They were just drug dealers in lab coats.
October 15, 2017 9:24 PM Subscribe
THE DRUG INDUSTRY’S TRIUMPH OVER THE DEA Amid a targeted lobbying effort, Congress weakened the DEA’s ability to go after drug distributors, even as opioid-related deaths continue to rise, a Washington Post and ‘60 Minutes’ investigation finds.
60 Minutes article with 30 minute video.
60 Minutes article with 30 minute video.
They were just drug dealers in lab coats expensive suits.
posted by j_curiouser at 11:19 PM on October 15, 2017 [6 favorites]
posted by j_curiouser at 11:19 PM on October 15, 2017 [6 favorites]
One could have a hundred link post about the awful shit the DEA has done and been involved with; the links would span to its inception and continue with a rich history of problematic behavior that continues to this day. But...
It seems the best thing they ever tried to do, however, got overturned by former DEA agents turned into hired guns for the drug-cartel (oh, oops, pharm industry) along with congressmen and senators that were overtly corrupt (oops, had received tremendous financial support from the drug-cartel (er, pharm industry)).
I guess the thing I'm trying to say is that this isn't something that happened to the DEA, this is something that happened to America, and is a crisis of nearly unimaginable scope that continues to this day.
In 2014 there were 8,124 homicides by guns, in 2015 there were 50,000 deaths by opiod overdose.* One way to think of it is what if there were 3 Las Vegas Massacres that occurred every single day; that's kind of what the opiod crisis is.
A spoiler for the piece: the congressman who helped push through the bill to gut the DEA power against opiod distributors is currently up for the position of running the DEA.
* Numbers I got from googling and following some links - feel to correct me on this.
posted by el io at 11:45 PM on October 15, 2017 [18 favorites]
It seems the best thing they ever tried to do, however, got overturned by former DEA agents turned into hired guns for the drug-cartel (oh, oops, pharm industry) along with congressmen and senators that were overtly corrupt (oops, had received tremendous financial support from the drug-cartel (er, pharm industry)).
I guess the thing I'm trying to say is that this isn't something that happened to the DEA, this is something that happened to America, and is a crisis of nearly unimaginable scope that continues to this day.
In 2014 there were 8,124 homicides by guns, in 2015 there were 50,000 deaths by opiod overdose.* One way to think of it is what if there were 3 Las Vegas Massacres that occurred every single day; that's kind of what the opiod crisis is.
A spoiler for the piece: the congressman who helped push through the bill to gut the DEA power against opiod distributors is currently up for the position of running the DEA.
* Numbers I got from googling and following some links - feel to correct me on this.
posted by el io at 11:45 PM on October 15, 2017 [18 favorites]
Good news, el io! Although in 2015 in the US, there were 36,252 deaths due to overall gun deaths vs 52,404 for overall drug overdoses, 'only' 20,101 of those were due to prescription painkillers! Clearly we're winning, and nothing needs to be changed on any front. At this rate, the guns can just shoot the drugs.
Choking on my {/} hamburger but don't worry, I'm not statistically significant.
posted by sysinfo at 12:23 AM on October 16, 2017 [7 favorites]
Choking on my {/} hamburger but don't worry, I'm not statistically significant.
posted by sysinfo at 12:23 AM on October 16, 2017 [7 favorites]
A spoiler for the piece: the congressman who helped push through the bill to gut the DEA power against opiod distributors is currently up for the position of running the DEA.
Is he wearing clocks around his neck at press conferences yet?
posted by thelonius at 2:48 AM on October 16, 2017
Is he wearing clocks around his neck at press conferences yet?
posted by thelonius at 2:48 AM on October 16, 2017
I read this and, out of curiosity, tried to find out which specific drug manufacturers make synthetic opioids. Turns out there are very many synthetic opioids and despite googling for about ten minutes I couldn't find any sort of clear way to map active ingredients to trade names and then to manufacturers. Does anyone know a resource that gives that information?
posted by Sublimity at 3:23 AM on October 16, 2017 [1 favorite]
posted by Sublimity at 3:23 AM on October 16, 2017 [1 favorite]
Sublimity, oxycontin is one of the main brand names, generic drug is oxycodone. There have been various formulations over the years. The other big one, I gather, is fentanyl. That doesn't really answer your question, and may be details that you already knew. But if not, at least that will give you some more useful search terms.
posted by eviemath at 3:34 AM on October 16, 2017
posted by eviemath at 3:34 AM on October 16, 2017
Finding the generic names of synthetic opioids is not difficult. Mapping it back to manufacturers is the challenge.
posted by Sublimity at 3:53 AM on October 16, 2017 [2 favorites]
posted by Sublimity at 3:53 AM on October 16, 2017 [2 favorites]
Mapping it back to manufacturers is the challenge.
I think the story may begin here: How the American opiate epidemic was started by one pharmaceutical company [Purdue Pharma]
Short version: Wiki
posted by Mister Bijou at 4:17 AM on October 16, 2017 [7 favorites]
I think the story may begin here: How the American opiate epidemic was started by one pharmaceutical company [Purdue Pharma]
Short version: Wiki
posted by Mister Bijou at 4:17 AM on October 16, 2017 [7 favorites]
Mapping it back to manufacturers is the challenge.
Aha: "buy fentanyl powder"
posted by Mister Bijou at 5:24 AM on October 16, 2017
Aha: "buy fentanyl powder"
posted by Mister Bijou at 5:24 AM on October 16, 2017
You can try looking the generic names up in the FDA Orange Book to see which companies are approved to market them in the US.
posted by interplanetjanet at 5:55 AM on October 16, 2017 [3 favorites]
posted by interplanetjanet at 5:55 AM on October 16, 2017 [3 favorites]
Also, WebMD and similar sites list the brand names prescription drugs are sold under, and you can google those brand names. Because of regulations, that will be a complete list (if you know the genetic/scientific names of the drugs for the initial search).
posted by eviemath at 6:42 AM on October 16, 2017
posted by eviemath at 6:42 AM on October 16, 2017
Did not respond:
The DEA’s top official at the time, acting administrator Chuck Rosenberg, declined repeated requests for interviews...
Loretta E. Lynch, who was attorney general at the time, declined a recent interview request.
Obama also declined to discuss the law...
Marino declined repeated requests for comment. Marino’s staff called the U.S. Capitol Police when The Post and “60 Minutes” tried to interview the congressman at his office on Sept. 12...
The DEA and Justice Department have denied or delayed more than a dozen requests filed by The Post and “60 Minutes” under the Freedom of Information Act for public records that might shed additional light on the matter. Some of those requests have been pending for nearly 18 months. The Post is now suing the Justice Department in federal court for some of those records...
[T]he DEA’s former associate chief counsel, D. Linden Barber... declined repeated requests for an interview...
Craig S. Morford, Cardinal’s chief legal and compliance officer... did not respond to requests for comment...
The DEA declined to make [Clifford Lee Reeves II, a career Justice attorney] available for an interview....
Jason Hadges, the senior DEA attorney overseeing pharmaceutical enforcement cases who, according to former agency supervisors and lawyers, had been demanding a higher standard of proof on cases. Hadges left the DEA in May to join the pharmaceutical and biotechnology regulatory division of Hogan Lovells, a high-powered D.C. law firm. He declined to comment, citing “client sensitivities.”
Mike Gill, who had served as the chief of staff to DEA Administrator Chuck Rosenberg, left the agency to join one of the nation’s largest health-care law firms. He declined to discuss why the DEA dropped its opposition to the bill or his new job.
Last December, seven months after the bill became law, Marino’s chief of staff took a job as a lobbyist with the National Association of Chain Drug Stores. Bill Tighe had served as Marino’s point man on the legislation. The association was a key backer of the bill. Tighe declined to comment.
Marsha Blackburn, who co-sponsored the House version of the bill, received $120,000 in campaign contributions from the pharmaceutical industry. She did not respond to requests for an interview.
In addition to Blackburn, Marino and Hatch, The Post sought comment from the other nine co-sponsors of the 2016 bill. Only four responded.
posted by doctornemo at 7:10 AM on October 16, 2017 [9 favorites]
The DEA’s top official at the time, acting administrator Chuck Rosenberg, declined repeated requests for interviews...
Loretta E. Lynch, who was attorney general at the time, declined a recent interview request.
Obama also declined to discuss the law...
Marino declined repeated requests for comment. Marino’s staff called the U.S. Capitol Police when The Post and “60 Minutes” tried to interview the congressman at his office on Sept. 12...
The DEA and Justice Department have denied or delayed more than a dozen requests filed by The Post and “60 Minutes” under the Freedom of Information Act for public records that might shed additional light on the matter. Some of those requests have been pending for nearly 18 months. The Post is now suing the Justice Department in federal court for some of those records...
[T]he DEA’s former associate chief counsel, D. Linden Barber... declined repeated requests for an interview...
Craig S. Morford, Cardinal’s chief legal and compliance officer... did not respond to requests for comment...
The DEA declined to make [Clifford Lee Reeves II, a career Justice attorney] available for an interview....
Jason Hadges, the senior DEA attorney overseeing pharmaceutical enforcement cases who, according to former agency supervisors and lawyers, had been demanding a higher standard of proof on cases. Hadges left the DEA in May to join the pharmaceutical and biotechnology regulatory division of Hogan Lovells, a high-powered D.C. law firm. He declined to comment, citing “client sensitivities.”
Mike Gill, who had served as the chief of staff to DEA Administrator Chuck Rosenberg, left the agency to join one of the nation’s largest health-care law firms. He declined to discuss why the DEA dropped its opposition to the bill or his new job.
Last December, seven months after the bill became law, Marino’s chief of staff took a job as a lobbyist with the National Association of Chain Drug Stores. Bill Tighe had served as Marino’s point man on the legislation. The association was a key backer of the bill. Tighe declined to comment.
Marsha Blackburn, who co-sponsored the House version of the bill, received $120,000 in campaign contributions from the pharmaceutical industry. She did not respond to requests for an interview.
In addition to Blackburn, Marino and Hatch, The Post sought comment from the other nine co-sponsors of the 2016 bill. Only four responded.
posted by doctornemo at 7:10 AM on October 16, 2017 [9 favorites]
Did not respond:
That's really what got me. This wasn't the fault of the DEA. The DOJ, the House, the Senate, the Obama administration AND the DEA all folded. With a million angels watching, and they never move a wing. In one of the most contentious political environments that has existed in the nation, the vote was a model of bipartisan legislation. They all folded, and they can't even look us in the eye.
posted by zabuni at 7:35 AM on October 16, 2017 [7 favorites]
That's really what got me. This wasn't the fault of the DEA. The DOJ, the House, the Senate, the Obama administration AND the DEA all folded. With a million angels watching, and they never move a wing. In one of the most contentious political environments that has existed in the nation, the vote was a model of bipartisan legislation. They all folded, and they can't even look us in the eye.
posted by zabuni at 7:35 AM on October 16, 2017 [7 favorites]
OxyContin is the extended/controlled release formulation of oxycodone (which was developed in Germany 100 years ago after Bayer stopped making heroin because it was too addictive).
"In 1996, Purdue Pharma introduced OxyContin, a controlled release formulation of oxycodone. The product has been a commercial success, and since its introduction, Purdue has earned more than US$31 billion from OxyContin."
posted by elsietheeel at 7:48 AM on October 16, 2017 [3 favorites]
"In 1996, Purdue Pharma introduced OxyContin, a controlled release formulation of oxycodone. The product has been a commercial success, and since its introduction, Purdue has earned more than US$31 billion from OxyContin."
posted by elsietheeel at 7:48 AM on October 16, 2017 [3 favorites]
Interesting that the article frames the issue as legitimate versus illegitimate opioid use when it's more complex than that. A lot of people with actual chronic pain are prescribed opioids even though they're ineffective for chronic pain management, because doctors lack the tools or knowledge to combat chronic pain and so they offer acute relief. Even though long-term use puts patients at high risk of overdose and addiction. Is that prescription legitimate or illegitimate?
The opioid epidemic won't be halted until we have better ways to understand and manage chronic pain, and medication-assisted treatment centers receive more funding and less stigma.
posted by Emily's Fist at 8:38 AM on October 16, 2017 [9 favorites]
The opioid epidemic won't be halted until we have better ways to understand and manage chronic pain, and medication-assisted treatment centers receive more funding and less stigma.
posted by Emily's Fist at 8:38 AM on October 16, 2017 [9 favorites]
Purdue may have been the spark, and may have helped expand the crisis beyond crumbling inner city neighborhoods into white middle class suburbs, but it was the Mexican cartels which poured gasoline on the flames.
posted by caddis at 8:43 AM on October 16, 2017 [2 favorites]
posted by caddis at 8:43 AM on October 16, 2017 [2 favorites]
A lot of people with actual chronic pain are prescribed opioids even though they're ineffective for chronic pain management, because doctors lack the tools or knowledge to combat chronic pain and so they offer acute relief
pot works a whole lot better for chronic pain, and as they're figuring out the relationship between trauma and chronic pain, there's promise in other (currently illegal, but widely available) drugs.
We don't really lack the tools. We've got at least the first generation of rudimentary tools, and a decent idea about where to look for more.
But...politics. It's a political problem. Which seems somehow so much more intractable.
posted by schadenfrau at 8:49 AM on October 16, 2017 [3 favorites]
pot works a whole lot better for chronic pain, and as they're figuring out the relationship between trauma and chronic pain, there's promise in other (currently illegal, but widely available) drugs.
We don't really lack the tools. We've got at least the first generation of rudimentary tools, and a decent idea about where to look for more.
But...politics. It's a political problem. Which seems somehow so much more intractable.
posted by schadenfrau at 8:49 AM on October 16, 2017 [3 favorites]
"The opioid epidemic cost the U.S. economy $78.5 billion in 2013, according to the U.S. Centers for Disease Control and Prevention, a quarter of which was paid by taxpayers through increased public costs for health care, criminal justice, and treatment. The industry, the suits contend, should bear the financial burden of this wreckage." This will be an interesting legal battle to watch.
posted by Fuzzy Monster at 9:17 AM on October 16, 2017 [2 favorites]
posted by Fuzzy Monster at 9:17 AM on October 16, 2017 [2 favorites]
Is that prescription legitimate or illegitimate?
I don't find this a hard question at all: legitimate. A treatment which is not ideal does not thus magically become illegitimate. Otherwise, you'd better be prepared to declare a huge number of chemo scripts illegitimate.
A lot of people with actual chronic pain are prescribed opioids even though they're ineffective for chronic pain management
Also, this kind of statement can really only be made by someone who's never really battled a chronic pain problem. Relief of acute pain is effective treatment if your pain otherwise substantially interferes with your ability to lead your life. Opioids carry real risks. Even aside from the possibility of addiction, they have their own side effects which can be debilitating. And, of course, habituation may limit effectiveness for some. They should not be casually prescribed long-term and good follow-up is essential. But I know multiple people who are only able to carry on their lives because of carefully-managed opioid use for chronic pain. Waving it away as "ineffective" because it seems morally superior to you for them to be doing yoga or something instead is just irresponsible and ignorant.
posted by praemunire at 9:45 AM on October 16, 2017 [15 favorites]
I don't find this a hard question at all: legitimate. A treatment which is not ideal does not thus magically become illegitimate. Otherwise, you'd better be prepared to declare a huge number of chemo scripts illegitimate.
A lot of people with actual chronic pain are prescribed opioids even though they're ineffective for chronic pain management
Also, this kind of statement can really only be made by someone who's never really battled a chronic pain problem. Relief of acute pain is effective treatment if your pain otherwise substantially interferes with your ability to lead your life. Opioids carry real risks. Even aside from the possibility of addiction, they have their own side effects which can be debilitating. And, of course, habituation may limit effectiveness for some. They should not be casually prescribed long-term and good follow-up is essential. But I know multiple people who are only able to carry on their lives because of carefully-managed opioid use for chronic pain. Waving it away as "ineffective" because it seems morally superior to you for them to be doing yoga or something instead is just irresponsible and ignorant.
posted by praemunire at 9:45 AM on October 16, 2017 [15 favorites]
Also, this kind of statement can really only be made by someone who's never really battled a chronic pain problem.
Um. No. This is incorrect.
Hi, I have chronic pain. Opioids are shitty for it because they are addictive as fuck. Different things work for different people in different circumstances, and for some people they're going to need opioids no matter what, but something with such a high potential for addiction and abuse should not be the first line of treatment, even for acute pain. (and again, pot is as effective or more effective, and it isn't literally worse than fucking heroin.)
posted by schadenfrau at 9:50 AM on October 16, 2017 [4 favorites]
Um. No. This is incorrect.
Hi, I have chronic pain. Opioids are shitty for it because they are addictive as fuck. Different things work for different people in different circumstances, and for some people they're going to need opioids no matter what, but something with such a high potential for addiction and abuse should not be the first line of treatment, even for acute pain. (and again, pot is as effective or more effective, and it isn't literally worse than fucking heroin.)
posted by schadenfrau at 9:50 AM on October 16, 2017 [4 favorites]
Not to abuse the edit window: IIRC opioids are also shitty because people develop massive tolerances. Shit stops working. And then you're addicted.
posted by schadenfrau at 9:52 AM on October 16, 2017 [4 favorites]
posted by schadenfrau at 9:52 AM on October 16, 2017 [4 favorites]
Not to mention the other fun side effects of chronic opiate use, including hormonal imbalances and hypogonadism.
posted by elsietheeel at 10:39 AM on October 16, 2017 [2 favorites]
posted by elsietheeel at 10:39 AM on October 16, 2017 [2 favorites]
Shit stops working. And then you're addicted.
And don't forget the horrific withdrawal symptoms!
posted by tobascodagama at 10:42 AM on October 16, 2017 [1 favorite]
And don't forget the horrific withdrawal symptoms!
posted by tobascodagama at 10:42 AM on October 16, 2017 [1 favorite]
Shit stops working.
There is a pill for that.
posted by caddis at 10:46 AM on October 16, 2017 [2 favorites]
There is a pill for that.
posted by caddis at 10:46 AM on October 16, 2017 [2 favorites]
Critical thread on the DEA's prosecution of the war on opioids prior to this most recent development: "The DEA's efforts cut off a licit supply of opioids simply spurred many users to turn to street drugs -- heroin / Fentanyl"
posted by grobstein at 11:37 AM on October 16, 2017 [4 favorites]
posted by grobstein at 11:37 AM on October 16, 2017 [4 favorites]
One aspect of the current opioid situation that doesn’t get the scrutiny it deserves is the manner in which Purdue Pharma convinced a number of influential healthcare organizations to support the increased use of opioids; a good summary is here. I remember well when more aggressive pain management was a hot topic in medicine and the popular wisdom was that we were too cautious in prescribing opioids. That may well have been true, but the pendulum has clearly swung too far in the other direction. We really need to find a reasonable middle route. We also need to look more at non-opioid ways of treating pain, but that is a whole additional topic.
posted by TedW at 12:12 PM on October 16, 2017 [5 favorites]
posted by TedW at 12:12 PM on October 16, 2017 [5 favorites]
I should have been clearer, but also please don't put words in my mouth and say I'm pushing for yoga or new-age stuff as a solution to chronic pain or that I think scripts are illegitimate. My point is that opioid deaths are being driven by legitimate prescriptions, which is a problem unaddressed by the DEA or WaPo article.
posted by Emily's Fist at 12:17 PM on October 16, 2017 [1 favorite]
posted by Emily's Fist at 12:17 PM on October 16, 2017 [1 favorite]
Legal Weed Could Help Curb Opioid Epidemic: Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.
Opioids have their place - for acute pain (surgery, broken bones), for cancer pain, and for end-of-life and hospice care (because "addiction" should not be a consideration for people who are already dying!) but it seems they are not optimal for most cases of chronic pain.
What I would like to see is: more research dedicated to non-opioid solutions for chronic pain, and this includes weed, which seems to be effective for many, and opioid addiction treated as a public health issue and not a criminal one. Except for the pharma companies - throw the book at them, and make them pay money for the treatment of addiction.
I don't like prohibition, or "Just Say No," or throwing addicts and low-level dealers in jail; treatment, not punishment, should be the watchword. But I think those responsible, like Perdue Pharma "Oxycontin is not addictive!" need to make restitution.
posted by Rosie M. Banks at 12:18 PM on October 16, 2017 [7 favorites]
Opioids have their place - for acute pain (surgery, broken bones), for cancer pain, and for end-of-life and hospice care (because "addiction" should not be a consideration for people who are already dying!) but it seems they are not optimal for most cases of chronic pain.
What I would like to see is: more research dedicated to non-opioid solutions for chronic pain, and this includes weed, which seems to be effective for many, and opioid addiction treated as a public health issue and not a criminal one. Except for the pharma companies - throw the book at them, and make them pay money for the treatment of addiction.
I don't like prohibition, or "Just Say No," or throwing addicts and low-level dealers in jail; treatment, not punishment, should be the watchword. But I think those responsible, like Perdue Pharma "Oxycontin is not addictive!" need to make restitution.
posted by Rosie M. Banks at 12:18 PM on October 16, 2017 [7 favorites]
And yet I have to watch my loved ones jump through an ever-constricting series of hoops every month to get the medications that help them just function as human beings. My relative's new insurance company dictated that she has to start back at a lower level of something she tried years ago and then step up through a whole other series before she can have what actually works for her condition, so she's been nearly bedridden for a month. I'm not saying I don't care about people who abuse any given drug, it's just that most discussion tends to leave out the people who truly need it but have a hard time getting it because of the panic. She signed a contract saying she would only ever fill it at one pharmacy, but no pharmacy in the area will keep it in stock. So, even her trusted pharmacist she's had for years can only get it for her by special order after he's gotten the scrip from her doctor (takes at least two days). She can be called in at any time for a pill count or a urine test; if there's anything wrong with either or if she can't get the time off to go, the pain clinic kicks her out. I'm sure all of that stress is great for the health.
posted by The Underpants Monster at 1:06 PM on October 16, 2017 [8 favorites]
posted by The Underpants Monster at 1:06 PM on October 16, 2017 [8 favorites]
But I know multiple people who are only able to carry on their lives because of carefully-managed opioid use for chronic pain.
Probably better for chronic episodic pain than for daily use though.
posted by atoxyl at 1:26 PM on October 16, 2017
Probably better for chronic episodic pain than for daily use though.
posted by atoxyl at 1:26 PM on October 16, 2017
Rep. Tom Marino: Drug czar nominee and the opioid industry’s advocate in Congress
I've always heard the drug companies lobbied against legalized weed because they wanted people to buy their more expensive and more dangerous products instead. Anyone seen any reports on how far that goes?
posted by jeffburdges at 1:40 PM on October 16, 2017 [1 favorite]
I've always heard the drug companies lobbied against legalized weed because they wanted people to buy their more expensive and more dangerous products instead. Anyone seen any reports on how far that goes?
posted by jeffburdges at 1:40 PM on October 16, 2017 [1 favorite]
pot works a whole lot better for chronic pain
Not for everyone. I've been to countless doctors and tried basically everything, and the best relief for my chronic pain is opiods (hydrocodone). Been taking it for about a decade with no change in dosage, and no problems.
These days I'm in fear that I will have to stop working at some point, as its getting incredibly difficult to get any opiod prescriptions at all. I don't know where these "over prescribing" doctors are these days, but they're certainly not any of the ones I've seen.
It absolutely works for _some people_ with chronic pain. The deal with pain is that its pretty generic symptom, so there is no one (or even 2, or 5) solution for it. Everyone gets to spend a long time trying stuff and hope they can find something.
posted by thefoxgod at 1:58 PM on October 16, 2017 [7 favorites]
Not for everyone. I've been to countless doctors and tried basically everything, and the best relief for my chronic pain is opiods (hydrocodone). Been taking it for about a decade with no change in dosage, and no problems.
These days I'm in fear that I will have to stop working at some point, as its getting incredibly difficult to get any opiod prescriptions at all. I don't know where these "over prescribing" doctors are these days, but they're certainly not any of the ones I've seen.
It absolutely works for _some people_ with chronic pain. The deal with pain is that its pretty generic symptom, so there is no one (or even 2, or 5) solution for it. Everyone gets to spend a long time trying stuff and hope they can find something.
posted by thefoxgod at 1:58 PM on October 16, 2017 [7 favorites]
Shit stops working. And then you're addicted.
This absolutely does not happen to everyone. Been on the same dose of hydrocodone for a decade now (although getting very difficult to continue). Pot doesn't work, OTC painkillers like ibuprofen/etc don't work. I've had massage, physical therapy, surgery, countless shots (steroids, etc), tons of tests/scans/etc. One thing works and works well. Yet I still have to "try" new stuff all the time and go to a doctor at least once a month (these days, didn't use to be true) because otherwise I can't get a simple prescription for the only thing thats worked in those 10 years.
posted by thefoxgod at 2:00 PM on October 16, 2017 [5 favorites]
This absolutely does not happen to everyone. Been on the same dose of hydrocodone for a decade now (although getting very difficult to continue). Pot doesn't work, OTC painkillers like ibuprofen/etc don't work. I've had massage, physical therapy, surgery, countless shots (steroids, etc), tons of tests/scans/etc. One thing works and works well. Yet I still have to "try" new stuff all the time and go to a doctor at least once a month (these days, didn't use to be true) because otherwise I can't get a simple prescription for the only thing thats worked in those 10 years.
posted by thefoxgod at 2:00 PM on October 16, 2017 [5 favorites]
Los Angeles Times on the problems with OxyContin's marketing vs reality
"OxyContin’s stunning success masked a fundamental problem: The drug wears off hours early in many people, a Los Angeles Times investigation found. OxyContin is a chemical cousin of heroin, and when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug."
posted by sirshannon at 2:30 PM on October 16, 2017 [4 favorites]
"OxyContin’s stunning success masked a fundamental problem: The drug wears off hours early in many people, a Los Angeles Times investigation found. OxyContin is a chemical cousin of heroin, and when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug."
posted by sirshannon at 2:30 PM on October 16, 2017 [4 favorites]
I don't know where these "over prescribing" doctors are these days, but they're certainly not any of the ones I've seen.
Glancing at your profile, you're a fellow Californian? The state maintains a website with opioid statistics visualized, which shows you exactly where they are. If you tweak it to show prescriptions per county, you can see the 17% of CA counties in which there are enough opioid prescriptions for every man, woman, and child to have one with some left over. It's really a county-dependent problem, here.
Of course opioids work well and are necessary for many people's daily lives. If they weren't, this wouldn't be a crises. But longterm use IS highly associated with dependence, and overdoses ARE rising at alarming rates, and rates of people reporting chronic pain are rising as well. It's not like people are overdosing on purpose. That's why I said that we won't see this problem go away until we have a better way to treat pain, because that legitimate problem is what's driving the whole shebang - not evil pharmacists prescribing it for fun and money or whatever.
I challenge anyone to look at this chart and not be alarmed by the trends. This isn't a fake panic over nothing. The CDC estimates that 2 million Americans are dependent on prescription opioids and over 1,000 people are treated every day in emergency rooms for overdoses. 33,000 people died from opioid overdoes in 2015 and 20,000 of those were due to prescription opioid overdoses. That's comparable to the 35k people who died in auto accidents the same year, and trends are still increasing rapidly.
I'm not saying that opioids should be banned or made harder for patients to access. That is absolutely the wrong path, and it's ridiculous so many states are taking it. It's actually driving a heroin epidemic in many states, including California. This is why I dislike the article framing this as a "DEA enforcement" issue.
The problem is there aren't good options to help people suffering from pain for whom opioid use is dangerous, or for the millions who are already dependent. Medication-assisted treatment is extremely effective at helping people who are dependent, but there are not nearly enough methadone clinics or doctors approved to prescribe buprenorphine to meet the need, because of stigma and misinformation. It's not about woo-woo "moral" alternatives, which I do not advocate for nor care about. It's about the fact that a poor history of research into chronic pain -- an issue that disproportionately affects women -- has resulted in situations where we lack generally safe ways to treat it for a wide slice of the population, and as a result painkiller overdose is one of the leading causes of preventable death in the country and rising steadily.
posted by Emily's Fist at 4:56 PM on October 16, 2017 [6 favorites]
Glancing at your profile, you're a fellow Californian? The state maintains a website with opioid statistics visualized, which shows you exactly where they are. If you tweak it to show prescriptions per county, you can see the 17% of CA counties in which there are enough opioid prescriptions for every man, woman, and child to have one with some left over. It's really a county-dependent problem, here.
Of course opioids work well and are necessary for many people's daily lives. If they weren't, this wouldn't be a crises. But longterm use IS highly associated with dependence, and overdoses ARE rising at alarming rates, and rates of people reporting chronic pain are rising as well. It's not like people are overdosing on purpose. That's why I said that we won't see this problem go away until we have a better way to treat pain, because that legitimate problem is what's driving the whole shebang - not evil pharmacists prescribing it for fun and money or whatever.
I challenge anyone to look at this chart and not be alarmed by the trends. This isn't a fake panic over nothing. The CDC estimates that 2 million Americans are dependent on prescription opioids and over 1,000 people are treated every day in emergency rooms for overdoses. 33,000 people died from opioid overdoes in 2015 and 20,000 of those were due to prescription opioid overdoses. That's comparable to the 35k people who died in auto accidents the same year, and trends are still increasing rapidly.
I'm not saying that opioids should be banned or made harder for patients to access. That is absolutely the wrong path, and it's ridiculous so many states are taking it. It's actually driving a heroin epidemic in many states, including California. This is why I dislike the article framing this as a "DEA enforcement" issue.
The problem is there aren't good options to help people suffering from pain for whom opioid use is dangerous, or for the millions who are already dependent. Medication-assisted treatment is extremely effective at helping people who are dependent, but there are not nearly enough methadone clinics or doctors approved to prescribe buprenorphine to meet the need, because of stigma and misinformation. It's not about woo-woo "moral" alternatives, which I do not advocate for nor care about. It's about the fact that a poor history of research into chronic pain -- an issue that disproportionately affects women -- has resulted in situations where we lack generally safe ways to treat it for a wide slice of the population, and as a result painkiller overdose is one of the leading causes of preventable death in the country and rising steadily.
posted by Emily's Fist at 4:56 PM on October 16, 2017 [6 favorites]
Yeah, I think we basically agree. I don't like it when people make blanket statements about "opiods don't work" or "pot is better than opiods", etc. Medicine is rarely if ever one-size-fits-all, and opiods are effective for some of us (and thus I am sometimes worried about potential reactions to the crisis).
That said, there _is_ a crisis that is real, and I definitely believe a lot of people taking opiods don't need to and are probably being harmed by them. And the enforcement/drug-war style approach is not working (and I suspect Trump will double down on that in his planned "action" next week). Just like it doesn't work with purely recreational drugs.
The real answer probably starts with having a functioning healthcare system, sadly (sadly because we're moving in the opposite direction in the US). Having lots of real treatment options is something most people don't get (I'm lucky enough to be able to get essentially unlimited medical care, but for most people they're not going to even get a chance to try alternatives first).
posted by thefoxgod at 5:35 PM on October 16, 2017 [3 favorites]
That said, there _is_ a crisis that is real, and I definitely believe a lot of people taking opiods don't need to and are probably being harmed by them. And the enforcement/drug-war style approach is not working (and I suspect Trump will double down on that in his planned "action" next week). Just like it doesn't work with purely recreational drugs.
The real answer probably starts with having a functioning healthcare system, sadly (sadly because we're moving in the opposite direction in the US). Having lots of real treatment options is something most people don't get (I'm lucky enough to be able to get essentially unlimited medical care, but for most people they're not going to even get a chance to try alternatives first).
posted by thefoxgod at 5:35 PM on October 16, 2017 [3 favorites]
The biggest thing they could do tomorrow to save lives being lost to the opioid epidemic is ease the restrictions on buprenorphine prescribers, especially where there are already few providers. Make it free and it would really put a huge dent in the problem. Opioid dependence in and of itself isn't a life threatening problem. Being forced onto the black market where drugs, even those that look legit, may well be fake and are of unknown purity and dose.
People don't set out to overdose, and I suspect most deaths due to prescription opioids are among those who acquired it illicitly (and probably are largely young people abusing them occasionally who haven't built up a tolerance). People who are habituated to opioids are not likely to OD when they know what they are taking and aren't relapsing after a period of abstinence.
Once on maintenance therapy, one can live a normal life long enough to get things back in order enough to finally see a path to eventual full recovery. Though as far as I'm concerned, someone keeping their shit together while on long term maintenance is recovered in every sense that matters. Plenty of people have to take other kinds of drugs for the rest of their lives, after all.
posted by wierdo at 12:34 AM on October 17, 2017 [1 favorite]
People don't set out to overdose, and I suspect most deaths due to prescription opioids are among those who acquired it illicitly (and probably are largely young people abusing them occasionally who haven't built up a tolerance). People who are habituated to opioids are not likely to OD when they know what they are taking and aren't relapsing after a period of abstinence.
Once on maintenance therapy, one can live a normal life long enough to get things back in order enough to finally see a path to eventual full recovery. Though as far as I'm concerned, someone keeping their shit together while on long term maintenance is recovered in every sense that matters. Plenty of people have to take other kinds of drugs for the rest of their lives, after all.
posted by wierdo at 12:34 AM on October 17, 2017 [1 favorite]
As bad as the problem of doctors over-prescribing (or corruptly prescribing) super potent painkillers is, I think it's dwarfed by the newer issue of mass-produced fentanyl powders being used in counterfeit meds.
With Fentanyl being (supposedly) easy to make, there is no limitation on its production because of world poppy supply, and as a result counterfeit Oxyconton and Roxicodone (both just oxycodone pills) are EVERYWHERE, and most of the operations pressing these pills don't have the ability to safely dilute the fentanyl evenly between pills. Some might contain 1mg of Fentanyl, some might contain 5mg or more, and people die from this every day. Fentanyl is the devil, in powder form.
Sadly the economics of counterfeit pharmaceuticals seems to be too appealing for people to overlook. Very, very unintelligent people are spending $10-15k on raw materials and pill presses from sites like the one listed above, and end up with a return of $1,000,000 or more.
Despite insurers not covering it, there are shots and implants that can cost as little as $600 that make people immune to opiate highs for one or multiple months - lots of traditional recovery types don't believe in them, but IMHO that's utter crap.
Things are going to a get a lot worse before they ever get better, and it's sad.
posted by GreyboxHero at 6:58 AM on October 17, 2017 [2 favorites]
With Fentanyl being (supposedly) easy to make, there is no limitation on its production because of world poppy supply, and as a result counterfeit Oxyconton and Roxicodone (both just oxycodone pills) are EVERYWHERE, and most of the operations pressing these pills don't have the ability to safely dilute the fentanyl evenly between pills. Some might contain 1mg of Fentanyl, some might contain 5mg or more, and people die from this every day. Fentanyl is the devil, in powder form.
Sadly the economics of counterfeit pharmaceuticals seems to be too appealing for people to overlook. Very, very unintelligent people are spending $10-15k on raw materials and pill presses from sites like the one listed above, and end up with a return of $1,000,000 or more.
Despite insurers not covering it, there are shots and implants that can cost as little as $600 that make people immune to opiate highs for one or multiple months - lots of traditional recovery types don't believe in them, but IMHO that's utter crap.
Things are going to a get a lot worse before they ever get better, and it's sad.
posted by GreyboxHero at 6:58 AM on October 17, 2017 [2 favorites]
Hey! Coming soon to an everything near you! Bathtub morphine!
(Please note - there's nothing online about this at all after the initial announcement. Nothing. Draw your own conclusions)
posted by thatwhichfalls at 1:00 PM on October 17, 2017
(Please note - there's nothing online about this at all after the initial announcement. Nothing. Draw your own conclusions)
posted by thatwhichfalls at 1:00 PM on October 17, 2017
Google Is So Big, It Is Now Shaping Policy to Combat the Opioid Epidemic. And It’s Screwing It Up.
posted by jeffburdges at 1:53 PM on October 17, 2017 [1 favorite]
posted by jeffburdges at 1:53 PM on October 17, 2017 [1 favorite]
The U.S Is Draining the Global Opioid Supply: While the United States faces an epidemic of narcotic addiction, most of the world dies in pain. "The rate of death from opioid overdoses in the United States has more than doubled over the past decade. Amid a deluge of reports on the national crisis, it’s easy to lose sight of the fact that in much of the world, almost half of people die in preventable pain, without access to morphine for end-of-life care."
posted by homunculus at 12:06 PM on October 18, 2017 [2 favorites]
posted by homunculus at 12:06 PM on October 18, 2017 [2 favorites]
Maia Szalavitz (Maias): The Terrifying New Trend in Heroin Addiction: Just like they did in the 80s, Americans are increasingly going straight to heroin, skipping prescription opioids. Too bad US policy doesn't reflect that.
posted by homunculus at 3:37 PM on October 18, 2017
posted by homunculus at 3:37 PM on October 18, 2017
Significant drop in opioid deaths in Colorado since stores started legally selling recreational marijuana, study finds
posted by sebastienbailard at 9:04 PM on October 18, 2017 [7 favorites]
posted by sebastienbailard at 9:04 PM on October 18, 2017 [7 favorites]
The Secretive Family Making Billions From the Opioid Crisis. "You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?"
Interview with the author: Who Profits from the Opioid Crisis? Meet the Secretive Sackler Family Making Billions from OxyContin
posted by homunculus at 12:39 PM on October 19, 2017 [3 favorites]
Interview with the author: Who Profits from the Opioid Crisis? Meet the Secretive Sackler Family Making Billions from OxyContin
posted by homunculus at 12:39 PM on October 19, 2017 [3 favorites]
America's opioid crisis: how prescription drugs sparked a national trauma
posted by the man of twists and turns at 8:15 AM on October 27, 2017
posted by the man of twists and turns at 8:15 AM on October 27, 2017
People Are Dying Because of Ignorance, not Because of Opioids
Interview with the author: Neuroscientist Dr. Carl Hart: People Are Dying in Opioid Crisis Because of Politicians’ Ignorance
posted by homunculus at 12:33 PM on October 27, 2017
Interview with the author: Neuroscientist Dr. Carl Hart: People Are Dying in Opioid Crisis Because of Politicians’ Ignorance
posted by homunculus at 12:33 PM on October 27, 2017
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Couldn't've happened to a nicer police agency
posted by grobstein at 10:50 PM on October 15, 2017 [4 favorites]