot _overstate_ ".

~~~
bopcrane
absolutely. It's important to get sleep =)

------
jmadsen
Let's not ignore how a great many people got hooked on these in the first
place: Through their doctor.

Here is a relevant article from today:

[http://thehustle.co/oxycontin-global](http://thehustle.co/oxycontin-global)

Like tobacco, too much resistance in the US means Oxycontin is going global.

A shame the presidential candidates don't seem (as far as I'm aware) to have
mentioned this epidemic as one of the important crisis facing America. Might
have resonated deeper than ISIS or some other things.

~~~
gopalv
> A shame the presidential candidates don't seem (as far as I'm aware)

There was a fair bit of that (particularly NH primary, I think), though a lot
of it was lost in the noise of emails, FBI & the leaks.

[http://www.vox.com/2016/9/21/12973740/trump-clinton-
opioid-h...](http://www.vox.com/2016/9/21/12973740/trump-clinton-opioid-
heroin-epidemic)

I probably picked up on that was when I had to go pick up painkillers for a
family member ... with all the added complications of looking the way I do.

------
ghamrick
I question the ethical culpability of big pharma. Taken from the article "Drug
companies had bombarded West Virginia’s rural towns with record numbers of
narcotics, according to court records: 300,000 tablets of hydrocodone to the
mom-and-pop pharmacy in the town of War, population 808; half a million
oxycodone pills to Kermit, population 400. During a five-year period ending in
2013, a single drug company had shipped more than 60 million doses of
hydrocodone into a state with fewer than 1 million working-age adults."

I would prefer to use the term 'criminal liability' but I suspect there is
none for this crime

edit - IANAL - to be defined as a crime it would have to violate a criminal
law, and while this is ethically odious, it is most probably not criminal

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yarou
The opioid receptors and their corresponding endorphins are truly beautiful. A
work of art in its own right.

I think the epidemic here is not one of public health, but of the
socioeconomic variety. If you are unemployed and don't have meaningful
relationships, you will naturally try to escape your reality. Heroin is the
quintessential drug of choice for those who want to dream.

------
gotthemwmds
This page is so poorly designed that I -- an engineer with 15 years experience
and a mid 6 figure salary -- can not figure out how to read the actual
article.

Why are newspapers trying this hard to implement shitty webUX gimmicks? Give
me the words.

~~~
gotthemwmds
Might be a Chrome issue? There is something that locks scrolling about 500ms
after the page loads. No overlay or anything, just a totally unresponsive
picture of some sad kids.

Overall though, this is pretty pathetic on their part.

