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Ask HN: What do you think the most effective solution to the opioid crisis is?
4 points by arikr on Aug 10, 2017 | hide | past | web | favorite | 7 comments
What do you think the most effective solution to the opioid crisis is?

It is a multifaceted problem, but one aspect is having better answers to treating chronic pain, whether that be physical therapy, pharmaceuticals, psychotherapy, etc.

It very much is a mind-body thing because ultimately the brain gets signals from the body and it is the mind that determines if those signals are pain or just noise.

I think also situations of social inequality are feeding the opioid crisis. Black people in America were early adopters of trends such as the breakdown of the family and believing that "there ain't no making it" and now we are seeing that rural whites are experiencing these.

It's all a matter of perspective. The people in charge don't think of it as a problem. They think of it as one of several solutions to a much bigger problem. Overpopulation.

A problem they have been trying to solve for 100+ years. This is a solution they have worked very hard on. The fact that it is also a very profitable tool for social control is a bonus.

Haven't taken a deep dive into any data on this, but the first thing that comes to mind is marijuana legalization

Ironically, that is precisely what's causing the influx of heroin from the southern border. Recent decriminalization and legalization of marijuana has significantly bit into cartel's profits, causing them to push much more heroin in an attempt to recoup their losses.

Housing affordability in rich cities prevents the poor, who are on opiods, from moving to where better opportunities are.

Increasing housing supply in silicon valley and subsidizing moving are the cure

You could also actually have a safety net and do other things to help improve folks' lives. Actually help folks get out of their current groove. After all, if we are moving folks to places with better opportunities, there is a chance the person will fail and suddenly, they are in an area without their previous support group, friends, and family.

I understand that is a positive so long as it is good, as a change of lifestyle seems to help kick some addiction - but there needs to be something to ensure they don't wind up in the same place in a new city.

Unless indicated otherwise, source [1] is used.

I read a bit about this when I first heard about it approximately a year ago, and as far as I can tell, there's no clean solution. There are essentially two main components of the opioid crisis:

1. Overprescription of opioid CPDs (controlled prescription drugs). 2. An influx of heroin provided by the cartels over the southern border.

In order to make headway in this issue, both of these sources need to be addressed ASAP. I know that for some people weaker painkillers do very little for them (vicodin does very little for me), but excesses in peoples prescriptions (getting 30+ when they need <10) and increasing prescription rates over the last two decades are huge contributors to the current crisis. And, despite the fact that border security has recently been taken up as a mantra for arbitrary bigotry, it might be necessary to qualm this crisis. I hate to say it, but if the wall could help, then building it might not be such a bad thing.

Some important points:

1. Opiate and benzodiazepine CPDs cause more deaths than heroin and cocaine combined, and have since 2002 (25,760 deaths in 2014). 2. The population of abusers of heroin is approximately one tenth of the population of abusers of CPDs. However, the number of deaths due to heroin is approximately half of those due to CPDs. 3. From 2002-2011 the number of CPD abusers initiating heroin use was 3.6% of the total number of CPD abusers 2002-2011, but was 79% of new heroin abusers because the size difference between the CPD/heroin abuser populations. 4. In 2013, the CPD abuser population was estimated to be 15x the heroin abuser population. In 2013, it was estimated to be 10x. 5. In 2013, 78% of heroin admissions had been in treatment once before and 27% had been in treatment five or more times before - in other words, the relapse rate is extremely high. 6. Comparison between opioid medication prescription rate [2] and deaths due to heroin OD per 100000 [1, pg. 55].

For anyone who isn't alarmed by the opioid crises, here's a statistic on deaths in the USA due to heroin overdose by year (which the CDC estimates is undercounted by as much as 30%!):

2007: 2402

2008: 3041

2009: 3278

2010: 3036

2011: 4397

2012: 5927

2013: 8257

2014: 10574

2015: 12989 [4]

And don't forget the 250% jump from 2013-14 in Fentanyl-related deaths [3]!

1. https://www.dea.gov/resource-center/2016%20NDTA%20Summary.pd...

2. https://www.cdc.gov/drugoverdose/data/prescribing.html

3. https://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.p...

4. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm

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