The Opiate and Heroin Epidemic in America (1 Viewer)

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Post is also tabloid-esque but this is pretty well documented issue...

"Tranq" (Animal Tranquilizer Xylazine-laced Fentanyl) known for causing ****loads of deaths and necrotic/rotting flesh at injections sites... has contaminated the bulk of "heroin" supply in some cities. We need better harm reduction and rehab programs in place.

Flesh-eating drug ‘tranq’ meant for animals now linked to thousands of heroin, fentanyl ODs

The flesh-eating animal tranquilizer xylazine has been linked to thousands of drug overdoses across the country as it inundates heroin and fentanyl supplies in places such as Philadelphia, Delaware…

nypost.com

 

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Shocking no one (or at least not me) the legalization of marijuana has resulted in a surge of addiction and mental illness, particularly among teens.

The whole concept that MJ is harmless is and was bunk.

Your link is to a Daily Mail article, which is a UK tabloid. I'd prefer to look at actual studies that show this "surge of addiction and mental illness". Do you have any peer reviewed studies that show this causal relationship?

I too base my medical opinions on Tabloid articles that don't cite any actual peer reviewed studies.

NIH ok with you guys?

Implications of Marijuana Legalization for Adolescent Substance Use

Marijuana that is legally available for adults has multiple implications for adolescent substance use. One potential effect that legalization may have is an increase in adolescent use to due increased availability, greater social acceptance, and possibly ...

www.ncbi.nlm.nih.gov

Adolescent marijuana use has been associated with impairment in a number of areas: impaired cognitive functioning,36 increased risk of developing marijuana dependence,37 elevated rates of school dropout,38 an elevated risk of developing psychotic illnesses,39,40 and an increased rate of engaging in risky behaviors.41 Weekly marijuana use under age 18 years has been associated with an eight-point drop in intelligence among those who develop persistent dependence, while those with adult onset of comparable levels of use are less affected; importantly, the loss of cognitive capacity may not recover completely after desisting from marijuana use.42

That is the pertinent part. Mental illness, dependence, school dropout, permanent drop in IQ. Not sure what the outrage is here - I figured these kind of effects were well known and accepted as par for the course. IMO, the onus should be on folks to show this stuff doesn't happen - that it does happen is common sense (and, as can be seen, well documented).

You mean the paper that went on to say this?

However, the authors noted that “although adolescents who use marijuana heavily demonstrate decrements compared to non-using teens, it is still unknown whether marijuana use caused or contributed to these effects.” Similarly, early use has been associated with poor outcomes in a number of other domains, however, these associations do not necessarily signify causality. Instead early use may act as a marker of a more generalized tendency to engage in risky behaviors.

Also, I'm not aware of any legalization efforts that support use under the age of 18... I may be missing something, though.

 

[The Z Machine]

Agreed that we should try and restrict cannabis use by those under 18.

But is there a surge of addiction and mental illness for adults post legalization? I'd like to see that analysis.

 

[Tau837]

Oregon Medical Board Should Resign – Or Be Fired

“I live in the state of Oregon and have been a chronic pain patient for almost 20 years. The Oregon State Medical Board is holding ALL physicians—including pain management specialists -- to the extremely low dose threshold of 90 Morphine Milligram Equivalent (MME) daily dose, based on the outdated 2016 CDC Guidelines.”

“If an Oregon physician crosses over that 90 MME dose threshold, they are issued a ’Complaint & Notice’ by the Oregon Medical Board -- which almost always then turns into a “Stipulated Order” In which the Medical Board directs that all of the physician’s patients must be “tapered to 90 MME or less, or transitioned to Buprenorphine.”

“The physician has absolutely no choice but to comply. If they do not follow the order, then further action will be taken against them, including possible loss of license, fines, etc… The only patients listed by the Oregon Board as exempt from the 90 MME in these ’stipulations’ are end-of-life, active cancer, or hospice patients.”

“The Oregon State Medical Board is causing patients dire harm with these Stipulated Orders, mandating widespread forced tapers that are strongly warned against by multiple Federal agencies. It is the patients that end up paying the price in dire harm, not the physician.”

Wow. I feel for any residents of Oregon who suffer from severe, chronic pain.

 

[Tau837]

U.S. Prescription Opioid Use Fell 7.4% in 2022

The amount of prescription opioids sold in the United States fell another 7.4% last year, according to a new report by the IQVIA Institute, a healthcare data tracking firm.

Since their peak in 2011, per capita use of prescription opioids by Americans has declined 64 percent, falling to levels last seen in the year 2000. Despite that historic decline, fatal overdoses in the U.S. have climbed to record levels, fueled primarily by illicit fentanyl and other street drugs.

“The greatest reductions in prescription opioid volume — measured in morphine milligram equivalents (MME) — have been in higher-risk segments receiving greater than 90 MMEs per day,” the IQVIA report found. “Despite significant progress in reducing opioid prescriptions to combat the opioid overdose epidemic, overdose deaths have been rising, primarily due to illicit synthetic opioids.”

The CDC estimates there were 108,712 overdose deaths in the 12-month period ending in November, 2022. About 72,000 of those deaths involved heroin or synthetic opioids such as fentanyl.

By comparison, drug deaths involving legal prescription opioids have remained relatively flat, averaging about 16,000 a year since 2017. They ticked upwards in 2020 and 2021, but appear have trended downward again in 2022, according to the IQVIA.

More evidence that this Government war on presciption opioids is completely misguided.

From the same article:

It appears likely that prescription opioid use will fall again in 2023, due in part to further cuts in opioid production quotas imposed on drug makers by the Drug Enforcement Administration. The DEA says the opioid supply will still be “sufficient to meet all legitimate needs,” but as PNN has reported, some manufacturers are currently reporting shortages of oxycodone and hydrocodone.

The DEA is actively harming pain patients with this policy approach. My wife has been on a particular medication that is very helpful to her for more than a decade, and starting last month, she is unable to get it due to shortage of supply. This is crushing after getting past all of the hurdles related to insurance and pharmacies, only to find that there is no supply available to fill the prescriptions. There is no true subsitute for this particular medication, so her suffering has increased and her quality of life has declined. Thanks to the DEA.

I can't adequately express how stressful and depressing it is to be a severe chronic pain patient or a caregiver for such a patient in this climate the Government has created. Before all of this started, we already had to deal with her pain and many associated health issues, insurance challenges, pharmacy challenges, and associated financial challenges... but at least she could get her legitimately prescribed medication. Over the years of this opioid hysteria, her health has progressively declined and her pain has progressively increased, while at the same time the challenge of getting legitimate pain medication to help her has become harder and harder.

I hope none of the rest of you here are going through this. If so, you have my empathy.

 

[rockaction]

I hope none of the rest of you here are going through this. If so, you have my empathy.

I've told you before you have my sympathy and continue to do so. I hate seeing you bump this thread in obvious grief over your wife's situation. There is no reason that a patient should not be able to request palliative care for chronic pain. I'm truly sorry.

 

[Tau837]

I hope none of the rest of you here are going through this. If so, you have my empathy.

I've told you before you have my sympathy and continue to do so. I hate seeing you bump this thread in obvious grief over your wife's situation. There is no reason that a patient should not be able to request palliative care for chronic pain. I'm truly sorry.

Thanks, GB. I appreciate it.

 

[Tau837]

Everything the government thinks it knows about the opioid crisis is wrong

 

[Tau837]

Large Study Debunks Myths About Rx Opioid Addiction

In an analysis of nearly 3.5 million Australians who were prescribed opioids for the first time, researchers found that 92% never progressed beyond low opioid use and only 3% became persistent users or needed higher doses. The “sustained use” of opioids occurred mostly in seniors (65 and older) suffering from cancer, depression, anxiety and other chronic health problems...

“Overall, these findings suggest that most people who initiate an opioid prescription are likely to have low, time-limited exposure to opioids with little indication of ongoing use. This possibility is an important consideration for policymakers and stakeholders considering population-level prescribing of high-risk drugs,” researchers reported in JAMA Network Open.

“Opioids are essential drugs for acute and cancer pain, and many people with CNCP (chronic non-cancer pain) benefit from opioids. Continued focus and policy responses based on findings from a small group of people with increased risk of harms run the risk of limiting access to people who safely derive objective benefits from opioids.”

No surprise to anyone who was paying attention all along.

 

[Tau837]

US Opioid Guidelines 2022 -More and Less Than Meets the Eye

ABSTRACT

The United States is currently embroiled in a contentious and multi-dimensional public conversation about addiction-related mortality, chronic pain, and government regulation of clinicians who employ opioid analgesic pain relievers in treating pain. The US Centers for Disease Control and Prevention (CDC) have published and updated guidelines to clinicians concerning appropriate practices for managing severe chronic pain by means of opioid analgesic pain relievers.This Critical Policy Review briefly outlines the history of US public health policy on regulation of prescription opioid pain relievers. The author then compares recommendations and data sources of the updated November 2022 CDC guidelines against findings from a wide range of pertinent clinical literature. He finds that the most recent effort by CDC is fatally flawed by weak evidence and methodologically unsound research, disproportionate emphasis on risk, and failure to address genetically mediated variability in minimum effective opioid dose between individuals. Compounding these difficulties are indications of professional conflicts of interest and persistent anti-opioid bias on the part authors of the most recently released CDC guidelines.

Conclusions

...However, multipleinstances were foundwhere CDC authors appear to have over-generalized or misinterpreted from very weak medical evidence. Despite repeated assertions that patient care must be individualized, a one-size-fits-all framework wasconstructed of proposed restrictions on prescribing, based on Morphine Milligram Equivalent Dose thresholds. There are also indications of preexisting and unacknowledged professional conflict of interest on the part of at least one of the writers.

Overall, the most significant–and methodologically fatal –error of CDC-2022 may beits failure to address genetics of opioid metabolism. Genetic polymorphism in expression of CYP450 liver enzymes introduces a wide range in opioid minimum effective dose and sensitivity toside effects between individuals. None of the outcome’sreviews referenced in CDC-2022 even acknowledgedsuch variations, rendering their findings of very limited value,if notoutright biased. Of secondary import are persistent over-emphasis on “risk” and a naïve over-generalization of the supposed benefits of non-opioid or non-invasive modalities of therapy as substitutions for opioid analgesics.

Taken in combination, these factors may warrant the repudiation of both CDC-2016 and CDC-2022, and withdrawal of CDC from policy making roles in the practice of pain medicine.

 

[Todem]

Watched the Netflix limited series Painkillers.

Man…..

 

[Tau837]

Government Data Refute the Notion That Overprescribing Caused the 'Opioid Crisis'

 

[Kev4029]

Government Data Refute the Notion That Overprescribing Caused the 'Opioid Crisis'

I don't think I read that data the same as you. First, it pulls two charts from an entire article from Science and ignores the rest of that article - maybe most importantly the "Caveats" section of the article. Second, the Science article and the charts don't provide any sort of data that conclude anything regarding what role prescribing opioids had on drug overdoses in the US, nor could there be anything really pulled to support your linked articles conclusions. Third, the one sweeping conclusion of the Science article is that overdose deaths, and specifically with opioids, have increased exponentially between the late 70s and mid 10s. Last, your linked article is building a strawman argument anyway making it sound like 1. the general consensus is that prescription opioids are exclusively the cause of overdoses and that 2. over prescription of opioids was/is the only cause of the opioid epidemic.

 

[Tau837]

I don't think I read that data the same as you. First, it pulls two charts from an entire article from Science and ignores the rest of that article - maybe most importantly the "Caveats" section of the article.
Second, the Science article and the charts don't provide any sort of data that conclude anything regarding what role prescribing opioids had on drug overdoses in the US, nor could there be anything really pulled to support your linked articles conclusions.

I know the author of the Reason article, Red Lawhern. I have previously linked some of his articles in this thread. He doesn't need to refer to the rest of the article to make the points he made with the charts. And he obviously linked the article so readers could easily read it in its entirety, which I did.

From the Science article:

By examining all available data on accidental poisoning deaths back to 1979 and showing that the overall 38-year curve is exponential, we provide evidence that the current wave of opioid overdose deaths (due to prescription opioids, heroin, and fentanyl) may just be the latest manifestation of a more fundamental longer-term process...

The epidemic of drug overdoses in the United States has been inexorably tracking along an exponential growth curve since at least 1979, well before the surge in opioid prescribing in the mid-1990s.

IMO those statements clearly show that prescription opioids didn't cause the problem.

As for the caveats in the Science article, IMO they support Red's primary point. I have posted multiple times about these same caveats in this thread. They are well known to most people who seriously follow this "prescription opioid epidemic" subject.

Last, your linked article is building a strawman argument anyway making it sound like 1. the general consensus is that prescription opioids are exclusively the cause of overdoses and that 2. over prescription of opioids was/is the only cause of the opioid epidemic.

It doesn't really matter if people in the Government (CDC, DEA, etc.) have said that prescription opioids have been the exclusive cause. They have inappropriately cited it as at minimum a primary cause significant enough to justify putting in place regulations and initiatives that have actively harmed chronic pain patients and their physicians and continue to do so. That harm is indisputable. I have probably posted 50+ articles in this thread documenting it.

When is the Government going to stop doing that harm to innocent people who are suffering and those who want to help treat them?

 

[Psychopav]

I don't think I read that data the same as you. First, it pulls two charts from an entire article from Science and ignores the rest of that article - maybe most importantly the "Caveats" section of the article.
Second, the Science article and the charts don't provide any sort of data that conclude anything regarding what role prescribing opioids had on drug overdoses in the US, nor could there be anything really pulled to support your linked articles conclusions.

I know the author of the Reason article, Red Lawhern. I have previously linked some of his articles in this thread. He doesn't need to refer to the rest of the article to make the points he made with the charts. And he obviously linked the article so readers could easily read it in its entirety, which I did.

From the Science article:

By examining all available data on accidental poisoning deaths back to 1979 and showing that the overall 38-year curve is exponential, we provide evidence that the current wave of opioid overdose deaths (due to prescription opioids, heroin, and fentanyl) may just be the latest manifestation of a more fundamental longer-term process...

The epidemic of drug overdoses in the United States has been inexorably tracking along an exponential growth curve since at least 1979, well before the surge in opioid prescribing in the mid-1990s.

IMO those statements clearly show that prescription opioids didn't cause the problem.

As for the caveats in the Science article, IMO they support Red's primary point. I have posted multiple times about these same caveats in this thread. They are well known to most people who seriously follow this "prescription opioid epidemic" subject.

Last, your linked article is building a strawman argument anyway making it sound like 1. the general consensus is that prescription opioids are exclusively the cause of overdoses and that 2. over prescription of opioids was/is the only cause of the opioid epidemic.

It doesn't really matter if people in the Government (CDC, DEA, etc.) have said that prescription opioids have been the exclusive cause. They have inappropriately cited it as at minimum a primary cause significant enough to justify putting in place regulations and initiatives that have actively harmed chronic pain patients and their physicians and continue to do so. That harm is indisputable. I have probably posted 50+ articles in this thread documenting it.

When is the Government going to stop doing that harm to innocent people who are suffering and those who want to help treat them?

Not only chronic pain sufferers either. The regulations have allowed insurance companies to make providers jump through hoops to prescribe opioids. I've had multiple situations where a family member was prescribed an opioid due to a critical pain situation (ER, surgery, etc.) but the prescriptions were denied by the insurance company. So while I could still access the medications, I was forced to pay out of pocket when they would have otherwise been reduced cost or free.

The upshot is that CVS is my pharmacy and Aetna (owned by CVS) is my insurance carrier. This is a class action lawsuit waiting to happen imo, and I'll be happy to join when it does. Ridiculous.