
Overdose Deaths Set a Record Last Year - digital55
https://www.nytimes.com/interactive/2018/11/29/upshot/fentanyl-drug-overdose-deaths.html
======
nacho2sweet
I live in Vancouver which has always been ground zero for opiates for 30+
years. 1100 deaths a year just here over fentanyl. Constant ambulances and
fire trucks on at all times just injecting narcan. Article about how China is
basically using the trade as a bargaining trade and extradition chip.
[https://globalnews.ca/news/4658188/fentanyl-china-canada-
dip...](https://globalnews.ca/news/4658188/fentanyl-china-canada-diplomatic-
tensions/)

Seem to remember us joining the Afghan war for fewer deaths.

~~~
acct1771
Is narcan injected now?

~~~
nacho2sweet
It is injected and some of the opiates on the streets are so strong here you
are starting to need administer multiple injections. There is the nasal spray
and that is often given out on the streets so addicts can help each other.

There are narcan administration classes all the time and it is given to and by
night life workers because fentanyl is showing up in party drugs like cocaine
and mdma. Lots of friends said they have quit their favourite extracurriculars
but they get drunk and in a good mood and forget at 2am, or they know their
dealer etc... Pretty scary.

------
mruts
I used to be addicting to heroin. The problem is with fentanyl, not heroin.
I've had 2 close friends die from overdoses, and both involved fentanyl. I got
close myself a couple times (or so my wife says, I was passed out), and both
were fentanyl laced doses.

I honestly and truly believe that opiates (and all drugs) should be legal. I
think you would find the number of overdoses drop drastically if that were the
case.

No one wants to do fentanyl, it doesn't last as long and feels weird. Heroin
itself is very safe if it's not cut and the purity is known ahead of time.

~~~
throwaway5752
_" Heroin itself is very safe"_

Heroin might be relatively safer than fentanyl. It's a terrible drug that
ruins live and families and has been for centuries. It irreversibly harms your
brain, wrecks your veins, is the most addictive common drug, and is tolerance-
forming.

~~~
mruts
Heroin doesn't have any neurotoxicity profile to speak of. It's safer than
almost another other drug for your brain (assuming you don't overdose and have
oxygen-deprivation, of course)

Moreover, it only harms your veins if you shoot it.

It is addictive and tolerance forming, but that's about the only downside.

Let's take myself for example. I have a good salary and used to spend maybe
40k/year on heroin. That's a big cost for sure, that's why I quit. But because
I could afford to do it, there weren't any other downsides. In fact, there
were a lot of upsides.

I worked harder and longer than any of my coworkers could even dream of. I
could pump out high quality code for 20 hours straight. No one knew I was
addicted to anything. In fact, over the 2 years I was addicted I got promoted
and got huge bonuses every year for being a quote "killer".

People think the common social effects of heroin (stealing, homelessness, etc)
are inherent to the drug itself, but that simply isn't true. These negative
effects have more to do with the laws and culture we have built up around the
drug, not the drug itself.

Nitpick, but, heroin hasn't been ruining lives for "centuries." It wasn't even
invented a hundred years ago.

~~~
maxxxxx
"Let's take myself for example. I have a good salary and used to spend maybe
40k/year on heroin. That's a big cost for sure, that's why I quit. But because
I could afford to do it, there weren't any other downsides. In fact, there
were a lot of upsides."

I knew a guy like that. He took heroin and cocaine and was highly functioning
in his professional life. His private life was a mess though. From time to
time he disappeared for a week or two but professionally he did ok. But over a
few years he got more erratic and things started to fall apart.

Based on that experience I think there are a lot of drug addicts around but
nobody notices. Especially in upper management I suspect a lot of people are
on something to keep up with pace.

~~~
throwaway5752
_" lot of drug addicts around but nobody notices"_

Everybody notices. Nobody talks about it. I hope you understand you are one of
the lucky ones, and that it eats people and family alive. Social programs and
mental health programs ... social workers involved in that area could probably
write books. It's a horrible, horrible drug. I never said it was neurotoxic.
It just is just a big old dopamine button and it's incredibly difficult for
many people to not let it consume them (to the point of stealing and lying
from whomever is necessary). The tolerance that builds up and the pain of
withdrawal make people do things they would never do otherwise. A really
substantial number of people can't self regulate opiates (Prince, Tom Petty,
Philip Seymour Hoffman, and 70,000 other people per year) and dealers can and
will trap regular people in addiction to the maximal extent they can. If it's
legal, it will only get worse.

~~~
maxxxxx
"If it's legal, it will only get worse. "

All the stuff you wrote also applies to alcohol and there we decided a long
time that prohibition doesn't work.

~~~
throwaway5752
I think that ignores how much worse heroin is than alcohol on every metric
under typical usage and in the aggregate. We have prohibition all over the
place. We prohit murder. We prohibit drunk driving even though we allow
drinking. There is no obvious dividing line between what drugs should be
illegal, regulated, or how much regulation (of which prohibition the maximal
subset). Unless you don't think it should be illegal to give heroin to a baby,
for example, then we are already talking about degrees of regulation. Talk of
prohibition is useless. Do you want a Nordic model of highly regulated,
decriminalized? Because that is a whole different ballgame.

I really don't care about the policy that much, either, I just wanted to
strongly push back on people minimizing the dangers of heroin. It is a lethal,
life destroying drug and it's one of only a few I would strongly advice people
to never even try once, regardless of legality. If I can convince a single HN
commenter to avoid it, then I'm happy.

~~~
maxxxxx
" Do you want a Nordic model of highly regulated, decriminalized? "

Yes this would allow addicted people to participate in normal life openly and
allow for therapy options. Prison is very expensive so that money could be
shifted to treatment.

BTW, don't minimize the dangers of alcohol. Alcohol is often involved in
traffic accidents, domestic violence, and gun deaths. It also has a lot of
negative health effects. A huge number of people die from alcohol every year.

------
sampleinajar
"Opioid prescriptions have been falling, even as the death rates from
overdoses are rising" Gee, it's almost as if "overprescribing" and then
cutting off the supply had the affect of driving some who are addicted to buy
opiates with less quality control, and they are dying from it.

~~~
presscast
I'm a bit puzzled by your comment. Are you suggesting that we should have
continued to over-prescribe?

~~~
tonyarkles
There's a middle ground there. Cutting back on the number of new opiod
prescriptions is definitely a good thing, but you've got to be careful of how
you handle existing patients who have already been pulled into the problem.

From a harm reduction perspective, taking a patient who is, say, addicted to
legal oxycodone because they were overprescribed it. Now what do you do from
the perspective of what's best for the patient? Is it a good thing that
they're addicted to it? No... but is it more harmful to cut them off cold-
turkey? Or is it better to help work with them to figure out how to get off it
in a way that doesn't result in them seeking out street drugs to handle the
withdrawal?

~~~
closeparen
Is it definitely a good thing to have more people experiencing more pain?

------
NeedMoreTea
Maybe it's time to remember the British System, which had worked successfully
for decades.

Anslinger being put on the US team for the UN Committee on Drugs put paid to
that, and pressured other countries with less punitive drug approaches.
Anslinger has much to answer for; perhaps the one doctor who forgot
"discourage" does too.

For those who don't know, the British System was once globally famous, and
briefly put was "discourage, but prescribe"[0]. When it was overridden with a
more recognisable war on drugs there were only hundreds of addicts in the UK.
No one connected addiction to crime.

Highly doubtful we could return to that state, even if it was successfully
continued.

[0] [https://www.vice.com/en_uk/article/yw4nnk/when-boots-
prescri...](https://www.vice.com/en_uk/article/yw4nnk/when-boots-prescribed-
heroin-the-uk-did-drug-policy-right)

------
volkl48
It's looking like it's peaked, 2018 data is still provisional, but is
currently expected to show a modest decline after the final numbers are in.

11/30 article on topic:
[https://www.washingtonpost.com/business/2018/11/30/after-
rec...](https://www.washingtonpost.com/business/2018/11/30/after-record-
number-us-deaths-opioid-epidemic-may-be-receding/?utm_term=.37f14699ff32)

Data source: [https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-
data.htm](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm)

There is certainly far more work to be done.

~~~
wgerard
Curious because it's not mentioned: How much of that is due to higher
availability/usage of Narcan?

~~~
volkl48
Not really something this dataset (which is just about # of deaths + drug that
caused them) can tell you.

I'd imagine you'd need some sort of formal study of the data to try to assign
why deaths are starting to decline/plateau and what share a certain thing is
responsible for, there are other possible causes.

\-------

Opiate prescriptions are falling pretty significantly. Number of prescriptions
is down 22% from 2012-17, and volume (mg of opiates dispensed) dropped 12% in
2017 alone. [https://www.aafp.org/news/health-of-the-
public/20180425opioi...](https://www.aafp.org/news/health-of-the-
public/20180425opioidstudy.html)

That could be contributing to a decline in the "pipeline" of new addicts. Less
people starting on them and lower doses and shorter durations when they are
prescribed.

It would make sense for a decline spurred by that to not show up in opiate
deaths for a few years, my impression is that most people spiral downward for
a while before actually dying/ODing.

------
pjc50
This is a tragedy, but I can already see the conversation moving away from how
the problem might be fixed towards blaming it on foreign enemies. Which will
absolutely not help.

~~~
taylorswift_
How do you reason such? Most if not all of the illicit fentanyl comes from
China, where it is an uncontrolled substance. IMO this should definitely be
part of a comprehensive conversation.

~~~
neurobashing
I assume the parent comment's reasoning is, roughly:

The War on Drugs was, from one point of view, essentially a soft invasion of
central and south American countries; we sent DEA and military "advisors" to
burn the crops of farmers while the CIA treated narcos like Soviets.

Indisputable that, eg, yes mexican farmers were growing kush (or making coke,
etc) at the behest of powerful cartels. They were totally doing that.

It did not spend as much effort on why and how drugs became what they are in
our own country; laws had disproportionate impacts on some communities;
treatment was the refuge of the privileged. Slaking the need for drugs is more
than border enforcement, from this perspective.

So yeah, some dope comes from point A to point B, so stop it from making it to
point B, but also look at what's going on at point B to fix the problems that
aren't trafficking.

~~~
pjc50
Indeed. The War on Drugs is the kind of solution America likes, because it's a
war; and as a side benefit the CIA gets to mess with the soverignty of various
small countries. Effectiveness for actually _helping the victims_ was never
part of the point. If they didn't die they could be jailed and used as forced
labour.

~~~
taylorswift_
that's why I said "part" of a conversation. If it's known that China (or any
nation) is actively working against our citizens interests, it certainly makes
sense to include in any conversations relating to foreign affairs with that
country. Does that benefit people addicted to drugs in America? No. But it may
benefit people who could *potentially be addicted in the future.

------
taxicabjesus
Overdose deaths are only a fraction of the casualties of this particular war
on people. We should also count all the people who are in prison on charges of
self-medicating, and all the people who die in prison while being punished for
hurting no one but themselves.

I didn't know anything about Methadone until I'd taken a few people to the
various methadone clinics. I thought they were just medical drop-offs... and
thought it odd that their trip home was just a few minutes later. Eventually I
learned these people were going for their daily dose of methadone. One fellow
said he'd gotten addicted to painkillers following a car accident, and that
he'd never imagined _himself_ needing to visit a methadone clinic every day.

Towards the end of my taxi driving experience, I had a woman going from
WalMart to a half-way house. She'd spent 5 years in prison for sharing a
single opiate pill with a friend (circa 2010). She said something about the
cop who wrote her up for prosecution chuckling as he filled out the form. Over
her five years in prison several of her fellow inmates died from neglect.
She'd gained a lot of weight on prison food, which isn't very nutritious.

Apparently the State of Arizona is negligent-homiciding prisoners in the name
of helping them correct their behavior, which doesn't make much sense to me.
I'm sure all the other states' jails and prisons have similar conditions.

~~~
maxxxxx
"Apparently the State of Arizona is negligent-homiciding prisoners in the name
of helping them correct their behavior,"

They just want to punish people, they don't care about correcting behavior.

------
deyan
Can someone put this into context, or share a source that does? How does this
compare to other causes of death, for example?

The NYT article has comparisons on the absolute level (i.e. comparing to peak
car crash deaths and HIV deaths from 20-30 years ago) - but those are outdated
and misleading because they not relative and don't account for e.g. population
growth.

I am just trying to get a sense for the true magnitude of the problem, beyond
the scary headlines.

~~~
nostrademons
It's small relative to the total number of deaths in the U.S, but large
relative to deaths for that age group (< 55):

[https://www.cdc.gov/injury/images/lc-
charts/leading_causes_o...](https://www.cdc.gov/injury/images/lc-
charts/leading_causes_of_death_age_group_2016_1056w814h.gif)

[https://www.cdc.gov/injury/images/lc-
charts/leading_causes_o...](https://www.cdc.gov/injury/images/lc-
charts/leading_causes_of_death_highlighting_unintentional_2016_1040w800h.gif)

I assume overdoses are classed as "unintentional poisoning" \- they're the
leading cause of death for ages 25-45, nearly double car accidents and 3x
suicides. They're a very small fraction of deaths by cancer & heart disease,
but those usually happen after 50+. In terms of "preventable" deaths they and
car accidents are by far the biggest culprits. I'm surprised there's not more
of a push toward self-driving cars and mass transit, but other than that it
makes sense to focus on overdoses.

The other interesting thing that stood out to me in the data was how much the
homicide rate has dropped since 1980. We have this perception that the world
is getting more dangerous, but it's not actually reflected in the data, and by
far the biggest danger to us now is ourselves.

------
jmts
Based on some of the comments regarding the role that foreign countries have
in the market, I thoroughly recommend people give "Narconomics" by Tom
Wainright a read. It approaches the drug trade from an economic perspective,
and I found it quite interesting to read about how prohibition in one market
creates problems in other markets that can likely only be solved by ending
prohibition.

------
viggity
God damn it, I want to know these numbers for people that have a legitimate
prescription vs a "fentanyl" death from someone who bought an illicit drug
that was laced with fentanyl.

there are a lot of people legitimately in chronic pain who are turned away or
get the run around because we're cracking down on the wrong thing.

------
JoeAltmaier
Off the topic: looks like the half-life (or doubling-life anyway) is about 10
years. The number of deaths double in a decade, which means of course we're
setting records every year.

Time until everybody in USA is dead of opiods: 120 years

~~~
pavel_lishin
Joke's on you, statistics, I plan to be dead long before then.

------
orasis
Legalize psychedelics to treat addiction.

~~~
ams6110
There may be something to that, but I am guessing that any form of self-
medication is likely to be more destructive than helpful.

Use of pharmaceutical grade psychedelics in a clinical setting might have some
benefit.

~~~
pstuart
Let me make that decision myself, thank you very much.

~~~
aalleavitch
All of these overdoses are, likewise, people making these decisions for
themselves.

~~~
loeg
So are the smoking deaths.

I think it's undisputed that there would be a lot fewer deaths per addict if
the heroin available were (1) of a known concentration, (2) not fentanyl, and
(3) devoid of other harmful adulterants.

The problem people argue about re: legalizing heroin is that they expect the
number of addicts to rise.

------
zunzun
Fentanyl is not yet a controlled substance at its major global source: is this
racial vengeance for the Opium Wars?

~~~
sct202
There's a Chinese factory that will make you almost anything imaginable some
legally some illegally (violating IP or regulations). It's not part of a
conspiracy that there are also illegal drug factories.

