
What’s really causing the prescription drug crisis? - danharaj
http://www.latimes.com/opinion/op-ed/la-oe-hari-prescription-drug-crisis-cause-20170112-story.html
======
jordanb
This doesn't explain why people turn specifically to opiates and not to booze
or weed.

A recent article suggested that Purdue Pharmaceuticals dosing guidelines
pretty much guaranteed addiction to OxyContin, by advising doctors to only
ever prescribe the drug at 12 hour intervals despite the fact that it wore off
more quickly for a large number of patients.

When patients complained about the drug wearing off early, Doctors were
advised to not adjust the schedule but instead increase the dosage.

The pain-pleasure-reward cycle when the drug wears off early is what creates
the physical addiction, and increasing the dosage only made it worse.

Purdue insisted on a 12 hour schedule because that is the marketing
differentiater between OxyContin and generic opiates.

[http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

~~~
tominous
People _do_ turn to weed when it is legal [1]:

 _" The researchers found that doctors in a state where marijuana is legal
ended up prescribing an average of 1,826 fewer doses of painkillers per year"_

[1] [http://time.com/4404697/marijuana-opioid-
epidemic/](http://time.com/4404697/marijuana-opioid-epidemic/)

~~~
akjainaj
"an average of 1,826 fewer doses" is what percent?

~~~
xkcd-sucks
5 patients dosed once per day... Not a lot?

~~~
akjainaj
Yes, but without knowing what the total number of prescriptions is... it could
be 50%, or 0.005%

By the way, props to your nick :)

------
tcj_phx
The alcoholics I've known have all had underlying emotional problems. One
can't get over the business partner who left him holding the bag - it cost
hundreds of thousands of dollars for him to get the bank to leave him alone.

Another couldn't deal with her marriage falling apart. Prison also didn't help
her learn how to better deal with life.

I believe the third was turned into an alcoholic by methadone. The etiology of
this one's addictions is fascinating, but I think the main consideration is
the lack of stability growing up. Money was never a problem, but her family
life during childhood and teenage years was ... sub-optimal.

Emotionally-stable people tend to not become addicted to alcohol, heroin,
cocaine, etc. I've met former cocaine users whose attitude is "been there,
done that, no need to use again." That's kind of my attitude about alcohol - I
don't care for it at all, no matter the price.

A wise woman once said, "... When a person feels safe, the false ego goes
away." Helping people feel safe should be the #1 priority of every effort to
help someone with substance abuse problems.

~~~
sidek
You're absolutely right. Good emotional state is probably the key factor in
combating addiction. Yet it's important to remember that there exist other
factors at play in addiction, and that we should target them too. For
instance, addiction to alcohol seems to have some genetic factors. In some
genetic lines, almost every person with a low emotional state might be at huge
risk for addiction. And in others, almost no one might be at risk. We need to
also understand why that is, and combat that, too.

~~~
digi_owl
[http://www.stuartmcmillen.com/comics_en/rat-
park/](http://www.stuartmcmillen.com/comics_en/rat-park/)

~~~
rrdharan
Feel good story, results have not been reproduced:

[https://www.ncbi.nlm.nih.gov/pubmed/2616610?dopt=Abstract](https://www.ncbi.nlm.nih.gov/pubmed/2616610?dopt=Abstract)
[https://www.ncbi.nlm.nih.gov/pubmed/9148292?dopt=Abstract](https://www.ncbi.nlm.nih.gov/pubmed/9148292?dopt=Abstract)

~~~
zeroer
Thanks for the papers, but I take my science education solely in the form of
comics.

------
Alex3917
> Gin is legal today, and it is not causing social collapse.

Gin isn't legal the way it was back then. It's only sold in stores and places
with liquor licenses, it's heavily taxed, and there are all sorts of rules
surrounding it. If in we had gin carts every twenty feet hawking it at kids
and the homeless and it only cost a few cents per shot, I'm sure we'd have all
the same problems.

~~~
haraldooo
Over here in Europe (at least in Germany) you can buy as much Gin as you like
in every supermarket - if you're over 18. I don't know if we have higher
alcohol abuse numbers than countries with stricter laws but I doubt it. Does
anyone have internationally comparable numbers?

EDIT: forgot: it's very cheap. If I remember correctly, you can get a one
litre bottle for < 10 EUR - certainly not the best there is but "good enough"
to get drunk as f __* - even with little or no money

~~~
mark_edward
Children and youth is a key part of the GP, the younger you are addicted to
something the worse off you are in terms of quitting and the more damage it's
doing. Drugs with significant brain damage accompanying heavy use (like
alcohol) are also going to double-fuck you by adding the bonus challenge of
doing so with lower IQ, executive control, etc.

~~~
wavefunction
It takes a lot less gin as well, since kids have such a smaller body mass than
adults.

------
devoply
It's the economy stupid. Americans have nothing in their lives but their jobs.
Take those away and they start self-medicating. Well that's my pet theory any
way. Also have to consider the demographic most affected by job loss.

Why not weed or alcohol? Because opiates produce a high and make you feel
good. Much like work might, if you had it.

~~~
CuriouslyC
Jobs are just a manifestation of a deeper problem. The truth is, the pace of
change is too fast for society at large. It has eroded our traditions and
ideas about life, and we have yet to rebuild them.

~~~
chillwaves
I agree with this statement. Especially if you look over a few thousand year
timeline. Of course, the rate of technology has accelerated but also some of
the earlier changes have been normalized though we still reel from them. Even
the sense of community has been completely redefined (or minimized) by
technology today, or the concept of society being focus on nuclear family
only. Some are a direct result of technology, but some changes, like the
concept of leisure time, come indirectly as we restructure our lives around
this technology (capitalism and the industrial revolution).

Compare this to where we were 2,000 years ago or 10,000 years ago.

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a_imho
Going off tangent, visiting a friend who has a TV I could not help noticing
roughly 2/3 of ads are for drugs, sometimes there was a full block filled with
them.

~~~
tunap
The other 1/3 seem to be malpractice lawyers and sugar products... unless you
included the sugar in the drugs category. This is why I watch sports on pirate
feeds, the repetitive, inane ads replaced by a static image and bad(not worse)
muzak.

------
danharaj
Excerpt: _Doctors in many parts of the world — including Canada and some
European countries — prescribe more powerful opiates than their peers in the
United States. In England, if, say, you get hit by a car, you may be given
diamorphine (the medical name for heroin) to manage your pain. Some people
take it for long periods. If what we’ve been told is right, they should become
addicted in huge numbers._

 _But this doesn’t occur. The Canadian physician Gabor Maté argues in his book
“In the Realm of Hungry Ghosts” that studies examining the medicinal use of
narcotics for pain relief find no significant risk of addiction. I’ve talked
with doctors in Canada and Europe about this very issue. They say it’s
vanishingly rare for a patient given diamorphine or a comparably strong
painkiller in a hospital setting to develop an addiction._

~~~
anon4this1
Diamorphine is given IV/IM/SC - not orally - which generally means that its
use is confined to a short period in the first few hours/days of a hospital
admission until the patient can be switched to oral medication. Noone is sent
home with diamorphine unless they are end stage palliative and they are on a
home syringe driver to get it.

OTOH oxycodone is almost always orally administered which means patients stay
on it for longer in hospital and are commonly discharged with a prescription
for more.

The doctors I work with who have done fellowships in USA state that oxycodone
is (?was) given out like lollywater compared to hospitals here, where it is
only prescribed if the patient has a REALLY good reason they can't have oral
morphine.

~~~
DanBC
But people in UK do get oramorph, which is a liquid oral morphine.

~~~
anon4this1
Patients (and addicts) state there is a particular euphoria that oxycodone has
(and diamorph/heroin) that morphine doesn't really have. Of course oral
morphine does cause addiction, but oxycodone just seems to have greatly
increased rates.

------
jsz0
From what I've seen most people get started with opiates using them as an
instant gratification anti-depressant. For that purpose they are effective for
a while until the consequences of addiction start to set in. The worst part of
this is in that period before addiction they actually are happier, more
outgoing, more fun to be around, etc. So there's a sort of social dependency
that goes along with the chemical dependency.

~~~
autokad
"... more outgoing"

does that happen with people taking them? i felt when I took oxycodone I
wanted to be left alone. it could have also been I was physically unwell, but
it felt like the 'wanting to be alone' was a symptom and wasnt in pain

~~~
klibertp
Yes. Depends on a person, like in your case, also depends on dosage and
tolerance, but being more outgoing, honest and speaking more is certainly
possible as an effect of using opiates.

What opiates do is they simply make you feel good. They give you a feeling of
enjoying yourself. They don't make you ecstatic (for most people), but they
give you all the pleasant feelings you could get after - for example - running
and winning a race, for free. How those feelings affect your actions differs
from person to person.

------
alpineidyll3
This article is not quantitative or scientific, although I am certain there is
some validity to it's claims. Any same person would agree that trying to take
these drugs away from addicts will only push them to heroin. However to become
addicted one must try a substance, and or medical system has allowed far too
many opiates to be sold and facilitated far too many first experiences. To the
tune of 4x the number of prescriptions which should exist given US
epidemiology.

The interesting question is how you could show rigorously that this type of
safety net is effective.

------
sidcool
Pharma profits are one of the reasons for the opiate crisis, which results in
Heroin addiction in some cases. India is a good model where pharmas don't get
a free hand.

~~~
autokad
how do you figure pharma profits are one of the reasons for the crisis and to
what extent is that reason?

also out of curiosity, did you read the article?

~~~
sidcool
Yes. I am not commenting strictly in context of the article. But there are
many documentaries stating that opiates are pushed to doctors.

------
moomin
Given that the "first story" is thoroughly misrepresented and then the key
facts lack important distinctions between short and long term use, I'm going
to hazard a guess that the whole of this article is bunk.

------
akjainaj
The first theory "has been endorsed by some excellent journalists and
broadcasters, from Sam Quinones to HBO’s John Oliver", two die-hard liberals,
and according to this article it does not make sense; the one that makes
sense, though, is the one that says that people living in zones historically
neglected by liberals (such as the Rust Belt) "feel more distressed and
disconnected".

------
DoodleBuggy
Is there really a crisis?

Some people use and abuse drugs, drink, gamble, who cares? It's a victimless
crime.

~~~
mikeyouse
Not sure a more substantive post would be helpful but opiate epidemic is
anything but victimless;

[http://imgur.com/2UNEmfF](http://imgur.com/2UNEmfF)

~~~
DoodleBuggy
Drug use is almost entirely victimless. This is well studied, researched,
documented.

By definition a victimless crime involves consenting parties with no harm to
outside parties. There can be situations where something does impact a non-
consenting party, which is when it stops being victimless.

~~~
tcbawo
There is often collateral damage among family (children!), friends, and
coworkers of addicts. Complications caused by prenatal drug/alcohol use are
also well documented.

~~~
DoodleBuggy
> By definition a victimless crime involves consenting parties with no harm to
> outside parties. There can be situations where something does impact a non-
> consenting party, which is when it stops being victimless.

~~~
aaron695
> By definition a victimless crime involves consenting parties with no harm to
> outside parties.

I think it involves no victims, including the consenting parties.

Suicide is not a victimless crime (assuming it's a crime)

Attempted suicide would be a victimless crime.

