
Overdoses Propel Rise in Mortality Rates of Young Whites - petethomas
http://mobile.nytimes.com/2016/01/17/science/drug-overdoses-propel-rise-in-mortality-rates-of-young-whites.html?_r=0
======
paganel
As an European I found this very interesting:

> There is a reason that blacks appear to have been spared the worst of the
> narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies
> have found that doctors are much more reluctant to prescribe painkillers to
> minority patients, worrying that they might sell them or become addicted.

If I read this correctly the doctors' pervasive racism is keeping young black
men alive.

~~~
TazeTSchnitzel
Studies have also shown inter-group empathy gaps. Or, basically, white people
don't believe black people's pain [to the same extent], similarly with men and
women.

That's probably also a factor.

~~~
finid
> Or, basically, white people don't believe black people's pain

If a guy is rushed into the ER, you, as a doctor or nurse, don't have to
believe anything. Just run the patient through the proper protocols,
regardless of race, age or gender.

Otherwise what's the Hippocratic Oath all about?

~~~
JshWright
It's not like there is a machine or a blood test you can use to find out the
person is experiencing "37.3 pain". The 'protocols' you refer to will
necessarily require a subjective evaluation of the pain the patient is
experiencing (as well as assessing other social factors that may point to a
higher risk of abuse).

There are people who will call the ambulance or show up at the ER, claiming
pain, when in fact they are 'simply' looking for drugs to meet their
addiction.

The only person who knows how much pain the patient is actually experiencing
is the patient themself. However, blindly relying on them to accurately report
that level pain is simply not an option, given the potential for abuse.

~~~
TazeTSchnitzel
I think the problem is not so much abuse as it is the vagueness of it. If
someone says they're in a lot of pain, how much pain is that?

Your perception is at least partly emotional.

------
cubano
I've come to the sad conclusion that ODing on heroin is a rite of passage with
that drug and simply...you either survive it or you don't.

I was fortunate enough to survive 4 hospital-trip-inducing ODs in my life.

I know it may sound flippant or glib or obvious, but when you start down that
path its always "oh, that will never happen to me" or "i'm too smart to make
that mistake"

Sad truth is...it pretty much happens to everyone.

~~~
randycupertino
Were you ever administered Narcan, and were you pissed when at whoever gave
you the Narcan? The times when I've administered it I've gotten yelled at for
ruining people's highs when they came back. One guy even threw a punch at me
in the back of the ambulance.

Glad you're still around.

~~~
JshWright
If you want them to be happier, preoxygenate before administering the Narcan.
They aren't pissed because you "ruined their high". They're pissed because
they're hypoxic (and therefore confused, disoriented, etc), and surrounded by
people in uniforms, and don't know how they got there.

Bag them up before you push the Narcan and you will have much happier
patients.

------
shaunrussell
I live in Rhode Island, and the heroin use is out of control. In the small
town I grew up we lose someone to OD every month or so, and I have many
acquaintances that are using. 5-10 years ago heroin use in the town was
unheard of. All of the people I know that use started with Oxycontin, and then
moved on to heroin when they became more desperate.

~~~
dikdik
That's how it is all across Indiana as well. It is awful. I was back there
this summer to see a friend, had to find a new place to crash at the last
minute because he had to go pull his brother out of a shed and let him detox
at his house.

People are broke and broken. Very few decent paying jobs even with a college
degree, if you are broke you don't have access to decent medical/psych care
either.

~~~
dexwiz
Same. Went home to Indiana for thanksgiving, and found out my 4th grade best
friend had ODed a few months before. Sad thing was, is that I wasn't surpised.

------
atirip
As european, may i ask from americans - what pains do you have so that doctors
so easily prescribe hard painkillers? When taking into account that one can
sue doctors easily in US, why they even dare?

~~~
Alex3917
> what pains do you have so that doctors so easily prescribe hard painkillers?

[http://www.nap.edu/catalog/13172/relieving-pain-in-
america-a...](http://www.nap.edu/catalog/13172/relieving-pain-in-america-a-
blueprint-for-transforming-prevention-care)

tl;dr - "Chronic pain conditions affect at least 116 million U.S. adults at a
cost of $560-635 billion annually in direct medical treatment costs and lost
productivity. [...] [It] is much more than a biological phenomenon and has
profound emotional and cognitive effects. [It] contributes greatly to national
rates of morbidity, mortality, and disability; and is rising in prevalence."

~~~
raverbashing
I wonder what would be the % of cases of chronic pain that would be solved
with weight management and moderate exercise.

~~~
DanBC
The bulk of disability (after mental illness) is musculo-skeletal. Very many
of those people would benefit from exercise. Here's a programme from BBC Radio
4.

[http://www.bbc.co.uk/programmes/b06vkg24](http://www.bbc.co.uk/programmes/b06vkg24)

> If you struggle to screw the top off a jar, or use your arms to push
> yourself out of your chair, that's a sure fire sign, according to Dr Philip
> Conaghan, consultant rheumatologist and Professor of Musculoskeletal
> Medicine at the University of Leeds, that your muscles are weak. And the
> good news is that building muscle strength will protect your joints, not
> damage them. Dr Conaghan tells Mark that there's a worrying lack of
> understanding about the impact of muscle weakness on arthritic joints.

------
ZoeZoeBee
According to the CDC 40% of Medicaid patients prescribed an opiate are
misusing or abusing the drug.

Almost half of prescription drug overdoses are by those on Medicaid.

Medicaid patients with an opiate drug prescription had about six prescriptions
on average in 2010.

Compared to people with private insurance options, Medicaid patients were much
more likely to be prescribed stronger painkillers and have more prescriptions.

[https://www.thefix.com/content/study-shows-40-medicaid-
patie...](https://www.thefix.com/content/study-shows-40-medicaid-patients-
opiate-prescriptions-abuse-painkillers)

------
aikah
> of both illegal drugs like heroin and prescription painkillers

I was a teenager in the early 90's and i'm horrified with that heroin come-
back. I don't understand how it can be, especially in western countries. What
the f. is happening ? I thought we dealt with that sh. long ago ?

~~~
stinos
> I thought we dealt with that sh. long ago?

In what way do you think it was dealt with? As far as I know for actions like
'The War on Drugs' it's at least debatble whether they actually did reduce the
amount of use of illigeal substances (let alone amount of related crime etc)?

~~~
aikah
I was thinking about pop culture + education more than "war on drugs", since I
live in Europe. I mean since when taking heroin is cool again ? it destroyed
or killed so many people i knew 20 years ago ...

~~~
DanBC
The article is mostly talking about people who are wrongly prescribed opioid
meds for long term pain.

They don't start taking those meds because it's cool. They start taking those
meds because they don't have access to pain clinics; they don't understand
that exercise is effective for many forms of pain (especially musculo-
skeletal); that opioids should not be used for long term pain, etc. The meds
become less effective if they're used for a long time, so people increase
their dose. They become addicted to the meds, and need higher doses. A couple
of things happen here.

1) Doctors restrict the meds. People then either buy illicit meds, which are
stronger than they're expecting; or they buy heroin because it's easy enough
to get.

2) People die from liver damage caused by the paracetamol that these pain meds
are often mixed with. Partly we used to think that combining paracetamol and
opioids meant we could use less of each (but that turns out to be untrue), and
partly some people thought that mixing a poisonous substance in with the
opioid would reduce abuse. (It sort of does, by killing the user.)

~~~
venomsnake
Paracetamol is may "favorite" medical substance. The damaging and helpful dose
are absurdly close. And that stuff is sold over the counter.

~~~
Gibbon1
My grandmother started drinking after my grandfather died. And died herself
ten years later of liver failure. I remember emptying out the medicine cabinet
and tossing a half empty 500 pill bottle of Tylenol in the trash. And then
finding two more unopened in the cabinet under the sink. My thought then was,
'this and the booze is what killed her.' That was 35 years ago.

------
JshWright
This is a complicated issue that is going to take time to solve. In the
meantime, we need to 'stop the bleeding' by getting Narcan[1] into the hands
of those most at risk of a Heroin overdose (or more importantly, into the
hands of those who are likely to be around them when they do OD).

[1]:
[https://en.wikipedia.org/wiki/Naloxone](https://en.wikipedia.org/wiki/Naloxone)

~~~
tomjen3
Thats certainly one thing we could do, if we value the druggies lives enough.
Honestly I don't see why we, as a society, should help those who won't help
themselves.

~~~
JshWright
I assume you don't have any close personal experience with addiction?

~~~
dennisgorelik
Are you saying that people who nearly died from OD have a good change of
becoming productive members of society?

~~~
JshWright
Ignoring your implication that someone must be "productive" to be worth saving
from death... You don't have to go any further than this comment page to find
likely examples of that (there are personal accounts of opiate abuse, and it's
probably a safe bet that someone who bothers to read Hacker News meets some
definition of "productive member of society").

~~~
dennisgorelik
1) Existence of individual examples is not a proof of good probability of
recovering from drug overdose into productive member of society.

2) Our society already has mechanisms that help in case of OD: People usually
try to call 911 if they see someone in a bad shape.

The question is whether we need to spend more resources on helping fixing OD
cases or may be spend these resources on other good causes.

------
orthoganol
For what it's worth, almost everyone I know my age has a relationship with
drugs that falls somewhere between open-to-the-idea, dabbling, or frequent-
but-functional. Designer drugs are viewed as cool and a status badge in some
ways. Concentration/ productivity drugs are popular, nootropics are trendy,
almost normalized. The other day a perfectly normal, if rather nerdy social
media manager I know brought up to me how he's looking to get into cocaine
because he thinks it'll be fun (but maybe that's just a social media manager
thing). Granted, the article said the rates were more associated with lower
socio economic groups, but I think all this still points to there being
something in the air.

~~~
cpncrunch
Where do you live? My experience is the complete opposite.

------
niels_olson
Autopsied one yesterday. Tox is pending, but all the circumstantial evidence
strongly points to heroin. Active duty, happened in his quarters on base.

------
ck2
The thing about the gateway oxycontin to heroin is that when people get
"clean" and then relapse, the idiots try to take their old dose and end up
killing themselves because they do not have the tolerance anymore:

[http://www.sciencemag.org/news/1998/06/heroin-relapse-ups-
ov...](http://www.sciencemag.org/news/1998/06/heroin-relapse-ups-overdose-
threat)

Living in a low income area, I am grateful every day that I do not seem to
have the attraction to drugs that so many people around here seem to have. I'm
not even tempted. Not patting myself on the back for that because I suspect it
is just fortunate genetics in that one regard. Now put a pizza or chocolate in
front of me and I have an impossible time stopping but that won't kill me of
course.

~~~
johnmaguire2013
> Now put a pizza or chocolate in front of me and I have an impossible time
> stopping but that won't kill me of course.

Obesity kills.

~~~
ck2
Well I run 5 miles every morning.

Plus I know better than to keep food like that around.

I assume it is exponentially harder for drug addiction though.

------
clebio
Non-mobile: [http://www.nytimes.com/2016/01/17/science/drug-overdoses-
pro...](http://www.nytimes.com/2016/01/17/science/drug-overdoses-propel-rise-
in-mortality-rates-of-young-whites.html)

------
marincounty
Bupenorpine. Made it free. It will help a lot of addicts. (Doctors shouldn't
have to take a special course in order to prescribe it.)

I'm getting tired of this opoid problem. I'm tired of addicts overdosing. As
to rehab--if you don't relapse--fine.

We have a drug for opioid dependenancy, and maybe even the a tool to combat
depression, and anxiety that's very safe. Unless you are hell bent on
overdosing, you don't need Suboxone, you could get by with Subutex--that is if
you can find a doctor to prescribe it? Once you have just bupenorpine in your
system; the physical cravings for opioids go away. Plus--you might give up a
few other bad habits too--like drinking?

~~~
wil421
Subutex and suboxone are not the answer just like methadone is not the answer.
I know people who I went to high school with take those for years and years.
Instead if doing pain killers they are now addicted to the pill that was
supposed to get rid of addiction.

Physical cravings aside its a mental game to get rid of an addiction. Every
time one of those friends stopped taking subutex/suboxone they would relapse.
Some people took them for 4-5 years and were on such a high dose they had
withdraws.

~~~
carbocation
The goal of suboxone therapy is not to free someone from physical dependence.
It is to save lives and restore livelihoods by replacing a dangerous and
debilitating drug whose use is associated with a whole set of unhealthy
behaviors with another drug that permits nearly normal functioning in society.

------
dghughes
Here in Canada it seems like there is a death each day caused by fentanyl.

Deaths seem to be a mix of direct use or not knowing it was mixed into another
drug.

Fentanyl is frighteningly powerful so little of it can kill.

------
FilterSweep
I'm sure the research is far less biased, But I couldn't escape the
connotations of "there _should_ be more black and hispanic deaths than white"
from the author of this piece. It seemed to decry of the actual issue of drug
OD less than this particular disparity.

------
coldcode
This makes me wonder how making drugs legal would affect the overall mortality
rate. The changes in Portugal are interesting but it's not the same culture as
the US. Would it make it worse (easier to get drugs) or better (less stigma
about treatment).

~~~
6d0debc071
> Would it make it worse (easier to get drugs) or better (less stigma about
> treatment).

That may not be as binary as it seems on idle reflection.

There certainly are drugs that used in extremes, and (occasionally) in
moderation, put people in a position where day to day functioning is
impossible, but equally there are drugs that cause very little harm for
reasonable consumption patterns. All else being equal, who would you rather
have living next door? A drunk or someone who smokes a fair bit of weed on the
weekend?

There's this thing that people do - certainly that governments seem to do with
respect to the issues surrounding decriminalisation and/or legalisation -
where the ideal, the thing they measure success by, is getting people to stop
doing something that they wouldn't choose for themselves. That metric doesn't
necessarily make a lot of sense.

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mohawk
That's a lot of lives that medical marijuana might have saved.

~~~
maxerickson
That's awfully glib. There is medical marijuana in Michigan (a relatively
restrictive regime, but still) and we still have pretty big problems with
prescription drug abuse and heroin. Never mind that marijuana is at least as
available as other illegal drugs. It's probably even easier and cheaper to get
than a prescription for opiates.

~~~
mohawk
A lot of these people got hooked on opiates through a prescription from their
doctor. These doctors prescribing opiates before trying medical marijuana for
pain management are endangering the wellbeing and lives of their patients.

~~~
niels_olson
I'm in California. The scene usually indicates poly-substance use. Source: the
autopsies for OD I've done.

