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Is the opioid death toll a thing in all of western society?

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D_W

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Separate topic - coming out of the Capitol thread. The statistics about alcohol and death are surprising. I looked them up as part of that discussion and generally don't carry around arguments like that.

Less on the alcohol thing and more on the overdose deaths. The movie industry and other things in the states have always provided us with odd portrayals of addicts vs. alcoholics, for example. If you knew a kid in a bad house with alcoholics (abuse, etc. all rolled into that), it was "that's a shame, but oh well, what can you do about it". If you brought up such things as weed (which I have no interest in and never did, and never tried, but it's fairly benign), you could get the older folks totally fired up. Including the alcoholics. The perception was an odd thing. Alcohol is a gaba agonist from what I understand. Take it away and someone who needs it to remain calm has no ability to control their fear. Gaba agonists tend to be something that you have to taper off of over a long period of time to change your body's regulation (but being no expert on alcohol, I'm guessing the lack of inhibitions and impaired judgement makes tapering pretty difficult to implement). Since I don't get a particular thrill out of it, I wouldn't have any difficulty doing this, but people who do get the thrill ..not the same.

On to the statistic that came out of the discussion - drug overdoses in the US are at least 10 times higher than firearm homicides that don't involve gang or drug-related crimes (sorry to offend anyone who thinks I should count those - I don't think you'll get them to go away and you have near zero chance of getting caught in them). the remaining number is something like 6000 and some fraction of that again has an avoidable element, but I can't see the data parsed further to find out what's "regular people run amok". So the number could be 20 or 30 times.

We're also keenly aware now thanks to publishing of information that a lot of the deaths are people who start with a prescription, find something they really like (just as I'm thankful for not having the lightswitch on effect from alcohol, I'm glad that I've never had any short term medication from a surgical procedure, etc, that was particularly thrilling).

What's the cause of all of the prescribing? The first thing you'll hear from simplified story tellers here in the states is that it's greedy docs and drug companies. I'm sure that's some part of it. Just about everyone who works has some level of greed and likes to grow their business. But what I'm interested to know is the other side of the cause here with the opioids, and that is that our medical association gets fascinated with ideals. Two that stand out to me is if you go through a low row and go to a psychiatrist here (something I had to do due to an adverse reaction to a migraine medication - a simple beta blocker), the psychiatrist will attempt to figure out how to make you happy "all the time" or "almost all of the time". I may be one of the few, but I think this is a dangerous thing to aim for, and said the same.

On the pain side, the medical society here apparently (relaying what I've heard from physicians) decided that pain was an important treatable issue and that the goal is no pain. This is, again, a pretty dangerous target for the average person. I've never taken an opioid and probably never will, but I understand that some people get the warm fuzzies from them above and beyond pain relief, but even for those in the latter, the dangerous part about the treatment is that there can be pain relief and reasonable functionality. As tolerance builds, it takes more, but the medical directive states that physicians should treat pain as they would any other condition.

The outcome of this was predictable.

Is this a universal international thing, or is it only in the united states (as in, I know there are pharma abusers everywhere, but is it as prevalent elsewhere in a per capita basis?). An equivalent basis in the UK by population would be something like 12k deaths per year with some sizable fraction of those being opiate addicts starting with a pain prescription.
 

Woody2Shoes

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I believe that the US particularly suffers from fentanyl misuse. It seems terrifyingly easy to go from a therapeutic dose to a fatal one - particularly when combined with other (prescription or otherwise) drugs and alcohol.


I think that drug misuse patterns are different depending on local supply and on local 'fashions' - British middle class folk happy to snort cocaine would probably never inject heroin, for example.

I also think that it is dangerous to consider 'weed' to be relatively benign. In the UK, cannabis is generally much more potent than it used to be - partly because of genetic engineering or selective breeding of plants, and partly because of synthetic additives.
 

Rorschach

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I think it's less of an issue here due to our prescription practices although our rules and (overly cheap) medication does cause a lot of waste.
 

Woody2Shoes

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I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health). One of the surprising things for a Brit visiting the US is the extent of 'consumer' advertising of drugs on TV etc. "Ask your doctor about XYZ..."
 

Jameshow

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The tide is changing here

Both antibiotics and opiates usage are being discouraged in many situations.

Pain clinics and social prescribing are increasing as ways of reducing dependance upon pain killers.

Also the GP system is only legal way to opiates and they aren't on easy repeat prescriptions so the chances of becoming addicted are restricted.

Cheers James
 

D_W

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I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health). One of the surprising things for a Brit visiting the US is the extent of 'consumer' advertising of drugs on TV etc. "Ask your doctor about XYZ..."
I wonder how much effect those advertisements have here - we disregard them in general. But, I'd imagine they're for hugely profitable drugs (like combination drugs her that cost several multiples of their constituents). I guess the point of them is to hit the people who have whatever condition being described. "tardive dyskinesia" and COPD inhalers are on TV constantly. As are things aimed at older folks and billed straight back to Medicare (mobility things, diabetic supplies, etc).

I tend to watch the off-channels (not the .1 major network current stuff, but the .2 -.5 channels here tend to have older reruns, which probably explains why I see the stuff above. Lots of over the counter gimmickry, too, like hot and cold belts, various pain relief rubs, etc).

Agree on the antidepressants. Their efficacy vs. passage of time is something like +15% (resolution of depression, etc). Most other approaches tried independently (exercise/talk) are more effective, but the latter are secondary approaches here and the former initial primary - presumably due to cost. It's cheaper to put someone on a generic antidepressant than it is for the care system to send someone to talk therapy.

Not glossing over folks who have "bad wiring" who can't get right no matter what, but rather the folks who can by addressing their issues head on.
 

Fitzroy

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My father was a pharmacist and most of the class of medications you mention are heavily controlled, my expectation was that deaths would be low. A quick search shows its in the hundreds not thousands.


Fitz.
 

D_W

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The number that I provided was for all drug overdose - no data on opioid overdose (I'd speculate that itself is rare, but overdose after folks end up turning to heroin would be higher). That was 67k for all of the US for all causes. I'd imagine also that some of those overdose deaths are overlap with the suicide totals. The daughter of a neighbor here (these people are older now, the daughter would be in her 60s if she was still alive) overdosed on railroad tracks and was subsequently run over. I guess there's a chance that was accidental, but not likely. It's something the woman said - not remotely close to something I'd ask for additional information on (the mother is now deceased - she was over 90 - unlucky that one child had a drug problem, another is a dry drunk - and a grandchild was later arrested holding up a gas station due to heroin addiction. A really odd illustration as it was once a close family and both grandparents were professionals).

At any rate, it looks like a comparable total for England and Wales last year was 4400. Overall a much lower rate.

starting about 5 years ago, controlled substances are now digitally tracked so that people developing tolerances can't string along separate doctors at the same time (which seems to have been a problem that was common and also encouraged by a small number of private practitioners - most of those either in jail now or no longer practicing). Our death rates are declining and I would anticipate they will continue to as you can't easily get absurd stories of Keith Richards type dosages legally.

There's a casualty in that process, too, I guess, which is immobile people with structural pain (as in, permanent injuries, etc) who will trade a much shortened lifetime for high dosages of pain relief.
 

D_W

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This chart would suggest I'm wrong about my suspicion - and this chart fairly well identifies the reason for the uptick.

There's a multi-year lag in this data - fortunately the totals have declined in the last couple of years, but not to pre-epidemic levels (which were closer or perhaps below the 4400 figure by per capita rate).

All of this is foreign to me other than knowing stories like those of my neighbor, but a tradesman here who works on heavy equipment told me that most of the people in his profession are broken down by the time they're 40, and that initially, opioids allowed a lot of them to continue working as normal to a later age (one would have to ask the question how much more irreparable damage they're doing to their bodies if they're covering up pain in the interim, but......he didn't think too much of my idea of planning for something like that going forward. "they're taking these away and making it harder for the working man to get by").
 

Glitch

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Recommended viewing. Great documentary - 'The Pharmacist' on Netflix
Shocking insight into prescription drug abuse in one town in the U.S.

Trailer on YT The Pharmacist trailer
 

Spectric

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I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health).
I believe that Tv advertising also has a major impact on mental health, really stupid adverts delibrately aimed at the more vunerable / gullable, they want you to give them all your money under the guise of gambling is fun, trying to sell pointless life insurance policies and then policies that might help pay some of your funeral cost. Does anyone take any of these adverts seriously, they are brain damaging propaganda that in some cases are almost scams.
 

billw

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I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health). One of the surprising things for a Brit visiting the US is the extent of 'consumer' advertising of drugs on TV etc. "Ask your doctor about XYZ..."
I can assure you that anti-depressants have had anything but a nasty effect on my mental health. Especially when I've forgotten to take them......
 

billw

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I believe that Tv advertising also has a major impact on mental health, really stupid adverts delibrately aimed at the more vunerable / gullable, they want you to give them all your money under the guise of gambling is fun, trying to sell pointless life insurance policies and then policies that might help pay some of your funeral cost. Does anyone take any of these adverts seriously, they are brain damaging propaganda that in some cases are almost scams.
Of course people take them seriously, that's why they exist. Funeral plans are the new PPI - the financial sector looks for ways to part people from money in return for worth less stuff. The government will eventually crack down and compensation will be paid, which will be funded by the next dodgy product that crops up.
 

billw

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@D_W I think part of the problem is that everything is profit-driven in the US. It's better to sell something risky and take the chance of being sued than not sell it at all. Do corporations care? Of course not. They'll *say* they do, but they're only remorseful when caught just like any criminal.
 

selectortone

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About ten years ago, while my daughter was living in Canada, she had a nasty fall at speed off her bike. She was in severe pain and was prescribed OxyContin. She told me later that she took one and it made her feel so wierd she threw the rest away. Now, my daughter was a bit of a free spirit back then, and recreational drugs were not exactly unfamiliar to her at that time, so for her to find them too much says a lot. Or perhaps her familiarity warned her off.

This was before the news in the Americas became full of stories of people getting hooked on them, and the great difficulty survivors had getting off them. I remember reading about a well respected lawyer who was prescribed opioids for chronic back pain after an accident and became hooked. It was so painful trying to wean himself off them that in the end his life fell apart and he killed himself. I shudder to think what might have happened if my daughter had stuck with that initial prescription.
 

D_W

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I think it's a two edged sword. Despite the complaining media, the standard of living here is high and the tax burden is relatively low. Corporate efficiency is almost entirely responsible for that.

In the case of the pain pills, at the outset, everyone probably thought they were gold. You can take them (apparently, I've only taken the codeine as a child mentioned above) late in a working career and keep working. They apparently control post surgery pain well, and for older folks, allow them to relax.

The trouble is, they're not good for you in the long term.

I can say at this point that my retirement accounts have about twice or three times as much money in them as I put in them. Without corporations, I wouldn't have it. I don't have the easy answer for it because no heavily socialized country has ever lasted long term. We're running the experiment right now, I guess.
 

D_W

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About ten years ago, while my daughter was living in Canada, she had a nasty fall at speed off her bike. She was in severe pain and was prescribed OxyContin. She told me later that she took one and it made her feel so wierd she threw the rest away. Now, my daughter was a bit of a free spirit back then, and recreational drugs were not exactly unfamiliar to her at that time, so for her to find them too much says a lot. Or perhaps her familiarity warned her off.

This was before the news in the Americas became full of stories of people getting hooked on them, and the great difficulty survivors had getting off them. I remember reading about a well respected lawyer who was prescribed opioids for chronic back pain after an accident and became hooked. It was so painful trying to wean himself off them that in the end his life fell apart and he killed himself. I shudder to think what might have happened if my daughter had stuck with that initial prescription.
I've heard the same about it. Codeine made my stomach hurt so bad that I forgot I had a broken wrist (which never hurt that bad in the first place). I can remember my doctor giving dictation into a device (remember when they did that?) "didn't take prescription - one tough kid!". I wasn't tough, I did what hurt less.

My dad had a knee replacement a couple of years ago. He had oxycontin or something similar afterwards and when he stopped taking it, all he said was that he could feel things in his knee that he didn't with it. I asked him if he felt like he was having withdrawals (nope!).

It seems a lot like alcohol. I could never become an alcoholic because drinking much isn't enjoyable. Same with cigarettes. I hear other people describe how great both are and am thankful I wasn't wired to like them.

I understand that for most people, opiates are a week or ten days of intense withdrawals to get off of.
I think the benzodiazepenes (just like alcohol) are much harder to kick, but heard once from a guy who went from opioids to heroin as his money went low that he fears all the time if he ever has heroin in front of him, he'll do it again. He's fully employed and hasn't done any of it for years, but it sticks with him.

Maybe the biggest danger here is something that works really well (alcohol seems to be the old school medication of choice for people trying to get away from their own mind, for example), don't know. Caffeine is the only thing I have no desire to kick. Glad I'm not Mormon.
 

billw

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I can say at this point that my retirement accounts have about twice or three times as much money in them as I put in them. Without corporations, I wouldn't have it. I don't have the easy answer for it because no heavily socialized country has ever lasted long term. We're running the experiment right now, I guess.
Most of Europe is heavily socialist compared to you. I don't see any failed states here. Your opening statement says a lot - Americans need perpetual growth to fund their retirement accounts, whereas many European states have social funds that provide for old age. I wonder what will happen in the US when big corporations run out of global expansion possibilities? Or the Chinese beat them to it? Economic liberalisation occurred because it was in the US national interest to push their domestic corporations outside their own market to facilitate the need for perpetual growth. What happens when you run out of countries to suck into the system? Pray for the return of Atlantis? Colonise Mars?
 

Stevem

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Wandering a bit off - topic : think USA will do what we in UK and some of our neighbours are doing - that is encouraging population growth (consumers) by any means (hence our immigration 'issues').
Closer to topic: I've seen two work colleagues that smoked marijuana (weed/blow) heavily over 20 years. Both lives ruined, it's unknown to me what happened to their kids/family. TBF , I've seen more lads ruined by alcohol. Sad.
 
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