Author Topic: Who's at Fault for the Opioid Epidemic?  (Read 9334 times)

Dynamic

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Re: Who's at Fault for the Opioid Epidemic?
« Reply #50 on: April 11, 2018, 04:04:17 AM »
I heard a good description on ep 661 of the Skeptics Guide to the Universe podcast recently about opioids, and from the show notes, I think this story was brought about by a recent study summarized in an LA Times article.

The gist seem to be that over a year-long clinical trial it appeared that over a year, i.e. for condition where pain is chronic (long-term) rather than acute (short-term spike) opioids offered no advantage over everyday non-opioid painkillers (I believe they referred to Tylenol, which I have understood is a US name or brand-name for paracetamol).

I think in the short term, opioids may be superior for pain relief and not caring, but over time their effectiveness at pain suppression lessens, requiring increase doses, and greatly increasing the likelihood of dependence and withdrawal symptoms, and long term non-opioids are at least as good. For end-of-life palliative care, opioids are very helpful, and dependence isn't really a problem.

As the evidence base changes I suspect that the best practice needs to be redefined and new guidelines for the default interventions issued across the medical community for long term (chronic) pain management in light of the best available evidence of benefits and side-effects. It may be that opioids still provide the best combination of effectiveness and reasonable safety for short-term use in certain categories of acute pain, but should be avoided for chronic pain management.

The SGU team made clear certain limitations of the trial, but it adds to a body of evidence that change may be required.


Cigarbutt

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Re: Who's at Fault for the Opioid Epidemic?
« Reply #51 on: April 11, 2018, 06:16:57 AM »
Since 2008, the number of opioid prescriptions and related deaths has gone up ++ (cdc data).
Fatalities from opioid overdoses has become the leading cause of mortality for Americans aged less than 50.
Americans "consume" 80% of the global opioid "supply" while they form less less than 5% of the world population.
Correlation or causation? And hard to pinpoint only one cause.

If you "believe" in the necessity to draw a line between personal freedom and societal constraints, have to look at the "quiet" and incremental changes that have occurred at the FDA in the last decades (helpful to envisage the range of outcomes for the pharma industry going forward).

Complex issue but simple in a way.
If you go to a hospital in the US for an ankle fracture, you are likely to get a large prescription of narcotics.
If you go to a hospital in Europe for an ankle fracture, you are likely to get a Tylenol/Paracetamol or equivalent prescription.
If you go to a hospital in Canada for an ankle fracture, you are likely to get something in between.
Why?

The "problem" is being recognized and changes have started to occur and will involve the different levels in the value chain and not only at the end stage. But it is like a big boat, a lot of energy necessary to initiate change and momentum. Maybe a template for things to come in healthcare. This is not beyond salvaging.

For those interested, here is a fascinating account of the problem with a human touch.
https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521/ref=sr_1_1?ie=UTF8&qid=1523452399&sr=8-1&keywords=dream%2Cland+quinones



rkbabang

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Re: Who's at Fault for the Opioid Epidemic?
« Reply #52 on: April 11, 2018, 06:44:45 AM »
I believe in little regulation and personal choice. People are going to do whatever they want to get a buzz. The drugs will vary over time.
Every time I hear this argument I wonder, where do you draw the line? Curious to hear your thoughts.

I don't draw lines.  And who gave you the power to draw them?  You do whatever you want to your body and let me do whatever I want to mine.

Not much to add to this thread, but "do whatever you want to your body and let me do whatever I want to mine" isn't the best argument.  There are too many real world externalities.  Who pays for the hospital stays, police force, etc. etc. for people who are drug addicted non-productive members of society? Drugs users don't exist in a vacuum.

Since violence would decrease substantially under legalization, medical costs (stabbings, gunshot wounds, etc) would drop dramatically as would police costs.  Gang warfare and the cost of militarized police are not cheap.  Your drug war doesn't exist in a vacuum.

Liberty

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Re: Who's at Fault for the Opioid Epidemic?
« Reply #53 on: July 05, 2018, 04:22:12 AM »
Wow, you guys have to listen to this:

https://overcast.fm/+LHyf76vDE

Investigative journalism is what we need more of...
"Most haystacks don't even have a needle." |  I'm on Twitter  | This podcast episode is a must-listen

DTEJD1997

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Re: Who's at Fault for the Opioid Epidemic?
« Reply #54 on: July 05, 2018, 07:10:14 AM »
I believe in little regulation and personal choice. People are going to do whatever they want to get a buzz. The drugs will vary over time.
Every time I hear this argument I wonder, where do you draw the line? Curious to hear your thoughts.

I don't draw lines.  And who gave you the power to draw them?  You do whatever you want to your body and let me do whatever I want to mine.

Not much to add to this thread, but "do whatever you want to your body and let me do whatever I want to mine" isn't the best argument.  There are too many real world externalities.  Who pays for the hospital stays, police force, etc. etc. for people who are drug addicted non-productive members of society? Drugs users don't exist in a vacuum.

Since violence would decrease substantially under legalization, medical costs (stabbings, gunshot wounds, etc) would drop dramatically as would police costs.  Gang warfare and the cost of militarized police are not cheap.  Your drug war doesn't exist in a vacuum.

If drugs were legalized, crime would decrease by a bigly amount.  How much crime is somehow related to drugs?  I would estimate probably 75% is in some way.

A lot of culture would change too!  "Gangsta rap" would probably decline by 90%+  Dealing drugs would no longer be a viable option.

Cigarbutt

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Re: Who's at Fault for the Opioid Epidemic?
« Reply #55 on: July 05, 2018, 07:20:35 AM »
Thank you for the interesting link (podcast).
A light is shone on Purdue Pharma.

Constructive criticism:

-Contrary to what the podcast suggests, this is not a single variable problem. Even if drug manufacturers such as Purdue Pharma bear a large part of the responsibility (which should be and likely will be assessed), there are many other contributing factors: users, prescribers and government agencies, especially the FDA.

-The FDA has been at least partially captured by the pharma industry and poitical ties prevent adequate control.

-The fact that there was an eleventh hour settlement in 2007 is only part of the problem. The failure to act (policy) on the information after is very hard to justify.

Here is a link that adds relevant details:
https://medium.com/@kfrydl/obama-the-opioid-crisis-7910ce57d0b6
IMO, change will occur when the crisis gets large enough.

BTW, I find it ironic that the podcast had publicity sections about the "US bank", a housing lender that has the "tools" that can help you "reach your dreams". Not the same degree of harm but nonetheless interesting that an FDIC-backed institution involved in the government-supervised and sponsored area of housing finance for the subprime customers and the like subsidizes a podcast related to addiction. The last time I checked, noboby went to prison after the last housing-fueled debt addiction episode.

« Last Edit: July 05, 2018, 07:24:04 AM by Cigarbutt »