
America’s opioid epidemic is worsening - octoploid
http://www.economist.com/blogs/graphicdetail/2017/03/daily-chart-3
======
padobson
I live in Trumbull County in Ohio, the dark red county in North East Ohio. We
recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly
.01% of the county's total population - so yeah, it's getting bad here.

There were recently two shootings within a mile of my house. Several people
dead. Both shootings were drug related.

I can't help but look around and believe that the needs these folks are trying
to satisfy are completely human, and that forcing the users to resort to black
markets leads to violence and overdoses. I can't help but think this problem
in my community could be solved by simply letting people get high.

Maybe the answer isn't to make heroin available OTC at Walgreens, but
supervised injection sites seem to be gaining traction[1]. I think a lot of
the dark red spots on the map, like mine, should probably consider this
option.

It's not like anything else is working.

[0][http://www.tribtoday.com/news/latest-
news/2017/03/fri-920-pm...](http://www.tribtoday.com/news/latest-
news/2017/03/fri-920-pm-23-overdoses-recorded-in-48-hours-in-trumbull/)
[1][http://www.seattletimes.com/seattle-news/health/safe-
injecti...](http://www.seattletimes.com/seattle-news/health/safe-injection-
sites-get-ok-from-king-county-health-board/)

~~~
tptacek
Isn't the counterargument to this to point out the Oxycontin abuse epidemic?
Doctors are prescribing years worth of opiates to patients. There have been
suggestions that Purdue Pharma's formulation of Oxy practically guarantees
dependence, because of the way it's dosed. Are the people dying of heroin
overdoses in white rural Ohio starting on heroin, or transitioning to it after
prescription opioids become too expensive?

Sam Quinones suggests that the actual trade in Mexican heroin is distinctively
_less_ violent than in other drugs; there's a pipeline of supply and
distribution designed to be low-key and customer-service driven. If violence
is coming from addicts and not from suppliers, increasing supply isn't going
to make those people any less desperate or violent.

~~~
jbooth
If you give them free H, they'll be a lot less desperate and a lot less
violent, presumably.

And.. why not? I've got multiple friends in my age group prematurely dead from
overdose. It's not like prohibition is accomplishing anything.

~~~
dsmithatx
Checkout Denmark. They had a huge problem with robberies and started giving
legal pure Heroin shots to users. They also helped them find jobs. No more
deaths and no more black market for Heroin. Hence burglaries also went away.

It looks like our current President is looking at cracking down on pot again
though so, I don't imagine we'll have a sensible drug policy anytime soon.
Only one motivated by profits.

~~~
interfixus
Which Denmark is this? Doesn't resemble the one I live in. Neither the
robberies problem nor the legal pure heroin, and most certainly not the
disappearance of burglaries - not statistically, not anecdotally, and not
according to the several people of my acquaintance who have had it happen to
them.

~~~
hive_mind
In the USA, there's a fantasy Denmark that exists in the media.

In the fantasy Denmark, there's no crime, all the women are hot blondes who
never get fat, there's cheap weed every where (and apparently free clean
heroin), the furniture is sleek, all the men are feminists who never objectify
women (there's no porn), the school system is fantastic (every child is good
at math), the healthcare is free and high-quality, education is universal,
free and high quality, and there are plenty of jobs for everyone (and high
quality ones too!).

Pretty much like the rest of fantasy Europe.

~~~
peteretep

        > the healthcare is free and high-quality
        > Pretty much like the rest of fantasy
        > Europe.
    

Isn't high-quality healthcare that's "free at the point of use" available in
most of real Western Europe too?

~~~
pfortuny
Well, as long as you are willing to wait about six months for knee surgery,
yes, it is free.

Or for any other type of intervention.

~~~
hvidgaard
There is a 3 month gurantee. If they have not diagnosed you, and started
treatment within that periode, you're free to go to a private clinic or
hospital, free of charge.

~~~
dagw
At least in wife's case there was an additional 4 month gap between "starting
treatment" and actual surgery.

~~~
hvidgaard
And with expected times like that, you are entirely free to use a private
hospital/clinic. Both myself and my wife have done so twice.

------
kilroy123
My sister is a heroin addict. To say this has devastated her life is an
understatement. Her body is wrecked. She looks way older than she is, she has
a pacemaker / defibrillator installed in her chest. And doctors keep saying
she will die soon if she doesn't stop.

Here is the most frustrating part. She has wanted to go to rehab a few times,
but since she is poor and unemployed, she has no health insurance for rehab.
What are her options? My parents have no money to help her.

I'll never understand the bull-shit US policy towards drugs. Let's spend
billions upon billions to "fight" drugs coming into the country, but let's
turn a blind eye to the companies pumping out hundreds of millions of pills.

Why the hell don't we spend those hundreds of billions on actually treating
the disease? If there was no demand, there would be no drug war to fight. Why
don't we try a new way?

~~~
maxerickson
Is Medicaid an option?

~~~
kilroy123
Sadly she only has Medi-Cal. Which only covers care for when she is detoxing.
No rehab.

------
ucaetano
And a potential solution to it:

[https://arstechnica.com/science/2017/03/tweaking-
fentanyls-c...](https://arstechnica.com/science/2017/03/tweaking-fentanyls-
chemical-structure-may-create-safer-opioid/)

 _For their chemical makeover, the researchers noted that when tissue is
damaged and hurting, it becomes inflamed and more acidic. The pH drops from
approximately 7.4—what’s seen in normal, healthy tissue—to between 5 and 7.
Fentanyl can work regardless of the pH, so it’s active throughout the nervous
system no matter what. But, if it was altered to only work at the lower pH,
then it could target just the pain source at the peripheral nerves, the
researchers hypothesized. And with no activity in the central nervous system,
it would dodge opioid’s serious side-effects, including addiction and systemic
responses that can be lethal during overdoses._

They're testing a modified version of fentanyl that only works in lower pH,
restricting its activity to injured areas of the body, eliminating the risk of
overdose and dependence:

 _In further experiments, the researchers noted that, unlike fentanyl, high
doses of NFEPP weren’t lethal to the rats. And rats on the NFEPP didn’t
display impaired motor activity or reward-seeking behavior linked to
addiction._

~~~
M_Grey
That's great, and there are other painkillers on the horizon too, but that's
"maybe" and "later". Today we could take concrete steps to alleviate this
crisis which we created in the first place. Cannabis is a good choice for
people addicted to opiates, along with medical detox. You also have to manage
underlying mental health, social, and medical issues.

No amount of throwing new molecules at these problems will solve them.

~~~
ucaetano
Agreed, and cannabis is a good choice not only for the addicted, but to those
suffering chronic pain what would eventually use opioids.

------
savanaly
Given that this article only touches on the supply of these drugs, is there a
tacit assumption that the demand for opioids is driven by unemployment? If so,
what can be done about the demand for these drugs in the long term? "Bringing
back jobs" to those people whose comparative advantage is no longer
manufacturing by taxing robots or imposing tariffs is a temporary stall, and
to the degree it does work it amounts to a fat, inefficient handout.

Fighting the "epidemic" at the supply level seems like a losing battle, as it
is for the hard drugs that plague inner cities. Addressing it at the demand
level has to be the answer, but I don't see any possible answers floated.

~~~
mholmes680
I think its more dissatisfaction with life in general, with unemployment maybe
being one of many triggers.

You're probably right about addressing at the demand level. But, I see the
problem being more societal - think no one really understands everything. You
take away self-reliance of people (whether they realize it or not) at many
levels... its cheaper to get some good-enough quality food at 13 places near
my home, so why should I learn to cook. I can get any vegetable I want at the
store, so I probably don't need to learn how to tend a garden. In both
instances as examples I'm losing a little control of my life. And then....

TV gives me entertainment, and the internet even more so, so maybe i'll just
sit back and let it entertain me. So maybe I don't need to read anymore. Its
easier to have short non-contextual entertainment bits, which rewire my brain
further to think differently [wrongly?]... [0]

And, now capitalism has made all margins of businesses so slim that there's no
real way to enter a business and still have a safety net in case you fail. You
either need to disrupt an industry, create a marketplace, find a niche, or
fail hard.

I think we're just starting to see the uglier stuff here. Short of some great
awakening I also don't see the correct prescription. Pun intended.

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

~~~
glangdale
Postman's book is now 32 years old! I read it as a teenager, which dates me...

I'm not sure about the Amusing Ourselves To Death stuff or the tut-tutting
about cooking and gardening, but overall, though, I think you're on the right
track. I'm sure that between automation of both manufacturing and services,
big-box retailers and the fact that the covering of the 'long tail' is done
very well by web-based business. It's hard to picture what a lot of people are
going to be able to _do_ in this circumstance and there seems to be the real
potential for a cascading unpleasantness.

If you even half-believe the 'technological unemployment' worry, the scary
part is that the non-automatable jobs that involved providing goods and
services to those displaced by technology will _also_ suffer.

There may be plenty of spare time for people to have that 'great awakening',
whatever that might turn out to be.

~~~
mholmes680
>>cooking and gardening

two examples of many, admittedly probably too personal. Others: technology
obsolescence, and the move toward not actually OWNing anything so nothing to
learn to repair.

>>If you even half-believe the 'technological unemployment' worry, the scary
part is that the non-automatable jobs that involved providing goods and
services to those displaced by technology will also suffer.

Yes... My context is now that as a parent, I'm seeing windows closing for the
kids' future that I had. I mean programming (maybe; I hope) and robot repair
will be very lucrative. So will professions like plumbing and electricians.

~~~
glangdale
I feel the 'parent context' too. I have kids old enough to be thinking more
seriously about what they want to do when they group up (i.e. early teens) and
it's difficult to know what to tell them. I suspect that many of the hopefully
lucrative paths you mentioned will be things that gets more and more 'sealed'
and routinized (i.e. robot repair == "remove broken assembly, put in new
assembly, send broken assembly to factory in low-cost geo for
salvage/repair").

It's not all doom and gloom, of course, and I think it's important to maintain
a positive outlook esp. in front of one's kids when talking about this stuff.
And of course, the growing helplessness and screen addiction of many of their
peers suggests that in competitive terms, finding and holding a good job might
be easier and easier (which isn't very encouraging overall, but appeals to the
"amoral familism" streak I occasionally get).

------
ocschwar
I'm going to comment here with a plug for the March For Science, on April 22.

Why?

Because the opioid epidemic started with a simple matter of scientists not
being allowed to science.

Purdue Pharmaceuticals marketed oxycontin as a drug that lasts for 12 hours.

The evidence indicated it only lasted for 8.

If Purdue's scientists were allowed to act on the evidence, i.e. to be actual
scientists, the whole world would have known this years ago. People prescribed
oxycontin would have been told to plan for 8 hours of relief, not 12.

Instead, hundreds of thousands of patients were subjected to 4 hours of pain a
day, and they sought relief with other drugs, including illegal ones. And the
epidemic began.

Science is important, yo.

~~~
devopsproject
You forgot the best part: It made Purdue rich. Instead of changing the
frequency of doses, they told doctors to up the strength which made the
company more money. The owners of Purdue are billionaires now:
[http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

------
oxide
Maintenance treatments with long-acting opioids like methadone tend to come
with a withdrawal that lasts for months.

Meanwhile, short-acting opiates like heroin have a withdrawal period that
lasts about a week. Is it any wonder methadone patients switch back to heroin
when they try to quit for good?

Mark my words, this isn't going away or getting any better. You can prosecute
doctors, regulate all you want, burn fields of poppies. None of it will affect
the demand nor the supply. You can't price or regulate someone out of an
addiction.

If people get cut off wholesale from their prescriptions because doctors are
being prosecuted for prescribing pain medication, they'll turn to heroin.
Which will be available, regardless of all the opium seized, regardless of
cartels dismantled.

Just like when Oxycontin went under a formulation change making it resistant
to abuse, which also caused the price to spike to a dollar per milligram.

People turned to heroin because it was cheaper, more potent, and much more
widely available than pharmaceuticals could ever be.

If you think pill junkies are bad, wait until you look down an alley to see a
heroin junkie injecting another junkie in the jugular because all her veins
are blown out. Watch your step, though, lest you get a syringe in your foot.

~~~
ZanyProgrammer
I've had friends get fucked up by head shop and online Kratom. It's very far
from benign.

~~~
oxide
I've gone ahead and edited my comment, not because of your comment, but just
because I felt like I wasn't making a clear point. Kratom is not even
mentioned anymore, sorry.

While kratom is habit forming and can "fuck you up" if you have no tolerance,
the true value is for the person already addicted to opiates looking to get
clean.

If you want to keep drugs out of the hands of kids, make them all legal and
watch the usage numbers fall. Banning a powdered leaf, that is quite self-
regulating, albeit habit-forming, is a step backwards in the quest to put out
the structure fire that the opiate crises has become.

~~~
DanBC
> If you want to keep drugs out of the hands of kids, make them all legal and
> watch the usage numbers fall.

Doesn't the UK experience with alcohol counter this?

(I am strongly in favour of legalisation of all drugs).

~~~
oxide
Amphetamine will be abused by college students. Alcohol will be abused by
highschool kids. It's a given. The allure of stuff like cocaine, with the
"what else was I lied to about, what am I missing out on" mindset goes out the
window when you stop lying and start letting people make their own choices.

~~~
alva
You can't stop all the drug abuse but the extent of use is not a given.
Amphetamine use of UK students appears to be extremely rare compared to the
US, its never really been a cultural thing here.

I suspect it is due to very few amphetamine drugs being prescribed, especially
to children. It seems to common to hear about people selling their legitimate
ADHD/ADD prescriptions to friends in the US. "Speed Paste" is the only
amphetamine properly in circulation and its use is mostly restricted to the
hardcore "junkie" groups, very much frowned upon from the casual drug
community.

None of the above is a solution, just to note the degree to which groups will
gravitate towards and use a drug is not a given. Culture and availability
probably affect use massively.

~~~
oxide
I completely agree. My example wasn't exactly the best, but relatively
applicable to the US nevertheless.

You raise many good points about drug use being different geographically and
culturally. It's very much about availability, local drug culture, etc.

For example, the speed paste. As you said, in the UK and in other European
countries amphetamine is usually amphetamine in paste form, not crystal
methylamphetamine like we usually see here in the states.

Culture and availability absolutely affects use massively, a point I didn't
mean to gloss over, and one I'm glad you raised.

~~~
alva
What a nice response :)

I think identifying these differences between countries will bring governments
a step closer to finding some sort of solution. Not exactly an easy one though
when it comes to culture though. How do you break strong cultural
associations?

There seems to be a number of (bad)role models that glorify different drugs in
sub-cultures. Opiate use is glamorised from what I can tell in southern
HipHop, Cannabis promoted all over the shop, Xanax frequently referred to in
Hollywood.

------
pnathan
So what is the answer here? Like another poster said, there's a _demand_
problem. How do we as a society address this? I've seen a lot of mumbles about
dealing with supply problems, dealing with overdose problems, but it'd be good
to head the problems off at the pass before they descend into major trouble.

I should also note, this is a burgeoning problem in the Puget Sound/Seattle
region. It's not just rural people dying.

Can someone knowledgeable about drug policy / sociology provide some insight
in this thread?

~~~
DougN7
Preventing that first time is probably the secret. It's got to be so much
harder to resist once you know what you're missing. And it's not like you're
rational about it and considering long term consequences when you're
confronted with a second opportunity.

Unfortunately, we live in a society where it's all good, live free, don't
judge, do what feels good, etc. That leads to things that feel extremely
good...

I'm grateful to parents, teachers and some scary videos in high school health
class that taught me to stay away.

~~~
tbrownaw
I remember reading somewhere about how a decent chunk of drug users just plain
grow out of it as they grow into life roles that it doesn't quite work for.

Nothing to do with theoretical long term consequences, just "this is more
trouble than it's worth".

~~~
pnathan
I'd concur.... anecdotes from reading Reddit suggest that's true for a number
of pot or hallucinogen users. They move on to more fulfilling roles in life.

~~~
wutbrodo
Well sure, for the safest, least-addictive drugs around. For more dangerous
drugs like alcohol or the ones discussed in this thread, "growing out of" an
abuse habit is orders of magnitude more difficult.

------
hackermailman
We have ~400 overdoses per month here. ~20% of that is fatal overdoses because
those ODs are from users doing it by themselves and not inside one of the
shooting galleries we have set up. The safe injection sites work as advertised
but for many reasons some addicts don't go there, mainly because debt
collecting gangsters and drug dealers hover all around the front doors, and
stigma of standing in an addict lineup that spreads for blocks for all to see.

There's a few reports here from VANDU a group run by addicts on the
effectiveness of peer-run supervised injection sites and needle exchanges,
meaning run by other addicts instead of government employees
[http://www.vandu.org/reports/](http://www.vandu.org/reports/)

The problem is synthetic opioid is being used to buff out heroin so street
dealers can save money by importing less heroin from India (how it comes into
Canada). They keep coming up with new synthetics to bypass precursor
prohibition or import laws, plus China has factories pumping this shit out
legally which can easily be smuggled since it costs far less than heroin from
India/Afghanistan.

Whenever you talk to a street addict basically the reason they got on heroin
was they had some other substance abuse problem, usually cocaine, alcohol or
meth, there was a shortage of that substance because either they couldn't
afford it, busts made it scarce, or they were in jail so through peers they
accessed heroin instead and got hooked.

Methadone doesn't work, they've already abandoned that idea here and moved to
just handing out heroin to the worst cases, or hydromorphone which has a
proven success rate in weening addicts off drugs.

Somewhere in all this is a solution that doesn't involve enabling career bums
who want free heroin for life and doesn't involve 400+ ambulance calls per
month draining our resources.

------
tim333
A potential solution:

>Legal Heroin Prescriptions: The ‘British System’ You Never Knew Existed

Basically prescribe heroin for the addicts so they don't need to deal / steal
and the thing dies out. You could link getting the prescription to doing
something useful work wise if you want to be moralistic. Been done since the
1920s - tried and tested.

[http://www.huffingtonpost.co.uk/entry/heroin-prescription-
di...](http://www.huffingtonpost.co.uk/entry/heroin-prescription-
diamorphine_uk_57fd2f6ee4b0430f66f67894)

~~~
everybodyknows
How does the "British system" work out long-term, for the addicts as
individuals -- resistance accumulation, vein damage, constipation? Do any live
on to old age? Or does it "work" for the rest of society because they die
peacefully, at home?

~~~
alex_hitchins
There is an issue that people get 'parked' on methadone and never fully come
off it. However, some people I know are now in their 70's and still managing
their addiction via Methadone prescribed by a GP. They have been on this
treatment since the late 80's. They would not be alive and working, paying
their taxes if this wasn't about.

------
rwmj
In the UK it appears that there's a Spice epidemic. It's often called
"synthetic cannabis" or "(formerly) legal highs", but it in reality it's all
kinds of research chemicals sprayed onto leaves to be smoked. It has some
pretty hideous side effects, and seems very addictive
([https://video.vice.com/en_uk/video/the-hard-lives-of-
britain...](https://video.vice.com/en_uk/video/the-hard-lives-of-britains-
synthetic-marijuana-addicts/55ccad2d2b68305332db7128))

Oh, and the government just handed the whole market over to illegal drug
dealers, with fairly predictable results.

~~~
DanBC
The spice epidemic is mostly prison related though.

Prisons should stop testing for cannabis; and should consider prescribing
cannabis of known strengths (and higher CBD rather than THC content).

(Also, they need to start providing a lot more mental health support and
meaningful activity).

~~~
goatsi
Artificial cannabinoids are also highly used in homeless populations because
of how cheap and powerful they are.

[https://www.vice.com/en_ca/article/synthetic-weed-is-a-
scour...](https://www.vice.com/en_ca/article/synthetic-weed-is-a-scourge-on-
brooklyns-homeless-population-727)

~~~
DanBC
Sure, but that's the US, not the UK.

~~~
goatsi
The vice video rwmj posted is all about homeless spice users in the the UK.

------
creaghpatr
If you're looking for a go-to book on America's opioid crisis- Dreamland by
Sam Quinones.

[http://www.goodreads.com/book/show/22529381-dreamland](http://www.goodreads.com/book/show/22529381-dreamland)

The devil is absolutely in the details and it seems like it's gonna get a lot
worse before it gets better.

~~~
rrdharan
Haven't read the book yet but Sam Quinones was on EconTalk recently and it was
pretty enlightening:

[http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...](http://www.econtalk.org/archives/2017/01/sam_quinones_on.html)

------
jstewartmobile
I'm on the gulf coast, and we just had a high-profile prosecution of a doctor
running a pill mill.

What if this whole mess isn't so much a technical problem to be solved as much
as it is our system functioning under its own perverse incentives? Other
countries don't have this problem.

In my own area of expertise, I have seen so many non-solutions force-fed to
the customer when an actual solution is not as profitable. It is not hard to
believe that medicine operates similarly.

~~~
knz
> What if this whole mess isn't so much a technical problem to be solved as
> much as it is our system functioning under its own perverse incentives?
> Other countries don't have this problem.

That description could easily be applied to many aspects of the US healthcare
system - an epidemic is a failing of public health.

------
6stringmerc
The first time I saw a TV commercial here in the US for a pill to battle opiod
induced constipation, I realized just how many people are taking large doses
of the stuff. Pretty staggering to me.

~~~
cheald
Yeah, those commercials are painful. If you're taking so many opioids that you
have trouble pooping, maybe the solution is to _take fewer opioids_ rather
than adding another medication to the mix. Really damning commentary on how
easily and flippantly we overmedicate.

~~~
GordonS
Even a low dose of less potent opioids such as codeine or dihydrocodeine can
cause constipation

~~~
cheald
So get some extra fiber and pop a Colace if it's really bad. Adding another
prescription medication seems like a pound worth of solution for an ounce's
worth of problem.

------
chx
Check
[https://morecrows.wordpress.com/2016/05/10/unnecessariat/](https://morecrows.wordpress.com/2016/05/10/unnecessariat/)
for some deep reasons and for a feel how bad it is. Don't blame this or that
pharma for it, that's a distraction.

------
parr0t
I'll never understand locking people up for having an addiction and treating
them like criminals. I'm not too educated on how it's handled in America but
in Australia you can go to your doctors and get signed up to a methadone
program without worrying about any legal repercussions.

My fiancé works at a pharmacy in Melbourne, Australia and says some of the
most lovely and friendly people who just want to get themselves together come
in regularly to get their $5 dose and it's saddening to see how badly society
judges them.

~~~
wutbrodo
I believe you can do the same here, but the (huge, purpose-defeating)
difference is that you need to be able to afford the rehab in a country that
isn't so keen on providing a safety net (somewhere upthread someone mentions
his sister ruining her life with heroin, wanting to go to rehab, but unable to
afford the cost, which is uncovered by Medi-Cal).

------
troisx
I know the United States will never do it, but Singapore barely has a drug
problem because they execute dealers and have mandatory treatment for users.
I'm not advocating the ridiculous policy that the Phillipines has, but
Singapore doesn't mess around if they find distribution levels of illegal
drugs on you. There also needs to be much stricter control of new
prescriptions for opioids, which lead to addiction.

~~~
oxide
>There also needs to be much stricter control of new prescriptions for opioids

Like the extremely strict controls in place? Like the prosecution of doctors
who run pill mills? Like the rescheduling of hydrocodone formulations?

In my local ER there is an entire framed info-poster explaining why you aren't
getting your meds refilled at the ER, you won't be getting fentanyl, dilaudid
or oxycodone prescribed to you no matter what. ED's work with your primary
care doctor and relay info to them. States have implemented pharmacy tech that
allows them to track prescriptions state-wide. (a former massive problem)

Hospitals are already doing this. Pharmacies, already doing this. Doctors are
terrified of the laymen telling them they know better in the court of law.
Pain is being undertreated now more than ever, which is the flipside to the
crackdown you don't seem aware of, which has been happening for years now.

There will _always_ be abusers. It's inevitable. The people who really suffer
from this kind of over-reach are people like my grandparents who are nearing
life's end. People dependent on pain medication for their quality of life.
Non-abusers.

Maybe quality of life means nothing to you, but to them it's all they have
left keeping them going. It's the only reason they can continue to live
through the constant pain, the enduring misery old age and lives of very hard
work has wrought upon them.

------
glangdale
The only thing that is good about this epidemic is that it seems to have moved
harm reduction onto the agenda after decades of militarized and/or "lock 'em
up and throw away the key" responses. Hopefully the result will be a more
rational response for _all_ of America's drug problems regardless of the color
of the users.

~~~
rm_-rf_slash
Are you kidding? The attorney general of the United States is on record saying
the one thing that kept him from joining the KKK was their marijuana use,
stating that "decent people don't smoke marijuana."

Public opinion may have shifted, but as far as the current White House is
concerned, it's their way or the highway.

~~~
soundwave106
For the record I've noticed the tone of reporting these days is a little
different as well, personally. It is harder for people to demonize
prescription drug abuse; you don't get quite as much of the broad stereotyping
and Hollywood-ization that happened in the 1980s on this subject.

Yes, some people cling to old-fashioned hardened attitudes. But if you look at
Gallup's poll on drugs ([http://www.gallup.com/poll/1657/illegal-
drugs.aspx](http://www.gallup.com/poll/1657/illegal-drugs.aspx)), people are
_way_ more worried about prescription drugs and the related heroin epidemic
these days. Way more than cocaine, certainly. It's not in the poll, but it's
hard to remember when the last time the boogeyman of the 1980s (crack cocaine)
came up in reports.

Support for marijuana legalization stands at 60% now, compared to the 1980s
where support was at 25%. There is a large age gap in support, in marijuana at
least ([http://www.gallup.com/poll/196550/support-legal-
marijuana.as...](http://www.gallup.com/poll/196550/support-legal-
marijuana.aspx) \-- 55+ 45% support, 18-34 77% support).

Although I'm sure harder stances will linger onward, as it has in the AG's
mind, the AG's stance is increasingly looking out of touch.

------
Clubber
>States have since cracked down on prescription opioid abuse, creating drug-
monitoring programmes and arresting unscrupulous doctors.

So if you look at the chart, when they started doing this, heroin overdoses
skyrocketed while pill overdoses stayed about the same. They doubled the
deaths with their crackdown solution, as if that has _ever_ worked.

------
grondilu
> The opioid epidemic has its roots in the explosive growth of prescription
> painkillers. Between 1991 and 2011, the number of opioid prescriptions
> (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied
> by American retail pharmacies increased from 76m to 219m. As the number of
> pain pills being doled out by doctors increased, so did their potency. In
> 2002 one in six users took a pill more powerful than morphine. By 2012 it
> was one in three.

I find this absolutely outrageous. I'm not American, but I stumble upon
articles mentioning this, and I do watch enough American TV series and movies
to have an idea of how acute the problem is (it's crazy how often in TV series
doctors seem to give pain killers like it's candy).

I have the impression that in Europe, painkillers are much less used but I
would not be surprised if the American trend were to contaminate medical
practice here.

Pain is a minor consequence of disease or trauma. Pain won't kill you, so why
would you risk become addicted to very dangerous drugs just to relieve it?

~~~
pjc50
> Pain is a minor consequence of disease

There speaks someone young and healthy. Some conditions are extremely painful
in the long term.

"It is estimated that more than 100 million people suffer from chronic pain in
this country,[11] and for some of them, opioid therapy may be appropriate. The
bulk of American patients who need relief from persistent, moderate-to-severe
non-cancer pain have back pain conditions (approximately 38 million) or
osteoarthritis (approximately 17 million)."

Source: [https://www.drugabuse.gov/about-nida/legislative-
activities/...](https://www.drugabuse.gov/about-nida/legislative-
activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-
prescription-drug-abuse)

"aggressive marketing by pharmaceutical companies"

"United States their biggest consumer globally, accounting for almost 100
percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for
oxycodone (e.g., Percocet)"

That does make it sound like a problem created by pharma drug pushing on TV.
But that doesn't mean the pain isn't real either.

Really the whole thing needs to be seen as a widespread public and social
health problem - which is exactly the sort of thing the US system is set up to
avoid seeing. Healthcare is _not_ just a matter of individual responsibility
or a contract between someone and their employer.

~~~
grondilu
> "aggressive marketing by pharmaceutical companies"

I'm wondering what that means, concretely. How exactly do they convince GPs to
prescribe pain killers even when it's not really appropriate? They can't just
pay them, can they?

~~~
pjc50
Well, yes:
[http://www.pharmadisclose.org/cme/ut000309.html](http://www.pharmadisclose.org/cme/ut000309.html)

[http://fortune.com/2016/06/21/doctors-cheaper-drug-
prescript...](http://fortune.com/2016/06/21/doctors-cheaper-drug-
prescriptions/)

------
vogelke
One of the best books I've ever read on _why_ the war on drugs is a bad idea.
It's written by a UK cop who was there nearly from the beginning.

    
    
      https://www.amazon.com/Good-Cop-Bad-War/dp/1785032690/
      Good Cop, Bad War (Paperback)
      Publisher: Ebury Press
      Language: English
      ISBN-10: 1785032690
      ISBN-13: 978-1785032691

------
lr4444lr
I say this mostly tongue-in-cheek because I hate to apply one bad policy to
fix another, but I bet if narcotic overprescription could more readily trigger
medical malpractice, you'd see doctors thinking more judiciously about their
use.

Even if exaggerated by an order of magnitude, stats like this are just
indefensible: [http://www.webmd.com/mental-
health/addiction/news/20160325/n...](http://www.webmd.com/mental-
health/addiction/news/20160325/nearly-all-us-doctors-overprescribe-addictive-
narcotic-painkillers-survey#1)

~~~
cmdrfred
What's funny is there is no evidence that these opioid pain killers are
actually effective in the long term for the management of pain. If it wasn't
for lobbying they likely wouldn't be legal to use in that way.

~~~
tylersmith
I've been taking opioids for nearly a year and they still work fine. Not sure
how long-term you mean.

~~~
cmdrfred
Stop taking them for a few days and you'll see what I mean. Many studies have
shown that patients who do not consume opioid medications have better long
term outcomes than those who do. It simply isn't effective in managing pain
long term, and also is not indicated for use in that manner.

~~~
tylersmith
When I stop taking them I'm in pain again. I think what you're trying to get
at is the opioids don't solve the underlying problem. But to say they're not
effective for managing pain is wrong. I use them to manage pain every day. I
get regular steroidal-epidural injections to solve the issue.

------
cowardlydragon
I read that Medicaid is being used to fuel the black market pipeline.

$3 copay gets you a $1000 street value opioids...

Of course this is corporate welfare for the opioid manufacturers.

I also read that one month 11% of Ohio's population was prescribed
painkillers.

------
karmelapple
Read Chasing the Scream [1], a fantastic book that documents drug prohibition
in the USA, how doctors who viewed it as a health issue got chased out of
their desire to help, and suggests many paths to helping people and making the
world a better, safer place.

I've posted this in enough threads that I probably seem like a bot advertising
for it, but seriously, it's a book worth reading and that can change someone's
entire opinion on the drug epidemic and what legislation we should pass.

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

------
malandrew
This article I recently submitted had some interesting stats on the
relationship between opiates and the welfare state:

[https://www.commentarymagazine.com/articles/our-
miserable-21...](https://www.commentarymagazine.com/articles/our-
miserable-21st-century/)

Although the entire article is worth reading, jump down to the paragraph that
begins with "The opioid epidemic..." and read for about ~5 paragraphs if
that's all that interests you.

------
hackuser
Is a war on drugs a good response? Hyper-aggressive policing? Lock up even
minor participants for decades?

Consider why people thought that was a good response when drugs struck other
communities.

~~~
wutbrodo
This is hardly news: the same dynamic played out in a different chronological
order between alcohol and marijuana prohibition. Alcohol was so ubiquitous
that Prohibition turned all of society (including "decent" people) into
criminals, so the response was that it's clearly an unworkable solution; we
can't lock up _everybody_. It's only simplifying a bit to say that marijuana
shared much the same ubiquity in certain _other_ communities, so the response
was.....let's just lock up everybody.

------
ransom1538
Could weed slow down the opioid epidemic? It gets you high, it is way cheaper,
way healthier (not smoked), it isn't addictive, curbs the urge for opioids,
easier to make, easier to sell.

[https://www.theatlantic.com/health/archive/2017/02/marijuana...](https://www.theatlantic.com/health/archive/2017/02/marijuana-
cannabinoids-opioids/515358/)

------
Jun8
What is causing the variation on the prescription opioid graph do you think?
The other two graphs don't have similar patterns to such degree.

------
droopybuns
These stories are so frightening to me that I contemplate just enduring the
suffering if I am ever unfortunate enough to be prescribed oxy or dilaudid.

------
pmoriarty
I once read of a 20-year-long study that found that when heroin-addicted UK
doctors were given unlimited access to pure heroin they performed slightly
better than their non-heroin-addicted colleagues, and they had no negative
long-term health consequences. If anyone else has heard of this study, or
especially if they have some documentation on it, I would appreciate a link.

------
dcroley
There is something obviously wrong or at least strange with the data that
backs that map. Look at the contrast across the border between Tennessee and
Georgia or between West Virginia and Virginia. I think some states must be
under-reporting things or reporting them differently. I would expect such a
map to track poverty maps or unemployment maps, but it does not.

~~~
kolbe
Correct. States have a great deal of variance when it comes to tracking
overdose deaths.

------
sanguy
Methadone clinics work; Zurich is a good example. Hard to manage; hard on the
community; but it eventually kills off the problem.

------
ainiriand
You know Trump's solution? Jail for everyone. No wonder why US has 25% of the
world's total inmate population...

[0][https://www.thoughtco.com/states-spending-money-prisons-
not-...](https://www.thoughtco.com/states-spending-money-prisons-not-
schools-4068528)

------
tlow
So the Federal Government should Legalize Cannabis and allow research into
it's painkiller effects?

------
rodionos
I watched this BBC documentary a few days ago:
[http://www.bbc.com/news/magazine-37992809](http://www.bbc.com/news/magazine-37992809)

It seems that new painkillers such as oxycodone have something to do with the
surge.

------
partycoder
John Oliver spoke about this in depth:
[https://www.youtube.com/watch?v=5pdPrQFjo2o](https://www.youtube.com/watch?v=5pdPrQFjo2o)

Humor aside, he managed to compile an impressive amount of testimonials and
facts.

------
shams93
The states with medical cannabis don't have anywhere near this problem. They
need to cover medical cannabis via medicaid that would seriously put a dent in
the crisis or at least keep it from growing bigger.

------
WhiteSource1
What is causing this? IS this prescription drug dependence? Because this
wasn't a problem 10 or 20 years ago!

------
yuhong
[https://www.reddit.com/r/politics/comments/5v43rj/how_mike_p...](https://www.reddit.com/r/politics/comments/5v43rj/how_mike_pence_used_obamacare_to_halt_indianas/ddzapo8/?st=izgcbq4v&sh=d07521d3)

Also read other comments in the thread about history of needle exchange
programs etc.

------
duncan_bayne
I _wondered_ what the political & law enforcement community was going to do,
with the clear failure of the War on Drugs and growing demands for legal
marijuana.

Never fear! Here's the latest Demon Drug, which we can use to whip up popular
support for another round of failed prohibition-mentality policies. No need to
worry about budget cuts, reduction in the availability of military weapons,
drones, etc. to law enforcement. There will still be a viable career in
persecuting some of the most vulnerable members of society.

Those in favour of harm minimisation need to fight for legalisation, or at the
very least decriminalisation as a strating point. Not just for _their_
favourite drug, but for those causing the most harm right now.

------
am185
US may need to follow Philippines anti-drug campaign.

~~~
lawless123
Suppose people can't overdose if they've already been murdered...

------
DoodleBuggy
Hard to believe there is really an "epidemic" beyond typical fearmongering and
political noise. People have always used drugs, this is nothing new.
Unfortunately all the hype and noise is having significantly negative
consequences to the medical community, doctors, and patients who actually need
these things.

~~~
devopsproject
Here are some alternative facts. Red means bad:
[https://www.brighthearthealth.com/wp-
content/uploads/OpioidA...](https://www.brighthearthealth.com/wp-
content/uploads/OpioidAbuseRipplesAcrossAmerica.png)

~~~
johan_larson
Wonder why the northern great plains are so resistant to this problem?

~~~
devopsproject
population density? Maybe the pill mills only located in certain areas.

