Why Opioids are such an American Problem

[herbavore]

You want to stop addiction? Fix society.

While I agree with this, I would like to also point out that every human being has exactly one way to effect "fixing" society and that is fixing his or her own internal self.I find it typically amerikan that we are calling this an opioid crisis when in fact it is a crisis of being.

What other country has ever been so successful at marketing self-hatred from the earliest years to old age?

What other culture has been so bent on dividing people from themselves so thoroughly that they need to numb themselves in order to cope with being alive? There are many places in the world where this is true--but those places are generally either suffering great poverty or are at war. People in the U.S. do not have combat going on in their streets and even the poorest among us are drowning in useless stuff. We have a massive mental health crisis and even those who care are at odds about how to address it within a culture bent on feeding it.

I support safe heroin injection sites but only with concurrent resources for recovery. And when I say resources for recovery I mean holistic, actual recovery so that people feel they can exist meaningfully within themselves for their brief stint here on the planet.

 

[cj]

While I agree with this, I would like to also point out that every human being has exactly one way to effect "fixing" society and that is fixing his or her own internal self.I find it typically amerikan that we are calling this an opioid crisis when in fact it is a crisis of being.

What other country has ever been so successful at marketing self-hatred from the earliest years to old age?

What other culture has been so bent on dividing people from themselves so thoroughly that they need to numb themselves in order to cope with being alive? There are many places in the world where this is true--but those places are generally either suffering great poverty or are at war. People in the U.S. do not have combat going on in their streets and even the poorest among us are drowning in useless stuff. We have a massive mental health crisis and even those who care are at odds about how to address it within a culture bent on feeding it.

I support safe heroin injection sites but only with concurrent resources for recovery. And when I say resources for recovery I mean holistic, actual recovery so that people feel they can exist meaningfully within themselves for their brief stint here on the planet.

What does concurrent holistic recovery look like? Like it's very obvious our current drug treatment techniques are a failure but I struggle to see what would really work that's realistic with the current political and social climate. People mostly want to punish addicts even if it is called help. Even the best programs treat clients as if they cannot be trusted. It becomes a self fufilling prophecy

 

[Jabberwocky]

As long as drug users are treated like criminals holistic recovery is a vey uphill battle.

Safe injection rooms would actually allow for holistic recovery in a way that abstience only program preclude. Generally speaking, it isn’t drug use per se that keep people from recovery, but rather the consequences of harmful drug use. Even the most extreme forms of drug use aren’t inherently harmful, or at least do not need to be as harmful as they currently are within the status qua.

There is little about the vast majority of drug use that is inherently harmful for all people, it’s just that the powers that be have created unreasonable consequences for anyone who chooses to use certain drugs. A lot of these consequences are emphasized again by so called treatment providers. It’s all very fucked. But the more we can do to focus in on the harmful consequences of certain modes of drug use and avoid pumping it all in the same basket, the more we can make meaningful efforts to creating a less aversive environment for all people.

Meaningful recovery isn’t going to be very accessible until we continue making progress on the way on drugs. That means creating more resources for public health programs such as safe injection facilities and less resources to public safety/drug law enforcement programs. It’s all about where the funding priorities are.

 

[S.J.B.]

Physical dependence and receptor down regulation are very real physiological occurrences.

That's comparable to the effect of, say, insulin on someone who has diabetes. They are not effects that keep people from functioning and living a relatively normal, healthy life. This is obvious when you look at people who are prescribed methadone or buprenorphine for maintenance. These drugs are opioids and have all of the same physical and psychological effects that the more "recreational" opioids do, yet people take them every day, go to work, and live their lives like everyone else.

People may not want to associate with an opiate user simply because the intoxication, not because the use of an illicit substance. Also, whether prescription or illicit, opioids can prevent a person from fulfilling social duties because of the physiological effects, unrelated to legal status. A person could get fired from a job because they are too high to function, not because they failed a drug test.

Someone taking a regular dose of an opioid on a regular schedule will not be significantly impaired. Again, this is evidenced by methadone, and other opioids don't work any differently.

 

[herbavore]

That's comparable to the effect of, say, insulin on someone who has diabetes. They are not effects that keep people from functioning and living a relatively normal, healthy life. This is obvious when you look at people who are prescribed methadone or buprenorphine for maintenance. These drugs are opioids and have all of the same physical and psychological effects that the more "recreational" opioids do, yet people take them every day, go to work, and live their lives like everyone else.



Someone taking a regular dose of an opioid on a regular schedule will not be significantly impaired. Again, this is evidenced by methadone, and other opioids don't work any differently.

How does tolerance fit into this? (real question--I have no idea)

 

[S.J.B.]

How does tolerance fit into this? (real question--I have no idea)

Sorry, I'm not exactly sure what you're asking. Someone with higher tolerance will need a higher maintenance dose and will also need a higher dose to become impaired, and someone with no tolerance will likely be at least somewhat impaired at any reasonably effective dose.

 

[Jabberwocky]

It distinguishes dependency from substance use disorder. It’s possible to be highly dependent on opioids but not experience any of the harm associated with a use disorder. Actually it’s quite common when one doesn’t have to resort to dealing with the legal and stigmatized aspects of using a highly criminalized, demonized substance like heroin.

 

[cj]

How does tolerance fit into this? (real question--I have no idea)

Tolerance isn't a big factor in methadone because of the drugs unique property which I dont understand from a pharmacological standpoint well enough to explain. But other maintenance opiods could require a gradual up titration though I have read in the heroin maintenance studies that patients eventually reach a dosing platue and stay there. Either way it's not a huge issue if your requiring them to dose in the clinic and not offering takehomes. Diversion is the only downside to large doses because the drug itself is dirt cheap in a clinical setting. The biggest expense in a maintenance clinic is the professionals who run it. Though economy of scale would kick in if we had a government run system instead of the private system we rely on now. I personally think running drug treatment for profit is unethical.

 

[Fresco]

Tolerance isn't a big factor in methadone because of the drugs unique property which I dont understand from a pharmacological standpoint well enough to explain

What do you mean tolerance isnt a factor?? Are you saying you can take methadone forever and get high off it??

 

[cj]

What do you mean tolerance isnt a factor?? Are you saying you can take methadone forever and get high off it??

No I'm saying you can take the same maintenance dose forever and still feel satisfied. I don't get high from maintenance.

 

[Jabberwocky]

Indeed. Nearly all patients receiving a dose of an ORT medication that they are allowed to raise as much as they want hit a platea during the first 6-24 months. The last time I was reading about the HAT programs in Switzerland and the old ones in the U.K. ended up with patients actually reducing their dose/frequency of dosing over the long term.

Tolerance is more an issue with shorter acting opioids, but even then such as with heroin folks tend to find a dose that they like which satiates cravings but doesn’t have so many side effects that it prevents them from living their lives in terms of employment and family.

 

[Vastness]

Everyone saying that this article is bullshit, and the prevalence of opioid addiction is a result of some other problems with society... the article is explicitly about America, and as such, explicitly compares America to other European countries, and specifically the UK. It also quite clearly explains the differences in both these countries' respective healthcare systems. America and the UK, or indeed most European countries, are not worlds apart in terms of lifestyle, all of them being developed, technologically advanced Western nations.

While other factors no doubt do play a part, I don't see how anyone can deny that the article is correct in it's assertion that the structure of the American healthcare system, and the prescribing habits of American doctors resulting from this, has played and continues to play a big part in the causation of opioid addictions in America, when compared to the rest of the developed Western world.

 

[cj]

Everyone saying that this article is bullshit, and the prevalence of opioid addiction is a result of some other problems with society... the article is explicitly about America, and as such, explicitly compares America to other European countries, and specifically the UK. It also quite clearly explains the differences in both these countries' respective healthcare systems. America and the UK, or indeed most European countries, are not worlds apart in terms of lifestyle, all of them being developed, technologically advanced Western nations.

While other factors no doubt do play a part, I don't see how anyone can deny that the article is correct in it's assertion that the structure of the American healthcare system, and the prescribing habits of American doctors resulting from this, has played and continues to play a big part in the causation of opioid addictions in America, when compared to the rest of the developed Western world.

I think blaming doctors is overly simplistic. The US does not have universal healthcare so cost is generally the overriding concern in medicine here. Painkillers are cheap. What happens is say someone has an injury that causes pain. It can be corrected by surgery but the person is uninsured and can't afford the surgery. That leaves the doctor in a position to either treat the pain with opiates or let the patient suffer. That is played out through the entire system in many different scenarios. Even when a patient has insurance often the insurance company fights tooth and nail to deny "elective" surgeries leaving the patient in pain until the problem deteriorates to the point of it being a "necessary" surgery. Basically my point is fingering doctors as the sole problem is lazy as they work within the system.

 

[Foreigner]

^ Indeed... in modern medicine, pain is seen as a disorder in of itself. According the WHO, pain relief meds must be widely available because humans should not be allowed to remain in pain if it's preventable. I know in practice many doctors ignore patients in pain but according to the edicts and teachings of modern medicine, pain should be alleviated. In a system that looks at cost-benefit first, that would mean giving pain meds to people who can't afford more costly but effective treatments.

 

[herbavore]

While other factors no doubt do play a part, I don't see how anyone can deny that the article is correct in it's assertion that the structure of the American healthcare system, and the prescribing habits of American doctors resulting from this, has played and continues to play a big part in the causation of opioid addictions in America, when compared to the rest of the developed Western world.

I do not disagree with this, vastness. It is a part--a huge part--of what got us where we are. However, I was trying to speak more to the results of this history and where to go from here.

If you want to read an insidious history read this article about the Sacklers, particularly the part about their revolutionary idea to advertise drugs directly to doctors in their journals. They were the beginning of big pharma's literally buying researchers, inventing conditions and then conveniently producing the medications for those conditions.

 

[Mafioso]

That's comparable to the effect of, say, insulin on someone who has diabetes. They are not effects that keep people from functioning and living a relatively normal, healthy life. This is obvious when you look at people who are prescribed methadone or buprenorphine for maintenance. These drugs are opioids and have all of the same physical and psychological effects that the more "recreational" opioids do, yet people take them every day, go to work, and live their lives like everyone else.



Someone taking a regular dose of an opioid on a regular schedule will not be significantly impaired. Again, this is evidenced by methadone, and other opioids don't work any differently.

To some degree. If someone is going into physical withdrawal due to opioid dependence it can be very limiting. "Regular" should be replaced with "low" or "moderate" because at some level the side effects become over powering and very intrusive. Someone can definitely become significantly impaired by methadone. On an "appropriate" dose of methadone or other opioid, a person may be able to function and live a fulfilling life, but that is not to say that it has no impact on behavior.

 

[cj]

To some degree. If someone is going into physical withdrawal due to opioid dependence it can be very limiting. "Regular" should be replaced with "low" or "moderate" because at some level the side effects become over powering and very intrusive. Someone can definitely become significantly impaired by methadone. On an "appropriate" dose of methadone or other opioid, a person may be able to function and live a fulfilling life, but that is not to say that it has no impact on behavior.

You have to remember that this treatment is for people who cannot stay abstinent. So the choice is not between sober and medicated it is between buying on the street vs going to a doctor. It's called harm reduction not harm elimination

 

[rujex]

USA isnt the only country with an opioid problem. Iran, Pakistan, Afghanistan etc. may have even bigger ones.

Blaming big pharma, the war on drugs, illegalization in general and limited treatment opportunities is leading nowhere. Its a complex problem, that cant be solved easy and fast.

Opioids where made illegal almost hundred years ago for a reason. The majority of people couldnt handle them safely.
The war on drugs started because illegalization didnt resolve the problem. Drugs where still available.
Big pharma gave some people a taste for opiods, but without black market opiods there wouldnt be such death an mysery.
Treatment made life better for a lot of people, but cant solve the problem itself. Some people may get clean but others will just live longer with their addiction. Young people will still get addicted.

If found, an easy and fast solution could be worth a hundred noble prizes.

In my opinion, people should stop thinking of opioid abuse as a major epidemic for a hole country. And start thinking of it, as an individual problem. A nation cant be healed, but individuals can. Every person is different. A nation is just a cluster of individuals. Everybody has his very own reason for addiction. Mass programs cant fix personal problems.

 

[Jabberwocky]

Real treatment won't be possible until drug users are no longer treated as criminals just because they use drugs.

And it is misleading to say that opioids where made illegal because people couldn't use them safely - the reality is that most people who used them were using them safely. Criminalization has far more to do with personal political agendas and people trying to make a career for themselves, that and good old fashioned racism/xenophobia.

Drugs weren't criminalized because they were or are dangerous - that kind of notion is pure drug was propaganda. Criminalization was used far more simply as part of political agendas and people attempting to gain/solidify power. Prohibition with alcohol highlights the seriousness of problems that criminalizing substances creates. Far more problems than those associated with the pharmacological consequences of drug use.

It's also misleading to say treatment has made life better for people. Of course it has, but treatment is pretty much a joke under the war on drugs. Real treatment programs are pretty much limited to abstinence only psychoeducation for the vast majority, which is basically the same shit that they've been trying to use for a hundred years or more (and which has produced dismal results). The problem is that the vast majority of people still don't have any access to treatment, and when they do it's access to some of the least effective treatment methods.

The reality is that we spend almost all the money used for drug policy related costs on DLE and the criminal justice system - relatively speaking very, very, very little money gets spent on treatment (and most of the treatment our drug policy funds is barbaric bullshit stuck in the early 20th century that doesn't have anything to do with the advances that have been made in addiction medicine over the last hundred years).

If the government really was concerned only with the harm associated with drug use, we'd have a totally different system in place. Criminalizing drugs across the board causes far more problems than the use of drugs themselves. I can think of at least four books that have clearly documented this process and phenomenon.

You're right, there isn't an easy solution to this. But what we're currently doing is about as far from a sustainable or effective solution than could be.

 

[CFC]

Real treatment won't be possible until drug users are no longer treated as criminals just because they use drugs.

You're right, there isn't an easy solution to this. But what we're currently doing is about as far from a sustainable or effective solution than could be.

Amen. Identifying why so many millions of people are so desperate to escape from the reality of modern society, and then adjusting society accordingly would, I suspect, go a long way towards solving the problem. Unfortunately those who do study the reasons generally find answers that are never going to appeal to those with power...