
Children of the Opioid Epidemic Are Flooding Foster Homes - happy-go-lucky
http://www.motherjones.com/politics/2017/07/children-ohio-opioid-epidemic/
======
ransom1538
What bothers me about this epidemic is how easy it could be for authorities to
stop. Fentanyl isn't created in the back of a motor home. It is a manufactured
and controlled narcotic. How controlled - just see the link below. All that
needs to happen is for the DEA (et al) to stop raiding homes and torturing
people and to pay a visit to these _out of control doctors_. Why a "Nurse
Practitioner" is allowed to prescribe opioids 21937 times - wtf? Opioid
prescribing is totally open and public - they aren't hiding it.

Here I have a list of the highest prescribing opioid doctors (sunday with beer
project):
[https://www.opendoctor.io/opioid/highest](https://www.opendoctor.io/opioid/highest)

(let me know if you want the sql or whatever).

~~~
marcoperaza
I remember that about a decade ago, doctors and others were criticizing the
DEA for being draconian in their regulations surrounding opiate prescriptions.
They were complaining that doctors often felt that they couldn't prescribe
even when there was legitimate need.

I don't know what happened in the interim, whether or how the DEA's policies
changed, but if only we had draconian DEA policies aggressively stopping
overprescription now.

As someone who used to naively believe in legalizing all drugs for
recreational use, this addiction epidemic has opened my eyes to why that's a
horrible idea.

~~~
mgkimsal
> but if only we had draconian DEA policies aggressively stopping
> overprescription now.

Not sure what the policies are now, but around me, I can _not_ go get any
prescription for any back pain (have really needed it twice in the past 3
years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins
around here all have signs on the front door saying "no prescriptions for
oxycontin, etc"

Now... yes, I could try to "see my GP", which generally means waiting a few
days. (and, I don't really have a GP anymore, because I can never get in to
see him).

What's strange is that about... 6 years ago, going to one of the same clinics,
my wife went with an eye problem. Specifically, she'd had a small piece of
sand get in her eye, and it was really sort/irritated. Home flushing wasn't
working, so we went to the clinic. As she was leaving, they asked if she felt
she needed any pain medication. "Well, not really, but it's a bit sore, and I
do have a headache". They gave her a script for 14 oxycontin on the spot. Same
place last year would not even _talk_ to me about pain medication ("go see
your GP").

~~~
nxc18
Those practices (handing out oxy) are a major contributor to the current
epidemic, if not the root cause.

I've gotten opiate prescriptions I had no business having without asking. I
get that some people need pain medication or will suffer, but there's a whole
lot of suffering that opiate addiction causes and that is not really factored
into the 'do no harm' calculation doctors are supposed to be doing.

It really is a great thing to see legitimate restrictions on these
prescriptions, as that should cut down on new addicts at the very least.

~~~
pkaye
I'm hearing on the one side that these legal prescriptions are causing the
problems but on the other had others say that these drugs being illegal is
causing the problem and if we made them legal that people will use them in a
safe manner. If people get addicted them when prescribed legally then how can
making them legal have any hope?

~~~
nostrademons
Making them legal at least keeps the problem out in the open, where it can be
regulated. Notice that the response to the opioid epidemic, as described in
this thread, is that clinics have stopped giving out oxycontin. When we had a
crack epidemic in the 80s or a heroin epidemic in the 60s and 70s, the
response was to send troops into the regions that produced those drugs. This
was both expensive and ineffective, and in many ways just made the problem
worse: with the whole distribution chain being completely illegal, street
prices went up, more money was made by a few outlaw kingpins, and that gave
them more resources to buy arms and escalate violence.

~~~
pkaye
These are highly addictive substances. If doctors can't stop the abuse now on
prescribed medicines who in the regulatory agencies can do better?

------
DanBC
> Given the scale of the crisis, it’s not hard to understand why, when Donald
> Trump promised Ohioans on the campaign trail to “spend the money” to
> confront the opioid crisis and build a wall so drugs would stop flowing in,

Have a look at this document with data from 2009. Compare usage rates in
Americans for opiates with opioids with prescription opioids:

[http://www.unodc.org/documents/data-and-
analysis/WDR2011/Sta...](http://www.unodc.org/documents/data-and-
analysis/WDR2011/StatAnnex-consumption.pdf)

Annual Prevalence of use as a percentage of the population aged 15-64 for the
year 2009

    
    
      Opioids 5.90%
      Opiates 0.57%
      Prescription Opioids 5.60%
    

Those drugs are being prescribed by doctors. The cause is not illicit drugs
from outside the US. The cause is the terrible healthcare for pain. Illicit
fentanyl coming in from outside the US now is just a symptom - stopping that
fentanyl will prevent death (because it's a very dangerous opioid) but it
won't do anything about the real problem: people in pain with inadequate
treatment for that pain.

~~~
throwaway91111
Also, fentanyl, which is a major illicit opiate source, mainly comes from
china. A wall could have no effect at all; and in fact could spur more deaths
if people turn to fentanyl.

------
paulddraper
I'm a foster parent, and this is definitely a real thing.

My state recently went into crisis mode for foster care, where they struggled
placing kids and filled up the group facility they normal use for short term
overflow. They're starting a program specializing in short-term placements.

Opioids have been blamed for the recent increases.

[http://fox13now.com/2017/05/12/resources-stretched-thin-
as-m...](http://fox13now.com/2017/05/12/resources-stretched-thin-as-more-
children-entering-foster-care-in-utah-than-ever-before/)

And this is in a state (Utah) with an already relatively low rate of children
in state custody. Surely if we are struggling, other states must be as well.

I don't know what politics to sorry or what macro policy changes will "fix"
this, but I know how I can help. Circumstances vary, but if yours permit you
to do foster care, I recommend looking seriously at it.

~~~
ericabiz
Can you say more here or offer some links on what it's like to be a foster
parent? I'm adopted and had to deal with some ACEs, and being a foster parent
really does call to me. My dad was an attorney and also volunteered to help
with foster kids, so I had exposure to them as a child. I want to look more
into it.

Also, if you have biological kids of your own, how did they deal with foster
kids? I have a daughter and would like to have another bio child as well.

~~~
Animats
A lesbian couple in Oakland I know have two foster girls from a Nepal refugee
camp. It's been all uphill with them. They've had them since age 14, and now
they're 18. English was a problem, but they're mostly past that. Their
schooling is poor; despite Kumon, tutoring, and the Berkeley International
School, one of them can't pass the DMV written driving test.

Attitude is an issue. The girls grew up in a refugee camp where they didn't
have much, but nobody had to do anything. Now they've been dumped into an
complex alien society where they have to become self-supporting. It doesn't
help that the girls think their role is to find a man and be supported by him.
The girls have strong ideas about the role of women, and despite being
fostered by lesbians who do home remodeling and industrial design, they have
zero interest in learning those skills.

The people who supervise the foster child program think they're doing a great
job. The kids have sort of learned to read, and one of them got a job at an
ice cream store. They got high school diplomas, only because California
stopped requiring the high school exit exam at the beginning of 2016. This is
better than average for the program.

Both girls can use a smartphone for entertainment purposes.

~~~
paulddraper
> This is better than average for the program.

I wonder how much of this has to do with Oakland, which has a reputation for
having troubled communities.

> They've had them since age 14

Foster care or otherwise, changing someone's habits and worldview starting at
fourteen is tough. Kudos for them for trying.

------
dreamdu5t
According to Pew Research: "National data doesn’t identify how many children
are removed from their homes because of a parent’s substance abuse. And
there’s no one standard for how states report substance abuse and child
neglect."

[http://www.pewtrusts.org/en/research-and-
analysis/blogs/stat...](http://www.pewtrusts.org/en/research-and-
analysis/blogs/stateline/2016/10/07/drug-addiction-epidemic-creates-crisis-in-
foster-care)

------
pasbesoin
I spent the first half of 2016 helping a drug and alcohol addict kick her
habit of 20+ years. 6 days inpatient detox. Would have had 30 days rehab if
she'd stuck with it.

Had lost her driver's license years ago. So after she checked herself out
(admittedly, upon my investigating, for some legitimate reasons vis a vis that
program), I spent the next couple of months driving her to meetings, providing
childcare to make that possible, helping her get to the job her sister found
her, then the second job. Making sure she wasn't alone in the evenings, when
she would drink...

My major point. 6 days at one of the area's premier hospitals. Thanks to the
ACA expansion of Medicaid. The rehab program would have gone under that, as
well. Foodstamps for her and her kids. A social worker and case management for
her daughter (living with grandma). Etc. Etc.

I had some warning signs, early on, but I hung in there -- advice from
experienced friends and experts advising patience. And thinking not just of
her, but of the kids; things seemed to gradually get better with them once I
got involved.

Anyway... Not just my support. All this _public_ support. That I don't
begrudge: Treat the problem. Take care of the kids.

Come fall, she's back together with her ex-boyfriend, who was a big Cruz
supporter. ("The Constitution! La la la, blah blah blah...")

And she -- previously having stated her indifference to politics, except for
hating Hillary for whatever gut felt reason -- starts expressing herself as a
big Trump supporter.

I'd explained to her, early on, that the ACA is what enabled me to keep
insurance. I don't get a tax break. It just gives me the opportunity to
participate, whereas before insurance companies would look for any pimple as
the basis to exclude me.

She gained sobriety through the support of the State, and someone who depends
on the ACA for his own well-being.

None of that seems to matter to her.

This experience has caused me to fundamentally rethink my ideas about how the
world works and how we can (or can't) tackle these problems.

Writing about all this makes me feel kind of small. Laying the situation out
there and sounding aggrieved.

But I do it, all the same, for the point it impressed upon me: I'm no longer
sure some people can be reached, through any level of action and good will.

It's a pretty sobering -- and saddening -- perspective.

P.S. We've been out of touch for months -- her choice. As far as I know, she's
still sober. Making plans a year out.

She's doing ok. But there seems to be no connection in her mind with providing
that opportunity to others.

I've been forced to realize and acknowledge that some people appear to be in
it purely for themselves. They can exhibit charm and engagement in furtherance
of this purpose. But real empathy and cooperation?

And, looking around, it's not just the addicts and "miscreants". There's a
significant portion of the population who really does believe and follow "I
got mine". And that is all they really respect in others.

It is, it turns out, a dog eat dog world. At least when it comes to dealing
with these people. Who, en masse, present a formidable problem to a
functioning society.

~~~
krastanov
Thank you for helping other people! You are making the world a better place,
and when you average it out it is working - humanity is more "humane" this
century than it was over the last couple of millennia.

Sure, there are those really disappointing frustrations, but I try to just
chalk them up to cost of doing business. That way you can focus on the fact
that the average is getting better and your efforts are making a difference,
even if slowly.

------
notadoc
The "opioid epidemic" is manufactured political and media hysteria. There have
always been drug addicts.

The end result to all of this hysteria will be nothing but more political
interference in doctor-patient relationships, more annoying obstacles and
hoops for patients to jump through, and more suffering for patients.

~~~
DanBC
It really, honestly, is not manufactured outrage.

[https://www.vox.com/policy-and-
politics/2017/6/28/15881246/d...](https://www.vox.com/policy-and-
politics/2017/6/28/15881246/drug-overdose-deaths-world)

> America has about 4 percent of the world’s population — but about 27 percent
> of the world’s drug overdose deaths

The US uses far more opioids than any other country. Does the US have far more
pain than any other country?

> and more suffering for patients.

No.

You seem to think that opioids are an effective treatment for long term pain.
They usually are not. The patient either stops taking them because of side
effects, and is still in pain. Or the patient develops a tolerance, and needs
to take more and more, and is now addicted to opioids and taking dangerously
large amounts of opioids and, importantly, is still in pain.

People with long term pain need rapid access to a specialist pain management
clinic. Opioids might be a choice of treatment, but they will be carefully
prescribed, not dished out.

~~~
notadoc
> You seem to think that opioids are an effective treatment for long term pain

Because it can be. In many cases of severe persistent pain, they are the
_only_ effective treatment. There are many situations where literally nothing
else works save for anesthetic infusions.

> and is now addicted to opioids

Those patients and doctors are making the determination that addiction is
better than the alternative. Why is anyones business if that is what they
decide? Frankly being addicted to a prescription painkiller is not any
different from addiction to ADHD medication, a benzodiazepine (which are far
worse in terms of addiction, withdrawal, and consequence), or an anti-
depressant.

> People with long term pain need rapid access to a specialist pain management
> clinic.

Sure. But do you expect a patient to come back every 6 hours for another
lidocaine injection? What do you think they do in pain management clinics? If
you think the side effects of an opiate are bad wait until you see people on
heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting
practically no relief from their pain at all but are heavily medicated.

~~~
DanBC
> In many cases of severe persistent pain, they are the only effective
> treatment.

I can believe some random person on the internet, or I can believe the Royal
College of Anaesthetists.

[https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-
awar...](https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-
aware/clinical-use-of-opioids/effectiveness-for-long-term-pain)

> Given the limited duration of clinical trials, data on efficacy of long term
> opioid use are available only from case series and open-label extensions of
> controlled trials. These latter have been systematically reviewed. Open-
> label extension data suggest that a small proportion of patients may derive
> continuing benefit from opioids in the long term but the relevance to
> clinical practice is uncertain as patients with co-morbidities that may
> predispose to problematic opioid use are generally excluded from clinical
> trials and evaluation of long term use does not, in these studies, identify
> potential benefits from placebo effect, benefits of additional therapies or
> spontaneous resolution of symptoms.

> Analysis of open label data does not enable firm conclusions regarding
> improvement in function or quality of life with long term opioid treatment.
> Data from prospective cohort studies suggest that opioids retard return to
> work after injury and may prolong functional recovery or worsen physical
> functioning. A Danish cross-sectional study has suggested that when
> comparing opioid users with non-opioid users, opioid use appears to be
> associated with poorer self-related quality of life and employment status,
> increased healthcare use, and worse pain. These studies do not demonstrate
> causality in relation to opioids and poor function in a number of domains
> but indicate that the hoped for end points of pain reduction and improvement
> in function are not being met with long term opioid treatment.

Particularly:

> Important Practice Points

> Patients who do not achieve useful pain relief from opioids within 2-4 weeks
> are unlikely to gain benefit in the long term.

> Patients who may benefit from opioids in the long term will demonstrate a
> favourable response within 2-4 weeks.

> Short-term efficacy does not guarantee long-term efficacy.

> Data regarding improvement in quality of life with long-term opioid use are
> inconclusive.

> There is no good evidence of dose-response with opioids, beyond doses used
> in clinical trials, usually up to 120mg/day morphine equivalent. There is no
> evidence for efficacy of high dose opioids in long-term pain.

That "no evidence" bit should worry you. Why doesn't it?

> Those patients and doctors are making the determination that addiction is
> better than the alternative

Because, as the RCA keep saying: opioids are not treating the pain, and are
causing harm to the patient. Patients keep taking the meds not because those
meds work, but because they are addicted to those meds.

~~~
notadoc
Your comments are best summarized as "I have no experience on this matter but
I can spend a few seconds on google and then copy and paste" which may work
well for writing a shell script but fortunately it's not how medicine or
health care works.

~~~
DanBC
Feel free to provide your own links.

You make it sound like I only just googled these. Even if that's true (and
it's not, and that's trivially easy to check) so what? I'm posting government
level advice backed by meta analysis.

Your the one posting your opinion. Frankly, I don't care about your personal
experience. Look at eg knee arthroscopy for an example of how useless personal
experience of both patients and doctors in health care.

------
rhspeer
Contimplating fostering a computer nerd to do QA. I believe that is how the
old apprenticeships worked.

Would also move out with a savings, a marketable skill, and references at 18.

Not a bad start for a Dev.

~~~
rhspeer
Huh, down votes signal it is reasonable to want a pet human, but not an
apprentice?

------
shams93
It's interesting we could be developing whole new non addictive classes of
pain killer from cannabis extracts but instead we standardize on oxyconton and
opiates. With a beat up, aging population of working people with chronic pain
of course it's a perfect storm. But in states that have embraced cannabis we
don't see this level of crisis .

~~~
dreamdu5t
It's a myth that heroin and opiate addiction are the result of pain killer
prescriptions: "According to the large, annually repeated and representative
National Survey on Drug Use and Health, 75 percent of all opioid misuse starts
with people using medication that wasn’t prescribed for them—obtained from a
friend, family member or dealer. "

~~~
throwanem
That certainly is the result of painkiller prescriptions - just not ones
written for the person who starts using.

