
Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017 - Alex3917
https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html
======
naccato
The sad truth is, the U.S. is a country that emphasizes punishment over
rehabilitation, and we've brought this upon ourselves by isolating people and
banning access to substances that they've become dependent on. The solution
here is not complex: give addicts safe access to the substances they're
addicted to and resources for improving their situation. It's disheartening,
to say the least, that one of the main strategies for dealing with this is
apparently "reducing medical prescriptions of opioids". People are in pain --
they need to be helped.

I highly recommend the book Chasing the Scream, for anyone who's looking for a
primer on the War on Drugs. It traces the hysteria around drug use back to the
1930s, when race panic was used to push forward prohibition in the face of
mounting evidence against that strategy.

~~~
okreallywtf
I've had discussions with coworkers and friends about this issue and similar
issues where there is a lot of moral ambiguity but a lot less academic
ambiguity - we basically know what works and doesn't work but what does work
is not morally acceptable to about half the country. It is super frustrating
to a lot of us because there doesn't seem to be a way to reach them, they can
change their minds but only when they are personally affected by the issue but
it doesn't seem to then spread much to their peers.

To paraphrase one conversation that reminded me a lot of the larger national
conversation "I play by the rules, why shouldn't everyone else?". It didn't
matter that punishment didn't help or in a lot of cases, was costing them more
and having worse outcomes, the larger (and to me, more trivial) moral and
emotional argument won out.

~~~
rndmize
This sounds exactly right to me. In discussions with a religious friend of
mine some years ago, I noticed that she had a tendency to conflate law and
morality, when they really have nothing to do with each other. Further, she
seemed to think that because it was illegal or bad to do something, it was
reasonable to expect that people wouldn't do that thing as a result. I found
(and find) this ridiculous - in large enough groups, you can use
incentive/disincentive structures to push the population's behavior in a
certain direction, but never with 100% effectiveness. Naturally, she
disagreed.

~~~
graphitezepp
The legal = moral line of thought is one of my most hated things to come
across. It correlating with the highly religious makes sense, but it's by no
means limited to them. It's incredibly wide spread in American culture to have
at least a small degree of that, people always feel naughty when they break
the law. I too find it ridiculous.

~~~
jwhitlark
I wonder sometimes if legal = moral is just a labor saving device for most of
the population.

------
toomanybeersies
As a comparison, the road toll in the USA is 33,000 per year. Firearms kill
about the same number (including 20,000 suicides).

3,000 people were killed in the 9/11 attacks.

72,000 overdose deaths is just a staggeringly large number.

~~~
Alex3917
> 72,000 overdose deaths is just a staggeringly large number.

It's still only a drop in the bucket compared to overall drug-related deaths
though. Tobacco-related deaths alone account for 500k deaths annually, and
that's not even counting deaths related to third-hand smoke.

~~~
toomanybeersies
The difference is that tobacco itself doesn't kill people. It's the long term
side effects. You can't overdose on cigarettes (although it is possible to OD
on nicotine).

72,000 is just the number of sudden effects, ignoring the chronic long term
effects of opiate abuse.

It the same thing with alcohol. Very few alcoholics die from alcohol
poisoning, it's the long term health problems that kill them.

~~~
Alex3917
> Very few alcoholics die from alcohol poisoning, it's the long term health
> problems that kill them.

Actually I think the median death from alcohol is mid-30s, with alcohol-
related accidents and suicides being more common than chronic health issues.

------
announcerman
The amount of responsibility laundering that's happening is staggering. Is it
the fault of the doctors for prescribing strong painkillers or the
responsibility of lobbyists for keeping the status quo as it is. Or is it the
responsibility of patients to not seek strong opiates for the smallest aches?
On whom falls the blame for this?

~~~
stef25
The doctors. Anyone who spends the better part of a decade studying medicine
can't be ignorant about opioids and addiction, regardless of what the slimy
Purdue representative tells them.

The only excuse they have for the blatant over prescribing of opioids (2
months worth of oxy for getting wisdom teeth pulled kind of thing) is that if
they don't do it, the patient will just go to another doctor.

But how can you justify setting someone up with fistfuls of oxy (knowing full
that heroin / fentanyl and a world of misery for them and their loved ones is
just around the corner) just "to make money" ?

> Or is it the responsibility of patients to not seek strong opiates for the
> smallest aches?

What the patient seeks is irrelevant. The only one who decides what
prescriptions a patient should take is a doctor.

Personally I suffered from lower back pain for about 10 years and went from
one useless quack to the next. Eventually I found a physio who taught me how
to strengthen my core, now I'm at the gym 2x a week and loving it, did
couch25K (and beyond) and am pain free for 3 years.

All I sought was pain relief but pills is not what I needed. If I was in
W-Virginia instead of the EU I guess I'd be shooting heroin by now.

The US health care system is broken in more ways than one, no doubt this is
made worse by various societal factors like joblessness.

~~~
umvi
> What the patient seeks is irrelevant. The only one who decides what
> prescriptions a patient should take is a doctor.

That kind of rubs me the wrong way, but I'm not sure why. I like having the
option of overriding the doctor if I disagree.

~~~
amaccuish
In the NHS, that isn't possible. You either take the doctor's treatment, or
you get no treatment at all. You can go around, asking different doctors, or
having a discussion with your doctor, but you will not be prescribed something
you don't need. The incentive being, that with a tax payer funded system,
money should go to those who actually need it. It is understood here I guess
that the doctor is the expert, not you.

~~~
toomuchtodo
I can totally appreciate this. As an American though, I have gone around my
doctor and ordered prescription medications online when they would not
prescribe them (ivermectin, anti-parisital, non-controlled substances, almost
zero risk to myself if my diagnosis was inaccurate).

~~~
umvi
Slightly related, sometimes I just want a new pair of glasses without the
hassle of going to/paying the eye doctor. I can still see 20/20 with my
current prescription, but since it's "expired", physical retailers won't sell
me glasses nor will they use their refractometer to read off the prescription
of my current pair. So I instead go online and order a pair from Zenni using
my expired prescription that I wrote down.

~~~
toomanybeersies
That's an interestingly unique problem to the USA I think.

Here in Australia, I haven't been to an optometrist in 5 or 6 years. I just
keep ordering new glasses for $60 a pair online, my vision hasn't changed
enough that I feel that I need to go to an optometrist again. The optometrist
is legally required to give me my prescription, which I can then use as I
want.

I haven't bought glasses in a brick and mortar store for 5 or 6 years (last
time I got an eye test), but I'm fairly sure they won't/can't refuse to make
me a pair to my specifications. Actually, I did get a pair made in the shop in
Vietnam 2 years ago, and they were more than happy to make them (overnight
too, I might add), although they did laugh at how blind I was.

------
simula67
> Analysts pointed to two major reasons for the increase: A growing number of
> Americans are using opioids, and drugs are becoming more deadly. It is the
> second factor that most likely explains the bulk of the increased number of
> overdoses last year.

So, the increase in deaths is likely because of drugs becoming more deadly.
How are drugs becoming more deadly ? It seems like this is how:

> Strong synthetic opioids like fentanyl and its analogues have become mixed
> into black-market supplies of heroin, cocaine, methamphetamine and the class
> of anti-anxiety medicines known as benzodiazepines. Unlike heroin, which is
> derived from poppy plants, fentanyl can be manufactured in a laboratory, and
> it is often easier to transport because it is more concentrated.

> In some places, the type of synthetic drugs mixed into heroin changes often,
> increasing the risk for users

So, preventing this blending of drugs could potentially improve the situation

> The number of opioid users has been going up “in most places, but not at
> this exponential rate,” said Brandon Marshall, an associate professor of
> epidemiology at the Brown University School of Public Health. “The dominant
> factor is the changing drug supply.”

Not sure how this happens is explained in the article, but that could
potentially be another attack vector

~~~
merinowool
If people had easy access to clean drugs, deaths could be avoided. Opiates are
fairly safe if dose is correct and are not contaminated. Then people could get
psychological help to remove the need to take them.

------
Nursie
The war on drugs is a staggering failure.

Drugs have infiltrated every level of society, from business leaders and
politicians to white and blue collar workers, to the bums on the street.

Drugs are causing tens of thousands of deaths a year in the US alone. I dread
to think the global total. The casualties of this war are mounting up rapidly.
This is before we even count the criminals and enforcers killed in open
combat.

Whole countries are on the verge of civil war or just plain collapse.

Yet in most countries talk of reform is either treated disparagingly or
suspiciously, as if all the speaker is interested in is a quick toot, or as if
they are a collaborator or traitor.

It's sick, it's weird, and it's deeply disastrous.

Meanwhile in Portugal, where possession is decriminalised, things seem to get
better all the time.

~~~
ssijak
It is very hypocritical for some politician to tell me what I can and what I
can`t put into my body. Recently in UK they enacted a law that criminalize any
substance that changes how you feel, but with the following remark "The ban is
so wide-ranging that a long list of substances such as alcohol, tobacco,
caffeine, food and medical products will have to be given special exemptions."
When you thought that you reached the limits of hypocrisy...

~~~
dionidium
This is the bourgeois line on drugs, believed exclusively by people who
haven't spent much time around crack and heroin addicts [0], prolonged
exposure to whom eliminates the comfortable fiction that what people put into
their body is _their own business_.

[0] Or severe alcoholics, for that matter.

~~~
shady-lady
I'm not sure if you're being downvoted for your viewpoint or your usage of
"This is the bourgeois line on drugs".

~~~
dionidium
I suppose that's a risk one takes when using that word in modern conversation,
but I literally mean it in the dictionary-definition sense (i.e. " _of or
characteristic of the middle class, typically with reference to its perceived
materialistic values or conventional attitudes_ ").

Feel free to substitute "middle-class" for "bourgeois" if it sounds less
political or inflammatory to your ears.

------
akuji1993
When I opened this, I thought they meant 72000 on the whole world. Nope, it's
just the US. That's an unbelievably high number to me.

~~~
jgtrosh
It's staggering! I just compared with traffic accident fatalities in 2017 and
it's 40,200 (according to [1]). It hadn't occurred to me that drugs were a
bigger killer than traffic accidents. Now maybe there's a big overlap over the
two figures?

Edit: just realized the drug death count is only for ODs, so the overlap
wouldn't be significant.

[1]: [https://www.nytimes.com/2017/02/15/business/highway-
traffic-...](https://www.nytimes.com/2017/02/15/business/highway-traffic-
safety.html)

------
PiggySpeed
This is absolutely terrible.

I worked in an inner-city setting servicing the addictions and psychiatry
population as the fentanyl crisis started evolving several years ago. I would
see the usual patient every day with no signs of instability, until they
suddenly disappeared for a few days and were later found to have overdosed.
Perfectly ordinary, pleasant people.

We try to prevent these events by sending teams around to check up on them
daily. However, resources are limited and we couldn't closely monitor
everyone. One of our patients had come across multiple close calls, but no
amount of persuasion would entice him to use his drugs in one of those public
injection sites, or to invest more heavily in drug therapy.

I have some hope for injectable hydromorphone programs being offered in
pharmacies. Patients would come into a private room with a dose already
measured out by the pharmacist. Pharmacies can already offer an unparalleled
degree of monitoring since they see their patients on a daily basis.

~~~
merinowool
Too many people profit from those deaths to have this happened.

------
nkkollaw
Pharmaceutical companies keep lobbying for being able to give people opioids
lightly, and keep giving doctors bonuses, to get people hooked until it's too
late to go back.

It's really true that the world works backwards. That's hundred of times the
deaths from terrorism, yet the US government is completely ignoring this
trend.

If heroin is criminalized, so should be these practices, yet everyone is
making money off of this: corporations, doctors, shareholders, politicians.

------
qudat
How many of these overdoses were because of suicide?

------
yters
Interestingly, this all is happening through legal routes. What would happen
if hard drugs are fully legalized?

Another weird thing, there are already loads of deaths through overdoses in
the inner city, but only now it is an epidemic? What changed?

~~~
3x
Overdoses would decrease. Nearly all recreational drugs should be legalized
with regulation to promote safe drug use. These substances should be sold in
single individually-packaged doses, with clear and explicit labeling. Taxation
can be used to selectively promote the use of safer alternatives to the
hardest drugs, for example making marijuana, opium, and mushrooms cheap
compared to drugs with a high risk of overdose or long term health
implications. The most dangerous drugs like fentanyl can remain prohibited and
there will be no market left for them. And, most important of all, the violent
black market around drugs would be massively diminished, and there would no
longer be situations where addicts are scared to call an ambulance because
they will end up in jail. Inconsistent drug purity by itself is a huge factor
in opioid overdoses, and it is one of many harmful side effects of
criminalization that will effectively disappear under a well-regulated legal
market.

~~~
yters
The prior question is: what is causing overdoses?

My understanding is the opioids are already regulated, controlled, and dosed
appropriately, since most are acquired through medical prescription. Why so
many overdoses, then?

My hypothesis is the drugs are addictive, and it takes more to get the same
high each time, which eventually leads to accidental overdose.

Additionally, drug use can lead to feeling trapped and hopeless, and that
might cause people to either carelessly or intentionally overdose.

~~~
leetcrew
> what is causing overdoses?

overdoses can happen in many ways. sometimes it is genuine user error; ie, the
person goes overboard and simply takes too much, or they don't properly
account for the drop in tolerance after a period of abstinence.

> most are acquired through medical prescription

this might be true overall, but i'm not sure it's true of illegal/abusive use
of the drugs. i can't easily find precise numbers, but prescription drugs
appear to account for less than half of total opioid overdose deaths [1].

this brings us to the next (and as far as i can tell, primary) cause of
overdose deaths: variance in purity. the purity of heroin varies wildly,
anywhere from 10-60% strength on the street. add fentanyl hotspots to the mix,
and suddenly addicts are overdosing on what they consider conservative
"tester" doses.

[1] [https://talbottcampus.com/prescription-drug-abuse-
statistics...](https://talbottcampus.com/prescription-drug-abuse-statistics/)

~~~
emiliobumachar
"the purity of heroin varies wildly, anywhere from 10-60% strength on the
street"

That's a sixfold increase. This is the key to understand overdoses. Keep in
mind the last time you went a little overboard with alcohol, coffee, or even
sugar. What would have happened if, unknown to you, you had actually taken six
times as much?

------
perl4ever
It seems like the term "overdoses" is obscuring the problem which is more
"toxic (lethal) stuff is increasingly being mixed into illicit drugs of all
kinds".

~~~
pitaj
There's a simple solution: legalize all drugs. All of them. Let people get
what they want. Then, if the government must do something, pump all that money
they were spending on the drug war into treatment centers.

~~~
perl4ever
I can't see how eliminating regulation of drugs is going to solve the problem
of people getting substances that are harmful or ineffective. There is no
simple solution, only the obvious _complicated_ one of regulating correctly.

------
bumholio
I cannot but wonder if North Americans feel responsible in the least for what
their voracious appetite for drugs is doing south of the US border. Mexico has
become almost ungovernable, the drug trade being one of the main factors
driving the decline.

~~~
dasil003
The appetite for drugs or the criminalization that creates the black market?
Heavy drug users have more immediate concerns than second and third order
effects of their lifestyle choices. The politicians and lobbyists responsible
for maintaining the status quo on the other hand, should probably pull their
heads out of their asses.

~~~
bumholio
I am sure a widescale decriminalization of hard drugs south of the US border
will be applauded in Washington. It would solve a large part of the drug crime
problems in these countries, while raining down industrial quantities of
pharmaceutical grade heroin on the US streets.

~~~
JamesBarney
I had a ex-friend(went to middle school with him) die recently from a drug
overdose, and when I was talking with his parents on the way to the burial
site his dad said that he could take him to any town in the U.S. and he could
find heroin, get back to the hotel, and get high in under an hour.

I don't think supply is limiting the amount of drugs that abusers are doing.

------
dalbasal
Looks like a sharp rise in heroine, cocaine & speed deaths too, even if
shallower than opioids.

Curious what a longer term chart would look like. This only charts 3 years. Is
it normal, having such big annual changes?

------
throwaway77384
Why decriminalise drug use, when you can reap billions in profits from the
deaths of thousands instead?

I'm not sure that's what people meant when they requested drugs be regulated
and taxes used for the greater good...

------
merinowool
Everyone who supports prohibition has blood on their hands. No, your ignorance
and stupidity is not an excuse. Pathetic people.

------
sergefaguet
and while this opioid shit is legal, psilocybin and LSD are not.

why should i have any respect for the legal system again? as opposed to seeing
it as a dumb bully with no moral authority?

------
some_account
This is by design. Look at any comedy movie these days, and the young adults
are doing drugs. It has become as natural as eating junk food. People view
being drugged and dumb to be fine these days because that's the Hollywood
propaganda and it's everywhere in western society.

~~~
pjc50
.. are you sure? This is the same Hollywood that's been editing cigarettes out
of movies? Could you cite an example scene?

~~~
yznovyak
??? Are you for real? Just google "stoner movies".

Off top of my head: The Pineapple Express, This is the End, Harold and Kumar
go to the White Castle, Jay and Silent Bob strike back.

~~~
pjc50
Weed (now legal in several states and not related to overdose deaths) is a
different prospect to opiates, though.

~~~
yznovyak
You can argue that weed is legal because of sustained Hollywood propaganda.

------
austincheney
I have always wondered how pain killers could be so addictive.

Stimulants are physically addictive. They modify signals in your physiology to
increase signal performance, in some way, and the body reacts to the temporary
performance boost. There is a craving for the stimulant the body has becoming
reliant upon and a withdrawal in the absence of that chemical. This manner of
physical addiction isn't a choice and everybody is roughly equally at risk.
Even laxatives are equally physically addictive in this manner even though
there is absolutely no modification to behavior from laxative consumption.

Pain killers, and other depressants, on the other hand, don't work this way.
With a very narrow exception to extreme alcohol consumption depressants are
not immediately physically addictive. They require a modification to behavior
to be addictive. In this way marijuana, which has no known physically
addictive properties, has shown to be addictive to a small segment of users.

I have always wondered how depressant addiction occurs. Unlike with stimulants
we are not all created equal. Some people are more prone to addiction from
depressants than others. Some few people do not find depressants at all
addicting and even detest their use. It makes me wonder what is the primary
behavioral switch that enables this manner of addiction.

~~~
RGamma
Please watch this before making other plainly wrong and unsubstantiated
comments like this:
[https://www.youtube.com/playlist?list=PL150326949691B199](https://www.youtube.com/playlist?list=PL150326949691B199)

The stimulant/depressant dichotomy doesn't hold by the way. For instance
alcohol's effect on the brain is not only very non-specific but also not very
well understood whatsoever (see
[https://en.wikipedia.org/wiki/Alcohol_(drug)#Pharmacology](https://en.wikipedia.org/wiki/Alcohol_\(drug\)#Pharmacology)
or the lecture). Or more precisely it (dose-dependently) acts directly or
indirectly inhibitory or excitatory simultaneously in various parts of the
brain.

And whatever mess mixed intoxication causes in your head...

~~~
austincheney
The physically addictive quality of alcohol has more to do with the liver and
less to do with the brain even though alcohol is known to cause brain damage.
The primary damage from excessive continuous alcohol consumption over a period
of 8 years or more is in the liver resulting in a variety of metabolic and
processing disorders. In some cases sudden severe withdrawal can be harmful
and possibly fatal as the liver is incapable of processing a variety of normal
functions has become partially reliant on the continued alcohol consumption to
address some of this functionality.

The most clear indicators of brain damage present in withdrawal are
destruction of GABA and dopamine receptors that can result in a variety of
behavior problems. The dopamine receptor damage is at least partially
resultant from the liver damage.

* [https://en.wikipedia.org/wiki/Alcoholic_liver_disease](https://en.wikipedia.org/wiki/Alcoholic_liver_disease)

* [https://en.wikipedia.org/wiki/Alcohol_withdrawal_syndrome](https://en.wikipedia.org/wiki/Alcohol_withdrawal_syndrome)

> Please watch this before making other plainly wrong

Perhaps you should have your facts together before attacking people with
divisive bias.

~~~
Nursie
You appear to be confusing addiction, which is happening in the brain and is
to do with the GABA and other receptors, with the nature of the withdrawal
symptoms.

