
Overdose deaths have fallen for six months - danso
https://www.statnews.com/2018/10/23/overdose-deaths-fall-for-six-months/
======
thrmsforbfast
The most important take-away from this article is the Science paper by Jalal
et al., "Changing dynamics of the drug overdose epidemic in the United States
from 1979 through 2016" [1].

In that paper, the authors conclude:

 _> The overall mortality rate for unintentional drug poisonings in the United
States grew exponentially from 1979 through 2016. This exponentially
increasing mortality rate has tracked along a remarkably smooth trajectory
(log linear R2 = 0.99) for at least 38 years. By contrast, the trajectories of
mortality rates from individual drugs have not tracked along exponential
trajectories._

The authors also suggest that we should attempt to "understand the forces that
are holding multiple subepidemics together onto a smooth exponential
trajectory", and suggest a double-whammy of increased supply (due to improved
communication, transportation, and manufacture) and increase demand (despair,
loss of purpose, and dissolution of communities) that cuts across both
demographics and geographic regions.

\--

[1]
[http://science.sciencemag.org/content/361/6408/eaau1184](http://science.sciencemag.org/content/361/6408/eaau1184)

~~~
JumpCrisscross
So drugs aren't getting deadlier, it's just that more of us are using more of
them? (Or more among us are using deadlier drugs than before?)

~~~
docbrown
Drugs are still getting stronger and deadlier and much cheaper. This is
obvious when you look at the a spike in Fentanyl use compared to other
narcotics. While the amount needed to get high is lower, the potency is much
higher. In addition to this, these packages are getting stepped on—where
dealers cut it with another substance—a hundred times over before it ends up
in someone’s veins with anything and everything.

~~~
_Schizotypy
The most important part to note is that fentanyl analogs are being used along
with other inert substance to increase the mass and potency at street level.
The problem with this is people easily underestimate the potency and use too
much on top of the issue of varying amounts of fentanyl used to cut increasing
risk.

~~~
docbrown
>The problem with this is people easily underestimate the potency and use too
much on top of the issue of varying amounts of fentanyl used to cut increasing
risk.

this is especially dangerous amongst users who are relapsing and initially
using their old dose amounts when starting again and their bodies aren’t able
to handle it

~~~
_Schizotypy
unfortunately, that's a risk with an untampered supply as well. things are
made EVEN WORSE with the fentanyl problem

~~~
docbrown
one of the problems with Fentanyl is how our hands are tied when it comes to
inbound shipments. Rogue laboratories in China are a pill-mill for these
synthetic drugs.

>Over the last decade, federal officials say, the Zheng group mailed and
shipped fentanyl and similar illicit chemicals to customers in more than 25
countries and 35 U.S. states. U.S. officials say the syndicate’s success, laid
bare in a recent federal indictment[1], partly helps explain America’s
skyrocketing death toll from drug overdoses. [2]

[1][https://www.justice.gov/opa/pr/two-chinese-nationals-
charged...](https://www.justice.gov/opa/pr/two-chinese-nationals-charged-
operating-global-opioid-and-drug-manufacturing-conspiracy)
[2][http://www.latimes.com/politics/la-na-pol-china-
fentanyl-201...](http://www.latimes.com/politics/la-na-pol-china-
fentanyl-20181019-story.html)

------
LaikaF
So something they briefly touch on is new research chemicals. What they don't
mention is what happened earlier this year.

FOSTA has slaughtered many avenues of sourcing research chemicals. It is
significantly more difficult to get them from a reliable source then it was
this time last year. While this doesn't stop anyone sufficiently determined,
it's harder to get a source of say fentanyl or U-47770 to cut with.

The US has been cracking down on producers of these in China, and many chinese
or US based resellers have either ceased to exist or changed their operation
(US seems to be heavily targeting opioids, China seems to be going after
ketamine and analogs) . In addition the Darknet Markets have taken a big hit
from Operation Bayonet. It's not to say that DNMs or their vendors or
customers are gone, just they're finding it harder to regroup. Though there
have been a number of high profile busts from the data of Operation Bayonet

This applies to more then just opioids though. Other drugs with overdose
potential, like stimulants are just harder to get a hold of. Most US domestic
sellers seem to focus on benzodiazepine analogs.

We'll see how long this lasts though, I doubt that whole scene is truly gone
but it might just be in hibernation for a bit.

~~~
post_break
Just wait until we stop subsidizing chinese epacket shipments. I bet those
illegal drugs coming in with fall off of a cliff assuming china doesn't
renegotiate the terms.

~~~
LeftTurnSignal
There's way too much profit for shipping costs to be any sort of factor in
this.

Spend a few hundred (even after losing a few shipments) and you can still
easily make it back with one good shipment getting through.

Honestly, I think that the bombs getting sent to government officials is going
to hurt things for them more than shipping costs would.

we'll see what the future holds though.

~~~
LaikaF
I agree with you on that bombs thing. Currently USPS mail is very
underscreened. All (or almost all) drugs in the US and coming in use USPS mail
due the fact they need a warrant to open your package.

They currently have greatly stepped up their screening game though, mostly due
to fentanyl. But that doesn't mean you have to ship straight to the US in
bulk. A common route for fake pressed xanax was alprazolam powder to canada
where it was pressed and either reshipped or smuggled into the US.

------
Kaveren
> "and cocaine and stimulants — a group that includes methamphetamine — are
> each now killing more than 10,000 people a year, a threshold they only
> crossed in the past few years."

I understand why people use drugs like heroin and fentanyl, but why
methamphetamine? Why do they not just use Adderall or pure amphetamine? What
is the gain? Amphetamine and Adderall in particular are not neurotoxic at
normal doses, and are very safe if used responsibly. Methamphetamine seems to
be inherently neurotoxic. Why risk your health when amphetamines and Adderall
are just as good?

~~~
tcj_phx
> but why methamphetamine? [...] Why risk your health when amphetamines and
> Adderall are just as good?

The phenomenon is called the "iron law of prohibition" [0]:

    
    
      The iron law of prohibition is a term 
      coined by Richard Cowan in 1986 which 
      posits that as law enforcement becomes 
      more intense, the potency of prohibited 
      substances increases. Cowan put it this 
      way: "the harder the enforcement, the 
      harder the drugs."
      
      This law is an application of the Alchian–
      Allen effect; Libertarian judge James P. 
      Gray calls the law the "cardinal rule of 
      prohibition", and notes that is a powerful 
      tool for the legalization of drugs.
      It is based on the premise that when drugs 
      or alcohol are prohibited, they will be 
      produced in black markets in more 
      concentrated and powerful forms, because 
      these more potent forms offer better 
      efficiency in the business model—they take 
      up less space in storage, less weight in 
      transportation, and they sell for more 
      money. Economist Mark Thornton writes that 
      the iron law of prohibition undermines the 
      argument in favor of prohibition, because 
      the higher potency forms are less safe for 
      the consumer. 
    

I learned this term from Johann Hari's book, _Chasing the Scream: The First
and Last Days of the War on Drugs_ [1].

The "epidemic" of opioid overdose deaths would be ended instantly by giving
the addicts all the pure heroin they need. ("I think I've mentioned this here
before... uhm, 'Switzerland'..., found it").

A response to my comment [2] said "drug overdose deaths fell by about two
thirds between 1995 (Heroin prescriptions started in about 1994) and 2012:"
[3].

Meth amphetamine is basically an anti-depressant - people don't need even
Adderall, they need safe anti-depressants (!SSRI)[4], and help finding
stability [5].

[0]
[https://en.wikipedia.org/wiki/Iron_law_of_prohibition](https://en.wikipedia.org/wiki/Iron_law_of_prohibition)

[1] [http://chasingthescream.com/](http://chasingthescream.com/)

[2]
[https://news.ycombinator.com/item?id=14782416](https://news.ycombinator.com/item?id=14782416)

[3]
[https://news.ycombinator.com/item?id=14783800](https://news.ycombinator.com/item?id=14783800)

[4]
[https://news.ycombinator.com/item?id=18211048](https://news.ycombinator.com/item?id=18211048)
(my comment about coca leaf's anti-depressant effects. Amphetamines are
somewhat similar.)

[5]
[https://news.ycombinator.com/item?id=17997852](https://news.ycombinator.com/item?id=17997852)

(edit: added [5], moved [4] to after "!SSRI") (Edit2: moved all the references
[] from inline to the bottom of the comment.)

~~~
imtringued
The vast majority of adverse effects are a result of the drug being illegal
rather than the effect of the drug itself.

With proper dosage and pure uncut drugs most addictions won't ruin the user's
life unless of course they have to spend all their money on drugs because they
cost so much. This leads to people becoming drug dealers to finance their
habits. They start cutting the drugs with cement dust or other shit that is
going to ruin the health of drug users downstream and smoke the drug for free.

------
grdeken
I know that in many states where there are serious problems they have provided
narcan to all first responders. I'm wondering if this is a bit of a false
positive in the data. The addiction levels could be the same, just fewer
people dying of overdose because more access to narcan. HN WDYT?

~~~
gwbas1c
> Many public health experts point to campaigns in Rhode Island, Vermont, and
> Massachusetts as models for addressing addiction, and all three states
> reported decreases in overdose deaths from March 2017 to March 2018 —
> declines that many of their neighbors did not see.

> “The states that have been comprehensive and have gone after evidence-based
> methods are seeing the declines,” said Brandon Marshall, a Brown University
> epidemiologist.

A good friend of mine is a cop in Massachusetts. He carries Narcan.

------
aphextron
Deaths are falling, but are overall drug usage and overdose rates falling?
Could this very well just be increased access and availability to Narcan,
along with increased familiarity with the symptoms to get access to treatment
quickly?

~~~
docbrown
>Could this very well just be increased access and availability to Narcan

Without looking up data right now: yes

edit: whoever claimed my comment is inaccurate should look at the stats for
Naxolene usage on opioid users
([https://www.health.ny.gov/statistics/opioid/data/pdf/nys_jul...](https://www.health.ny.gov/statistics/opioid/data/pdf/nys_jul18.pdf)).
In one (1) county, they administered Naxolene to over 6,000 users. With that
information, arguing there is no correlation between the wide spread
availability of reversal drugs and the drop in deaths is just.. wrong.

------
NPMaxwell
The main graph in the article is printed twice as wide as tall. Take the same
axes and print twice as tall as wide, and the trend and change are much more
obvious.

------
VLM
Isn't it just the usual logistical curve scenario? Rapid growth to meet the
desired need, until market saturation and users are dying off faster than they
can be born?

From a creationist standpoint all people are equally likely to become addicted
so you can use economic/cultural data as a proxy for susceptibility, however
in the real evolutionary based world we have been brutally selecting for non
addiction susceptible genetics and small scale culture for a long time, so at
some point you'd expect a crash in addiction rates.

Something like cig smoking can't be bred out because the addicts die horribly
in their 60s long after reproducing, but every teenage heroin overdose for the
last couple decades is a permanent culling of the herd of people who can't
handle their chemicals responsibly.

From a cultural standpoint I'm old enough that "Heroin just is not something
our people do" works pretty well until it doesn't anymore, its interesting the
study quotes seem to imply a grasp at any straw other than making heroin
culturally unacceptable again, which ironically is probably the only thing
that will work long term.

------
ars
Seems to me this is entirely due to a better economy. If you have a job and
money, you don't need to escape your life via drugs.

~~~
borkt
There can be other issues in life, such as interpersonal issues or stress
reactivity that lead to addiction probably far more often than a lack of a job
or money. See Michael Jackson, Prince, Demi Lovato, Philip Seymour Hoffman,
Tom Petty... the list is endless. Virtually anyone can become addicted if they
try these drugs and are dealing with stress.

~~~
squish78
I think the more accurate common denominator of the people you listed above is
past-peak career entertainers, not wealth

~~~
bsder
I think the more accurate common denominator is "entertainer". Some of those
were pretty damn popular when they died.

The issue is that drugs tend to be available and encouraged for rockers and
actors.

Heroin, in particular, seems to have an unnatural appeal to guitarists and
rockers and has claimed way more than it's fair share of them.

I really wish we would legalize some of these drugs even if we still keep them
behind a prescription. Legalizing the drugs would certainly help as then the
dosages would be controlled.

------
jacob019
Staggering numbers of dead, a major policy failure.

~~~
wufufufu
Awaiting the hour of reprisal, your time slips away.

~~~
vondur
Slayer lyrics?

------
TomK32
Of course the overdose deaths are falling: you can die only once.

~~~
shawnz
This comment has the subtle implication that you are "too good" to get
addicted to opioids. You should reconsider that attitude before it's too late.

~~~
philwelch
It's very crudely stated, but there's a bit of a truth to it.

Suppose that "susceptibility to opioid abuse" is a trait that's distributed
throughout the population; some people are very susceptible, and some people
are not very susceptible, but there's still an independent, individual factor
that is separate from e.g. cultural/economic/social angst/uncertainty/etc.,
the availability of opioids, and so forth.

When there is a breakthrough in one of these external social factors--either
opioids become a lot cheaper and more available, people slip into greater
levels of despair, whatever--more people are going to abuse opioids. Fair
enough. But not everyone is equally likely to abuse opioids even given the
exact same circumstances, so most of this increase in opioid abuse will be
concentrated in the chunk of the population that was more susceptible to it
all along.

Once the opioid epidemic goes on for a few years, the people most likely to
abuse opioids--and, for that matter, the people most likely to die from opioid
abuse--will die. And so, if the underlying social causes of opioid abuse stay
the same, you're going to see fewer opioid deaths, because the people who
would have died already have.

Since this isn't necessarily a genetic trait, we probably wouldn't see this
effect persist on the order of generations, but on the order of months to
years there's definitely a survivor bias, so to speak.

There isn't necessarily any moral judgment in here, either. I mean, there can
be, if you're a jerk about it, but the math itself doesn't work out any
differently for "susceptibility to opioid addiction" than it does for
"susceptibility to flu", and so if there's an epidemic of either one of those,
odds are that, barring intervention, the epidemic is going to kill whoever
it's going to kill and then move on. (This isn't cause for complacency,
either! Some epidemics can kill huge supermajorities of the population if you
just let them play themselves out, which is the true story of how the West[ern
Hemisphere] was won.)

------
hopefulengineer
Government has no incentive to do anything about this. They would prefer
disgruntled, jobless people keep themselves in a drug induced stupor to people
getting angry at their government stabbing them in the back for multi-national
corporations.

In reality these drugs coming in from foreign countries should be treated as
an act of war, we've already lost significantly more Americans to this
epidemic than Vietnam, the long term economic cost is probably in the hundreds
of billions. If another country did that kind of damage via bombing we would
retaliate, but these deaths from drugs don't have a big enough emotional
impact to get citizens angry

~~~
vorpalhex
Right, because dead people pay such awesome tax rates.

Clearly this is the fault of those nameless multi-national corporations who
are gleefully clasping their hands while laughing madly.

Obviously these drug addicts having major problems and injecting themselves
with illegally acquired, addictive drugs is exactly the same as bombing
innocent people, and we should retaliate by having the marines storm the lobby
of Pfizer.

~~~
hopefulengineer
Majority of deaths are caused by fentanyl produced in foreign countries and
shipped into the US to be cut into low quality drugs. So sanctioning those
countries would be a good first step

The initial addiction though is due to doctor's and drug companies. There's
plenty of evidence of drug companies pushing doctors to prescribe these drugs
when they really aren't needed. Fine the companies, arrest the doctors and
executives who push this stuff in the name of profit.

As for government, if you think the average congressmen cares about long term
tax revenue vs that sweet pharma lobby money today, you're naive.

~~~
emiliobumachar
Draconian enforcement against illegal drugs have been tried extensively. Up to
and including labeling exporting countries "narco states" and invading them.
It doesn't work. Someone else takes up the slack.

------
a_humean
That death rate is insane. How can republicans do effectively nothing about
this public health disaster? I am singling out republicans rather than the
political class generally as right now they have control of most state
legislatures and governorships, control of congress, control of the senate,
control of the supreme court, and control of the presidency. If they wanted to
do something to address this, they can do it. Evidently they would rather
people just die.

~~~
dang
Please don't take HN threads into political flamewars. Those are all the same,
therefore boring; plus we don't want this place to burn.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

~~~
a_humean
I'm sorry. Next time I'm be more indirect.

