The high: "The artist Nan Goldin and around 100 fellow demonstrators threw pill bottles into the moat surrounding an ancient Egyptian temple at the Metropolitan Museum in New York on Saturday, to protest sponsorship by the family that owns one of the largest makers of opioids. The pill bottles had been labeled by the protesters to say “prescribed to you by the Sackler Family”. The Sackler family wholly owns Purdue Pharma, which makes the prescription painkiller OxyContin. In 1974, the family paid for the Sackler Wing at the Met, in which the 2,000-year-old Temple of Dendur stands.Goldin, who recently recovered from a near-fatal addiction to OxyContin, led the protest. 'Shame!' she shouted. 'As artists and activists we demand funding for treatment: 150 people will die today, 10 while we are standing here, from drug overdoses'" (The Guardian).
As artists, we demand....
The low: "'When I was in China and other places, by the way, I said, "Mr. President, do you have a drug problem?" "No, no, no, we do not,' Trump said. 'Big country. 1.4 billion people, right? Not much of a drug problem... I said what do you attribute that to? "Well, the death penalty." Hey, if you are a drug dealer and you know you are going to get caught and you know that you are going to kill people... You're killing our kids.... But if you go to Singapore, I said, "Mr. President, what happens with your drugs?" "We don't have a problem"... I said "what do you mean no problem?" "We have a zero tolerance policy." What does that mean? "That means if we catch a drug dealer, death penalty,"' Trump said to applause.... 'A drug dealer will kill 2,000, 3,000, 5,000 people during the course of his or her life... You can kill thousands of people and go to jail for 30 days... They catch a drug dealer. They don't even put him in jail. Think of it. You kill one person, you get the death penalty in many states or you get life in prison. Think of it. You kill 5,000 people with drugs because you're smuggling them in and you're making a lot of money and people are dying and they don't even put you in jail. They don't do anything.'" (The Hill).
Think of it! That is: let it fester in your rotting heart for a while, and we'll see what happens.
March 12, 2018
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Well, the death penalty involves a drug overdose, so there's that.
"As Artists, We demand...." That's funny right there.
With OIC, the rotting will likely be lower down.
I believe Newt made the same point in the 90's.
The Upper East side is in for another shock when it dawns on them the Muslims don't like gays or dogs.
I'm letting it fester in my rotting heart, and as I do, I come to the conclusion that I've always come to, that there is no middle ground on addictive drugs. The government can either step back and let people do whatever they want, or it can "do something" and engage in a hapless and hopeless police like we do now, which probably makes the problem worse, or it can engage in a serious, Chinese-style effort in which the only possible way to offset the intense desire for drugs is the more intense fear of death. Mao ended the ruinous impact of opium on Chinese society by mass executions. Singapore is virtually drug free because they have zero tolerance and really do put people to death for possessing drugs. We will never do it here. The constitution, you know, and all that sort of thing. But Trump is right to say that is the only thing that would work is what has actually worked elsewhere.
I love they way they conflate illegally imported or manufactured drugs like carfentanil (which can kill on touch in its pure form), heroin, etc... with legally prescribed drugs that treat terrible pain. That's because "artists" are not bound by logic, they worship rhetoric, like the Sophists, and one of the best tools of rhetoric is omission.
Of course, they do a pretty could impression of a hopelessly stupid mob too.
This August, at least 96 heroin users overdosed in one devastating, brutal week in just one county in Ohio. It's believed that they were victims not only of their addictions to heroin, but of a synthetic opioid that some dealers are adding to the narcotic to give it an even more powerful – and completely deadly – kick: Carfentanil.
...
According to Synan, the drug seems to mainly be coming from China, where it is illegal, but illicitly manufactured in secret labs before being shipped to the U.S. People order it online and ship it through the U.S. Postal Service, before it eventually makes its way into the local heroin supply. While killing your customer base is a bad business model, according to Synan, dealers cut heroin with Carfentanil because it requires only minuscule amounts – smaller than a grain of salt – to increase the drug's potency. That lets dealers increase their supplies without much additional cost and gives users a nearly lethal bang for their buck. "Users give the dealer a good review – just like you do with Starbucks or McDonald's – telling other users that this dealer has good stuff. Soon customers start to build up. If four or five people die, I still have a hundred or two hundred customers lined up," says Synan. - https://www.rollingstone.com/culture/news/heroin-epidemics-new-terror-carfentanil-w438712
Given the above fact set, does the death penalty sound totally out of line?
Rolling Stone is not the only place you can find this stuff, just the one that I figure most of the haters of drug manufacturers might listen to.
The drug lords must be upset about the 8 years on, 8 years off, oscillating US Drug War.
Uncertainty is terrible for any business.
A relative of mine works in a hospital, and they had eight deaths in a single day our of 17 overdoses, due to Carfentanil. So I guess the whole Chinese drug problem thing is sort of like Trump's madman joke. It's our problem, not theirs.
But I take a drug daily that keeps me going for a condition that killed my grandpa, and forced my dad into a surgery that nobody wants, I am fine. Bless them.
I hope none of those people take drugs, and if they get cancer, I am sure they will head right to the nearest witch doctor.
I do not like or understand nested quotation marks. I'm always trying to figure out who is being quoted. There has to be a simple way to quote people without using them. I shiver when I see quotes within quotes.
Infinite Jest has it's flaws as a novel, but lack of prescience is not one of them.
My solution to the Heroin problem is to legalize heroin and outlaw Narcovan. The problem will solve itself in a couple of years.
The opioid crisis in our country is a result of the use and abuse of prescription narcotic drugs such as oxycontin, percocet, etc. Some people may turn to heroin when they can no longer obtain prescribed opoids, but many find ways to buy black market oxycontin, percocet, etc.
We need to end the drug war and decriminalize possession of drugs below certain quantities, as Portrugal has done.
Accusing someone of drug dealing, in such a legal environment, is a great way to get rid of or besmirch your enemies, just like accusing them of rape or sexual harassment.
However, like the rape or sexual harassment accusations and crimes, the Democrats will probably find themselves hardest hit by a Singapore policy. Just saying.
Unless, of course, California decides that it doesn't want to enforce THOSE laws either. They seem mighty selective these days re laws.
***
Artistes getting their panties in a bunch about drug use! Wow! I thought I saw it all. It would be interesting if Ms. Althouse could do a Lexis/Nexus search of the spokeswoman and see if she feels that same way about weed or ever advocated for legalization.
So color me very unimpressed when their motives were probably finding and excuse to hate on a rich (probably Conservative) family instead of giving a damn about the dead.
Treatment for addicts works but only when they face jail by probation revocation when routinely tested. Ergo: drug possession must remain a crime if we want to help the users who like getting Hogg.
As artists, we demand....
The internet is turning all art into a performance.
We talk about Amazon killing local retail shops, but camera phones and YouTube are the new Met.
The Sackler wing at the Met is one of the most profoundly beautiful indoor spaces. The little pill bottles look like floating cherry blossoms adding to the beauty..What were they protesting again? I don't think that's what the protesters were going for.
If China and Singapore don't have a drug problem, perhaps it's because their people believe tomorrow will be better than today.
Maybe it has to do with their governments not labeling half the population "deplorable", "irredeemable", and "not (part of our country)".
It might be because their leaders don't tell certain ethnic groups the system is stacked against them and they will never be allowed to succeed.
It could be because they worry a lot about making sure their people have jobs, rather than making a buck by sending people's livelihoods overseas.
This country isn't serious about getting people off drugs. This country is pushing full-on legalization of marijuana to remove the stigma so more people can feel safe using.
Pretty sure that all heroin and meth addicts started out using marijuana.
"I do not like or understand nested quotation marks. I'm always trying to figure out who is being quoted. There has to be a simple way to quote people without using them. I shiver when I see quotes within quotes."
The way it's supposed to be done is this. Let's say the third sentence above was a quote from another person. I would quote it this way:
"I do not like or understand nested quotation marks. I'm always trying to figure out who is being quoted. 'There has to be a simple way to quote people without using them.' I shiver when I see quotes within quotes."
That is, one puts the quoted quotes between apostrophes, not another pair of quotes. (If the quote within the quote contains yet another nested quote, that quote gets quote marks again.)
I would actually emphasize it this way:
"I do not like or understand nested quotation marks. I'm always trying to figure out who is being quoted. 'There has to be a simple way to quote people without using them.' I shiver when I see quotes within quotes."
Or, one can always make a reference to who is speaking, as in:
"I do not like or understand nested quotation marks. I'm always trying to figure out who is being quoted. My pal Tim says, 'There has to be a simple way to quote people without using them.' I shiver when I see quotes within quotes."
I agree with Cook.
“As artists and activists, we demand . . . “ is testament to the current vogue of intersectionality. You need to place yourself on the multidimensional map of race, religion, gender, sexual orientation, age, immigration status, etc., etc., etc. That gives your opinions and demands special relevance and by some magical process confers on you greater moral authority. Unless of course you happen to be a cis white American male, in which event sit down and shut up.
I don't pretend to know the solution to the drug addiction and overdose problems. All I do know is that what we're doing now isn't working. As the cliche goes, one definition of insanity is doing the same thing over and over while expecting a different outcome.
"Treatment for addicts works but only when they face jail by probation revocation when routinely tested. Ergo: drug possession must remain a crime if we want to help the users...."
Says who?
Given that there are only two ways out of drug use - dead and clean - you can make the case that all dealers are actively promoting the death of their clients.
Once you stop believing the fantasy of the responsible addict, the world becomes much more black and white.
The real question is who keeps promoting the fantasy?
The Dude: "It's like Lenin said: You look for the person who will benefit, and, uh, uh, you know..."
"The high and low..."
I don't like it. Reverse it.
BTW, the 'artists' should be shamed for littering.
Trumpit, it's clearer in the original article. Althouse has squashed it all together to confuse us.
The government can either step back and let people do whatever they want, or it can "do something" and engage in a hapless and hopeless police like we do now,
Building the wall will help some. The "Opioid crisis" is mostly due to heroin and other hard drugs that are being modified with fentanyl or other chemicals. It has very little to do (contrary to the opinions of Cookie) with oral pain meds used by people with chronic pain. The misrepresentations by fools like Cookie have pain doctors in a panic and refusing to prescribe necessary relief for patients with serious illness.
This country seems more than ever subject to these moral panics by poorly educated fools.
The Trump hatred is only one example.
"This country is pushing full-on legalization of marijuana to remove the stigma so more people can feel safe using."
Full-on legalization of marijuana makes sense because there's no valid reason to keep it illegal. Better pot than spirits.
(I have never smoked pot, and I don't drink, except for one or two beers a year.)
Ban all tobacco use as a health hazard, but hey, smoke all the weed you want wherever and whenever - it is your constitutional right!, is crazy anyway you slice it.
"Ban all tobacco use as a health hazard, but hey, smoke all the weed you want wherever and whenever - it is your constitutional right!, is crazy anyway you slice it."
Who has banned tobacco? It's still legal to sell and purchase. Legalize marijuana and tax its sales.
The way it's supposed to be done is this. Let's say the third sentence above was a quote from another person. I would quote it this way...
Sigh. I like Trumpit's comments better when she is describing her murderous fantasies about Trump or lecturing us all on how stupid we are, or even hectoring us for just not 'getting' why we should rue the day we passed on Hillary as POTUS.
The opioid crisis in our country is a result of the use and abuse of prescription narcotic drugs such as oxycontin, percocet, etc. Some people may turn to heroin when they can no longer obtain prescribed opoids,
This kind of argument works better if you have some kind of Bible substitute that you can hold to your breast and thump with your thumb, Cookie, because it's just a statement of faith. Just google Carfentinal yourself Cookie, if you don't believe Rolling Stone.
A former heroin addict, [Goldin] said she became addicted to the powerful painkillers [OxyContin] 'overnight'."
I wonder if she told the doctor she was a recovering heroin addict?
It's an argument about side-effects.
“Given that there are only two ways out of drug use - dead and clean - you can make the case that all dealers are actively promoting the death of their clients.
Once you stop believing the fantasy of the responsible addict, the world becomes much more black and white.”
Sure, pretending people have no agency is the surest way to save them and protect others. There is no clean without responsible. None.
When you market opioids as "non-habit forming" and sell them by the truckload to backwoods pharmacies without alerting the Feds, I question the purity of your motives.
Legalize marijuana and tax its sales.
The problem with that fantasy is that as soon as the taxes become noticeable in any way, it goes right back underground, on account of the whole infrastructure already exists.
When you market opioids as "non-habit forming" and sell them by the truckload to backwoods pharmacies without alerting the Feds, I question the purity of your motives.
Link please.
"I shiver when I see quotes within quotes."
There's a pill for that.
I don't think that there is any such thing as a "former heroin addict" any more than there is such a thing as a "former alcoholic."
Duterte is still very popular after all those killings of drug dealers - or alleged drug dealers. He had a bit of a popularity dip last October but seems to have recovered, notably because they have mainly stopped the killings, except possibly in more remote areas.
This in spite of tremendous foreign pressure.
Granted, the economy is still doing very well.
As for the state of the drug business there and the efficacy of having lots of dead drug dealers, the stats were always useless and they remain useless. Only anecdotal information exists, and it varies from same-old same-old to its totally gone locally here and there and all the drugs are now in the next town or province over.
One big point here is that cultures vary, including the ways their feedback loops work. In the US far more people are going to get exercised by the fate of some low-status stranger. Not so in Asia. Duterte got his worst internal criticism when cops killed the sons of respectable people, such as overseas workers (generally seen as popular heroes), which is why the cops have mostly cut it out.
All we need to make this thread complete is TTR to come and tell us that none of these opiates are illegally manufactured and imported. It's all "big pharma."
Trump doesn't want the death penalty for drug dealers. He's simply making his demand for a wall seem more reasonable.
I'm following the normal rule for quotes within quotes, but the Trump thing has quotes within quotes within quotes. I could invent my own approach, but once I've decided I don't want to use blocking and indenting, I am doing it in a technically correct way, even though it's a little hard to see.
The overall look of this post would be completely different with a block-and-indent approach, and it would lose its zing.
But if you say, Althouse, I'm not getting any zing, then no one, I think, is in my tree, I mean, it must be high or low...
Robert Cook, and other commenters,
Thank you kindly for the clear explanation. It's about time I understand how it works.
Have a nice day!
And then there is the public image of drug dealers. In the US there is a certain romanticism, and in some parts almost an affection for them. They certainly are often treated well by the entertainment media. Out there, all over Asia, they are about as popular as Muskim terrorists.
Death penalty for drug dealers is another big ask, like the wall. It softens you up and, as I said in the post, using a Trump locution, we'll see what happens.
Michael K. said,
"The 'Opioid crisis' is mostly due to heroin and other hard drugs that are being modified with fentanyl or other chemicals. It has very little to do (contrary to the opinions of Cookie) with oral pain meds used by people with chronic pain.
This suggests it is not so clear or clean cut.
On the other hand, this writer agrees assertively with Michael K.
So, perhaps the connection of prescribed opioids to the opioid crisis is overstated, or even false. If the connection is false, what are the drivers of rising opioid addiction in America?
(Not "which drugs are causing it?" but "What factors are leading to more people using opioids?")
Getting “high”, not Hogg.
tim in vermont said...
Legalize marijuana and tax its sales.
The problem with that fantasy is that as soon as the taxes become noticeable in any way, it goes right back underground, on account of the whole infrastructure already exists.
no problem at All! once we've legalized marijuana, we'll just past a law making it illegal not to pay taxes. If something is illegal, people can't do it: Problem solved!!
What drug do they want for treatment?
I suggest lower prices, high unemployment, and that good old social breakdown.
Michael K pontificated...
The "Opioid crisis" is mostly due to heroin and other hard drugs that are being modified with fentanyl or other chemicals. It has very little to do (contrary to the opinions of Cookie) with oral pain meds used by people with chronic pain.
That, of course, is incorrect.
In 2015 over half the narcotic ODs were from prescription drugs
This country seems more than ever subject to these moral panics by poorly educated fools.
Oh, do tell! Got some good personal anecdotes to go along with your post?
Consider the extreme increase in SS disability claims as a co-mingled symptom.
"And then there is the public image of drug dealers. In the US there is a certain romanticism, and in some parts almost an affection for them."
I don't know if this is true, but to the extent you can show that it is, it's because Americans love hustlers: anyone who can make a lot of money,by whatever means, and say "Fuck you!" to the rest of the world as he does it, is admired and envied.
You're not going to get juries to convict drug dealers when they know the dealers face the death penalty.
And too, the death penalty works so well for murderers now. Efficient, clean.
I think we established a couple of months ago I’m the commentariat’s bad boy when it comes to drugs of all kinds historically, currently specializing in max harrowing stuff like ayahuasca. Although I think J.Farmer was in there somewhere.
Recreational drugs should be illegal. But to explain why would be too meta in the face of the West’s decline into progressivism.
tim in vermont said...
The problem with that fantasy is that as soon as the taxes become noticeable in any way, it goes right back underground, on account of the whole infrastructure already exists.
Exactly the same thing happened with alcohol!
The delusional Colorado Dept of Revenue thinks they took in $247 million in pot taxes last year - what are they smoking?
"I suggest lower prices, high unemployment, and that good old social breakdown."
I don't know about "lower prices," but high unemployment and social breakdown are probably significant drivers of substance abuse and addiction.
I have been under the impression that opioid addiction dies not come ffrom over prescription of the medication for medical use. According the the article below, most illicit use of opioids comes from people using drugs that were not prescribed to them. It appears to me that people who abuse opioids do so after they have become drug addicts from another drug or who started their habit by buying drugs off the street or stealing them. Pharma and doctors are being made into the villains when they are not. It seems the habit of this country to blame someone other than the individual for the individual's actions.
https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
I do not know what the German word is for that sort of argument, Cookie, but in English it is disingenuous.
Thank you, too, Professor Althouse for your explanation. Your natural & flowing writing style is always lucid to me. Sometimes it is a bit deep for my shallowness, and require a greater effort on my part. It is my own sketchy English education that is to blame. I encourage all kids and adolescents to read more, be it fiction, non-fiction, or even blogs. My childhood was essentially without books; I watched a lot of TV though. That is not a good thing for the formation of one's mind from personal experience. One cannot recover completely in one's adulthood from that deprivation.
"I do not know what the German word is for that sort of argument, Cookie, but in English it is disingenuous."
Which argument do you refer to?
Everyone has romantic bandits.
There are such characters in every country.
There is a Filipino film genre about Robin-hoodish thieves.
If you squint a bit you will find even the Chinese have the type.
But the US is very different on the drug dealer thing. A Filipino "Breaking Bad" would never be. No Cheech and Chong either. The Chinese would be even more unwelcoming.
backwoods pharmacies
What exactly is a backwoods pharmacy?
The old man pointed with his pitchfork. Spit into the dirt. "Go down that road there. When the pavement runs out, look to your left for the dirt road into the swamp. Your car should fit through the swamp oaks. Keep your windows closed case of snakes dropping down from above. Drive slow and careful. If you drive too fast you're going to get stuck. But if you drive slow through the swamp and stay to the right around the sinkholes, you'll find it. The backwoods pharmacy. The CVS.
There are plenty of "pharmacies" in Californias backwoods.
backwoods pharmacies
I took that to mean what was a big problem around here in rural Wisconsin, that being meth labs. They're all gone now, because all of the meth comes from Mexico, and it is more potent.
"It's believed that they were victims not only of their addictions to heroin, but of a synthetic opioid that some dealers are adding to the narcotic to give it an even more powerful – and completely deadly – kick: Carfentanil."
Carfentanil = coffin nail?
Certain of the drug mixing practices described above would meet the requisite mens rea for a second or even first degree murder charge.
My childhood was essentially without books; I watched a lot of TV though. That is not a good thing for the formation of one's mind from personal experience. One cannot recover completely in one's adulthood from that deprivation.
But whatever you do Trumpit, never question your convictions! Remember that we are all stooopid idiots who don't think that Trump should die flailing on his bed from accidentally swallowing his forked tongue!
I have been under the impression that opioid addiction dies not come ffrom over prescription of the medication for medical use. According the the article below, most illicit use of opioids comes from people using drugs that were not prescribed to them. It appears to me that people who abuse opioids do so after they have become drug addicts from another drug or who started their habit by buying drugs off the street or stealing them. Pharma and doctors are being made into the villains when they are not.
Don't tell Robert Cook!
It appears to me that people who abuse opioids do so after they have become drug addicts from another drug or who started their habit by buying drugs off the street or stealing them.
I think so too but the stalker disagrees.
The romantic image of drug dealers is probably a racial thing. The whole black culture is based on drugs and violence in their music and movies.
Too bad education is not a positive for them.
A word of advice for the stalker. Wikipedia is not an authority on drug overdoses.
This is a better source than Wiki.
Since 2013, the Miami-Dade County Medical Examiner Department has experienced an increase in the number of opioid-related deaths. The majority of cases coincided with the introduction of fentanyl into the local heroin supply. From 2014 to 2015, Miami-Dade County experienced a near 600% increase in fentanyl-related deaths, followed by an additional 200% increase in 2016. In 2015, two novel fentanyl analogs were identified in medical examiner cases: beta-hydroxythiofentanyl and acetyl fentanyl. In 2016, four additional fentanyl analogs emerged: para-fluoroisobutyryl fentanyl, butyryl fentanyl, furanyl fentanyl and carfentanil, as well as the synthetic opioid U-47700.
You're welcome.
I understand that it is rare for people taking opioids, legitimately prescribed for pain, to become addicted. But, Robert Cook, the reason for the "epidemic" is that these powerful drugs deliver a superior high. And a lot of people like to get high and stay there. These drugs do the trick.
Hey! We could kill two birds with one stone.
Why don't we let our wackos shoot convicted drug dealers so they don't have to resort to shooting high school students.
We could build big shoot houses designed to look like a high school, with classrooms and lockers and everything. Just lock the convicted dealer in the "school" and send in a nut with a gun. The dealer would be punished, an example would be set and the nut could work out his frustration with America's education system in a healthy, wholesome way that benefits society.
Win-win!
Blogger Fernandistein said...
Michael K pontificated...
The "Opioid crisis" is mostly due to heroin and other hard drugs that are being modified with fentanyl or other chemicals. It has very little to do (contrary to the opinions of Cookie) with oral pain meds used by people with chronic pain.
That, of course, is incorrect.
Thanks for the link to Wikipedia which is a sloppy mess of either intentionally deceptive prose, or just stupidity on a stick.
\United States over 33,000 deaths occurred from opioids in 2015, 20,100 from prescription opioids and 13,000 from heroin.[
So only two kinds of OD deaths occurred? Heroin, or prescription opioids?
That's just my first question about your link Blogger Fernandistein.
tradguy,
"Getting 'high', not Hogg"
Well darn... I was just getting ready to compliment you for your astounding intersectionality.
do not know what the German word is for that sort of argument, Cookie, but in English it is disingenuous."
Which argument do you refer to?
Cook goes meta! That's fucking brilliant!
We glorify drug use in this country. Period.
Whodathunk that an "encyclopedia" edited by adults living in their mothers' basements would screw up the facts on drug overdoses in away that shifts blame away from users of illegal substances?
According the the article below, most illicit use of opioids comes from people using drugs that were not prescribed to them.
But I think they often were prescribed them at one time, or prescribed similar drugs and now can get the opioids but not their former prescriptions.
And opioids are not the only danger. Benzos are dangerous, too. Xanax, ativan, and klonopon. Mixed with alcohol they give a blackout drunk, but the mix is dangerous and benzos are physically addictive.
"Blogger Robert Cook said...
"I do not know what the German word is for that sort of argument, Cookie, but in English it is disingenuous."
Which argument do you refer to?"
That was hilarious, Bob. Probably not intentionally.
"I took that to mean what was a big problem around here in rural Wisconsin, that being meth labs. They're all gone now, because all of the meth comes from Mexico, and it is more potent."
Great, because now all we need is the wall.
"But I think they often were prescribed them at one time, or prescribed similar drugs and now can get the opioids but not their former prescriptions"
Fortunately, there's methadone clinics to help these poor souls.
Instapundit links a related piece by John Grisham in the LA Times.
"The rate of wrongful convictions in the United States is estimated to be somewhere between 2% to 10%. That may sound low, but when applied to a prison population of 2.3 million, the numbers become staggering. Can there really be 46,000 to 230,000 innocent people locked away?
Once an innocent person is convicted, it is next to impossible to get them out of prison. Over the past 25 years, the Innocence Project, where I serve on the board of directors, has secured through DNA testing the release of 349 innocent men and women, 20 of whom had been sent to death row. All told, there have been more than 2,000 exonerations, including 200 from death row, in the U.S. during that same period. But we’ve only scratched the surface."
http://www.latimes.com/opinion/op-ed/la-oe-grisham-wrongful-convictions-20180311-story.html
But I think they often were prescribed them at one time, or prescribed similar drugs and now can get the opioids but not their former prescriptions.
That comment seems to run counter to the link I posted above. It appears that those who are addicted to opioids did NOT get their start from a medically authorized use. Did I read the article too fast and miss something?
I remember another source, which I am too lazy to search for now, that the rate of addictions that result directly from a medical use of the drugs is about 1%.
I researched this for myself since I was prescribed an opioid for a back problem I once had. I was curious about all the hoopla regarding addictions due to the over-use of these kinds of drugs. I could not understand how any9one one would be so greatly affected when the drugs did noting more for me than to dull the pain, as they were intended. That is when I learned, I was not a special exception to the addiction problem, but very much in the majority - someone who did not get addicted from using opioid pain relief.
Hospital pharmacies fill prescriptions like all pharmacies do. But, I think that hospital pharmacists have a greater responsibility to the patient than do non-hospital pharmacists.
At 12:25 p.m., my mother was given four "drugs" to treat her hyperkalemia, a high potassium level. Offhand, I remember three of them: sodium bicarbonate (baking soda), calcium gluconate, and dextrose (a sugar). These are nutritional supplements not drugs, per se, to correct a blood chemistry imbalance. At 1:15 p.m., she was given intravenously 1 mg of Ativan, a tranquilizer. She had a bad reaction to that. At 2 p.m., the nurse came back from the pharmacy with a morphine pump. The nurse gave her 2 mg/hour via the pump, prescribed continuously by telephone. Unbelievably, I was at her bedside. That cumulative amount of morphine will, in a span of several hours, kill anyone by arresting their breathing. This was no mistake, it was murder. Should not the pharmacist question how a patient can be treated with beneficial compounds at 12:25 p.m., then be given a deadly amount of morphine starting at 2:00 p.m.? Should this not be a responsibility of a professional, highly trained hospital pharmacist. Who needs them if all they do is blindly fill prescriptions? A robot can do a better job of that.
But I think they often were prescribed them at one time, or prescribed similar drugs and now can get the opioids but not their former prescriptions.
There are undoubtedly people who become addicted by prescribed opioids. My opinion is that they had addictive tendencies first. Like alcoholics who are more easily addicted to drugs.
Most of the bad cases, and the deaths, however are not the usual grandma who has bad arthritis.
They are more like this one.
Brittany was a drug-seeker I knew by name, and I was not surprised when she rolled into the ER for the third time that month. As she lay on a wheeled paramedic bed pushed by an ambulance crew through big bay doors, her shrieks resounded down the hall and into the waiting area. She howled and swore through rotten teeth.
Before I uttered a greeting, she demanded that I give her the most powerful intravenous opioids in the hospital, and nothing else would do. This was Brittany’s usual weekly script — every Friday, her mysterious abdominal pain flared up again. During past visits, the simple promise of a prescription miraculously lessened her agony. Despite many extensive workups, tubes of blood wasted on laboratory tests and repeated CT scans pointlessly overexposing her with radiation, no cause of her pain had ever been discovered.
I was in the practice of surgery for 30 years and have never seen a patient become addicted from the treatment of real pain, such as postop pain.
I knew you had to watch out for those who have an addictive tendency, such as alcoholics. Those people get into trouble with Xanax and all sorts of mood altering drugs,
"Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy" by Theodore Dalrymple is an excellent read on our often wrong views of addiction. He calls bullshit on the addiction industry, the alleged difficulties of withdrawal and was in a position to do so.
Nan Goldin needs to get cancer and be denied strong pain killers.
I knew you had to watch out for those who have an addictive tendency, such as alcoholics. Those people get into trouble with Xanax and all sorts of mood altering drugs,
"Those people"
(Not "which drugs are causing it?" but "What factors are leading to more people using opioids?")
Seriously? Price and availability. Stuff is cheap and readily available.
Another thing. Not all addicts shoot up. Many snort it or smoke it.
Not all addicts are degenerate junkies robbing, stealing homeless emaciated.
Personable clean cut long time service manager at local Lexus dealership, 30 something, family man, O.D. Dead.
Other side of coin, last week in S.F., group three addicts dead from shooting up street drug they apparently shared.
I remember another source, which I am too lazy to search for now, that the rate of addictions that result directly from a medical use of the drugs is about 1%
But that 1% can be a big number, right?
I mean, sure maybe the minority can get addicted. But the minority of kids were killed without baby car seats, and the minority of people in cars without seatbelts were killed. The minority of people without gun locks had their kids shoot themselves.
I was in the practice of surgery for 30 years and have never seen a patient become addicted from the treatment of real pain, such as postop pain.
I've had two friends have a really hard time stopping them after taking them for post op pain. No they didn't become addicted. They are probably among the lucky majority who are prone to addiction. Or who were able to pull themselves back from the brink. Or who haven't lived a life surrounded by the glorification of drug use.
The wall won’t stop all the drugs shipped through the mail from China among other places nor the hungry ghosts in each of us that craves so much stuff. Of the two folks I know off who are shooting smack both started on oxy.. Tthe libertarian part of me believes people have a right to please or destroy themselves as they wish, but the addictive and wonton destructive circle that surrounds drugs like crack that hollowed out the black middle class,and the oxy overdoses that empty rural communities calls for an encompassing program and not simply death to dealers.
Here is the article I read in Bloomberg:
https://www.bloomberg.com/news/articles/2017-11-28/how-opioids-started-killing-americans
The title of that article is: A huge study of the epidemic’s acceleration shows most deaths began with a prescription.
By Natasha Rausch
November 28, 2017, 5:00 AM EST
"'(Not "which drugs are causing it?" but "What factors are leading to more people using opioids?")'
"Seriously? Price and availability. Stuff is cheap and readily available."
That doesn't explain why people choose to use opioids to begin with, or rather, why more people are doing so. If someone offered me a lifetime supply of heroin free, I wouldn't have the slightest temptation to accept the offer. I have been prescribed percocets and oxycodone after having had surgeries and a tooth extraction. I used them for a couple of days after the surgeries, and not at all after the dental work. I never did use even half of the quantity prescribed to me in any case.
roesch/voltaire said...
I agree.
The other thing about people having the right to destroy themselves or not as they wish is, the addicted brain is making choices that aren't in the best interest of it's owners. It's almost like a mental illness, where the brain becomes a free agent. Addicted people need to learn not to trust heir own thoughts about drugs (and alcohol).
Once again, I recommend "Bob and the Monster". People are worth saving.
"I was in the practice of surgery for 30 years and have never seen a patient become addicted from the treatment of real pain, such as postop pain."
Well, would a surgeon ever be in a position to see a patient whose addiction started with post-op prescription opioids and then progressed to a "pain clinic' cash for scripts model? This sounds a bit too much like the one paragraph letter to the NEJM that justified the whole explosion of Oxycontin for chronic pain industry. How, other than patient reporting, does anyone know what "real pain" in a chronic condition is? Post-op, yes (although even there, that can be tricky as to levels of opioids prescribed week or two after. But arthritis and even more amorphous back pain?
Dalrymple observes that withdrawal from drugs or alcohol has been dramatized by writers and films as being so difficult and horrifying that society has heaped sympathy on those "struggling" to go straight and confers heroism on those who succeed. In reality the physical addition to these substances is over in a few days leaving only emotional cravings entirely in the control of the former users. They might desire to get loaded but it is their minds doing the craving, not their bodies.
A monkey, btw, will become addicted to alcohol or drugs if given enough over time. His addiction has absolutely nothing to do with how his parents only gave him the little bananas.
May Bee, here is a link to the article you are referring to.
Patton Oswalt's wife was a successful writer. She died from a combination of Adderall, Xanax and the pain medication fentanyl.
I believe people- younger people especially- do not know what they are getting into with these drugs, and everything in modern culture tells them they are fun and harmless. Doesn't everyone just pop a Xanax now and then? Don't all the kids in college want Adderall?
Thanks, Robert Cook.
Robert Cook
You don't hang with people constantly scoring dope. This is both a full time job and a " lifestyle" and the backdrop is as likely an artist loft in your City as a trailer in the top end of the Appalachians. The people in this are considered cool by each other. And, for a while, by themselves.
China has a hug drug problem in spite of their draconian policies, execution is just political theater (and used as a means of political conntrol in some cases).
https://www.brookings.edu/wp-content/uploads/2016/07/A-Peoples-War-final.pdf
The theory that the epidemic begins with legally prescribed doses is a precursor to the gun control technique of taking the drugs from those who are entitled to them and leaving them to those outside the law.
The linked article fails to consider the obvious fact that there are many medical outlets profiting by writing scripts for people who don't need them. "Creating" addictions that actually already exist
That doesn't explain why people choose to use opioids to begin with, or rather, why more people are doing so. If someone offered me a lifetime supply of heroin free, I wouldn't have the slightest temptation to accept the offer.
I wouldn't either, but I got some Demorol when I was going through a tough labor. And it was a gentle, easy feeling. Later, I had a prescription for it at home for something else, and I never took it but I knew it was there and pretended I could take it if things go too crazy. Eventually I threw it out. But what if I were a different person? A person prone to addiction or person suffering from chronic anxiety or depression? I can see the temptation to feel that way.
Big increase of rape n the armed services. Why? When was the last guy court martialed and executed? Would that solve the problem?
Pretty sure that all heroin and meth addicts started out using marijuana.
And milk. They ALL started out drinking milk.
"Seriously? Price and availability. Stuff is cheap and readily available."
That doesn't explain why people choose to use opioids to begin with, or rather, why more people are doing so.
People take drugs to change the way they feel. Been that way since beginning of time.
People know the dangers of addiction but believe it will not be them.
Every person who does drugs does not become addicted.
Every addict does not end up a criminal, dead or on the street.
From Cookie's link:
According to the study, people with disorders such as depression, anxiety or alcohol abuse were at higher risk of opioid-related death.
I agree but the thing about "chronic pain" is way overblown.
One issue may be whether "chronic pain" is documented to some anatomic cause.
Correct me if I'm wrong, but I don't believe that milk is a drug or illegal.
The theory that the epidemic begins with legally prescribed doses is a precursor to the gun control technique of taking the drugs from those who are entitled to them and leaving them to those outside the law
The linked article fails to consider the obvious fact that there are many medical outlets profiting by writing scripts for people who don't need them. "Creating" addictions that actually already exist
But the second is till "legally" prescribed.
It's very hard to know if someone really does still have chronic pain from his back surgery, or if he really just likes the feeling of kind of a low-level opioid in his system. A lot of people like a little bit of a buzz. Our consumption of alcohol demonstrates that.
I agree we don't want people to not have the access to pain medication that they need, but I think being too paranoid about taking those away is not going to solve a real problem. Just letting addicts stay addicted or letting them die isn't a good solution either.
Are there other ways to manage pain? Other ways to manage anxiety?
We need Zombie Nancy Reagan.
Exactly, Full Moon at 11:05.
Also, opioids are not more effective for long term chronic pain.
In patients with stubborn back aches or hip or knee arthritis, opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping. And they provided slightly less pain relief.
So, perhaps the connection of prescribed opioids to the opioid crisis is overstated, or even false. If the connection is false, what are the drivers of rising opioid addiction in America?
For one, spiritual vacuum. When there is a void that God should fill, one will seek something else to fill it.
Well, would a surgeon ever be in a position to see a patient whose addiction started with post-op prescription opioids and then progressed to a "pain clinic' cash for scripts model?
A fair question. Not all surgeons follow post op patjents for a long time. I did for a practical reason.
When I first went into practice, the senior partner told me that he followed his postop patients almost forever, for the practical reason that some people have a second surgical condition and it is easy to see them for years. A lot stop coming but many do come back for years. I never charged them.
A patient going to a pain clinic, which are usually run by anesthesiologists, would be asked about the source of their pain and the pain doc would usually want to get information about why the pain lasted so long.
I don't know your experience with pain clinics but I went to one for 15 years after a 14 hour back surgery. I finally got along on just ibuprofen, which I take 800 mg of twice a day still. Fortunately, I never had GI problems but took 2 1/2 grams of ibuprofen daily for 15 years. My stepson had a massive GI bleed after a week of ibuprofen for a twisted knee.
I know there are crooks in medicine and knew a few but pain clinics are most often run by responsible people.
only emotional cravings entirely in the control of the former users. They might desire to get loaded but it is their minds doing the craving, not their bodies.
That's what the majority of treatment is. The mental and emotional work is incredibly hard. Some people - a lot of people- need help with that.
The problem is not opioids per se, but rather their administration or consumption. Opioids, like scalpels, are dual-use and subject to abuse. Like scalpels, opioids can be used to improve the quality of life, or to abort a life for casual or frivolous causes.
I have been asked to do some market research/recommendations/plans for introducing a new product to help the global cannabis industry. More than that I cannot say (NDA). One thing that became very clear is that government regs and required pricing guidelines have been very beneficial for the underground market. The bottom has dropped out of marijuana prices because there is now a huge glut of it on the market.
Stuff that used to sell for thousands-per-pound is now selling for $500. It could've been much worse: Thanks to the 'legal' cannabis stores and pricing guidelines there is at least a known (and artificial)price structure for the black market to compete against. Without the gov't to set prices, the going rate would've dropped even more. Also, having a source for 'legal' grass in the state makes it infinitely harder for LEOs to determine whether someone in possession of marijuana that has been taxed.
One might make the case, it would seem, that the best way to kill the black market would be just to legalize marijuana and remove much of the profit incentive.
"One might make the case, it would seem, that the best way to kill the black market would be just to legalize marijuana and remove much of the profit incentive."
Well, of course...this has always been clear. I suspect at least part of the reason marijuana is maintained as a Schedule 1 drug, (up there with heroin!) is to maintain the drug interdiction bureaucracy, which employs many people and is used by the US government to justify draconian laws and repressive law enforcement tactics. (A brother of mine was a DEA agent for 20 years.) Also, who knows whether the big distilleries now or once upon a time lobbied Congress to criminalize potential rival inebriates to their products?
In any case, keeping marijuana illegal serves the government's purposes and not the cause of public safety and health.
I read the short Bloomberg article and was concerned about its loose handling of the facts that it presented.
For instance, it's lead statistic, which sounds quite damning, makes the claim that 1/2 the people who succumbed to overdose between 2001 and 2007 were chronic pain sufferers. That is followed up by another claim from the American Journal of Psychiatry that 2/3 of people who dies were diagnosed with chronic pain and 1/3 were not.
What is interesting about both of these claims is that the article does not link to the original research paper, so we cannot get a clear picture of what the studies were actually claiming. As for the second claim, we don't even know what the cause of death of these people were. We are to infer that it was an over-dose, but maybe the intent of the writer was to leave that impression while leaving himself the "out" of plausible deniability by saying he didn't lie because he never made that claim. Did these people OD or does the author just want us to have that impression?
The next claim is even worse for inference. 33,000 people in 2015 died from opioid overdoses and most of those deaths were linked to prescription pain pills. Notice the inexact word "linked". How were they linked? Were they from stolen pills, pills bought off the street, or fraudulent scripts? Did these people get hooked on the pills from legitimate pain management or were they abusing the system because of an already developed drug habit? We don't know because, again, no original material was linked where we can dig deeper in to the details. I think, as before, the author wants us to draw conclusions not supported by the evidence.
And finally, there is the weak link cited that opioid prescriptions are 3 times that of 1999 to imply that it is the number of prescriptions that generate the abuse. While it is true that supply is greater and thus would be a contributing factor to their availability for abuse, it does not say if they are a cause of more abuse in general. Are opioids replacing other drugs such that the total number of addictions remains constant or are they fueling an increase in addiction? Author does not say, but that is the impression left for the reader.
All in all, I would say that this article does nothing to cast light on the real cause and effects of the opioid debate and instead looks to demonize both the drugs themselves, and by implication the medical industry that prescribes them.
On the other hand, countering this argument is the article I linked above that includes references to the many sources of the original research that supports their claims. For example, to contrast the 2/3rds referenced in the Bloomberg article, the Scientific American article references a 2014 paper published by JAMA that only 13% had a chronic pain condition.
That is quite a difference in claims.
The questions we need to ask are:
-Does the prescription of opioids create drug addicts that would not have happened with other forms of pain relief?
-Will the restriction of opioid drugs cause serious problems for pain sufferers who find significant relief with these medications?
-Does the risk of addiction outweigh the relief of pain or vice-versa?
For one, spiritual vacuum. When there is a void that God should fill, one will seek something else to fill it.
I am an atheist, but I firmly believe that we evolved to believe in some kind of god and when that belief goes away, it creates a hole.
Last night I saw upon the stair,
A little man who wasn't there,
He wasn't there again today
Oh, how I wish he'd go away.
Michael K reports: I finally got along on just ibuprofen, which I take 800 mg of twice a day still.
Hope you get your BUN & Creatinine levels checked regularly. But, then, you know that.
“I finally got along on just ibuprofen, which I take 800 mg of twice a day still.”
Huge dose, why not try Meloxicam?
Good analysis Wa St Blogger
There may be a shift to opioids or an increase as drug use seems to be more in style these days.
Certainly legal marijuana has set the stage.
In the 1970s, I used to get questions from patients about cocaine and if there was any danger in its recreational use.
I am just skeptical about genuine chronic pain patients being a lot of these overdoses.
"Huge dose, why not try Meloxicam?"
I took more for years and it is cheap. I buy 1000 pill bottles of 200 mg pills and take four at a time.
"Hope you get your BUN & Creatinine levels checked regularly. But, then, you know that."
Yup. After 25 years it seems to be tolerated.
I had a ten level thoracic fusion in 1993 when I had to retire.
Old gymnastic injury from college. I showed my x-rays to a neurosurgeon friend and he told me not to complain. I should be paraplegic, so I don't.
Looks like Nan the demanding artist's backstory is a bit more complicated:
http://reason.com/blog/2018/03/12/nan-goldins-background-complicates-her-a
MayBee, interesting comments to that article you posted. Some strong pushback from pain sufferers. The fact is that our genetics determine how effective certain drugs will be. I have no scientific proof for why, but I know ibuprofen is minimally effective while acetomyephin/Tylenol works for me. I also know Tylenol is bad for the liver so I try not to take it and have to double up on the Advil to get any response when I feel the need for pain relief.
I can't imagine what its like to live in constant chronic pain. I dont judge those who try anything to mask it. The abusers to get high are a different matter.
This is a multi level complex problem that, sorry to say, cannot be explained by one or two observations. Please read the book, "Dreamland," for more information.
Doctors, big pharma, illegal aliens, Medicare and Medicaid, our porous border to the south all share in the responsibility. Certainly the entertainment industry along with publishing share some blame.
Trump is opening the conversation. God bless him for that.
If we, as a society, are serious about reducing use and traffic of illegal drugs, the *only* realistic solution is to stand users and trafficers against the wall and shoot them.
The present "War on Drugs" just allows government workers to participate in the trade, at public expense.
"I took more for years and it is cheap. I buy 1000 pill bottles of 200 mg pills and take four at a time."
It sounds like you have an addiction to pain medication. I hope you can wean yourself off of it. Seek a professional's advice about how best to do that. You may have a psychological addition as well as physical addiction by this point. Good luck with your detox.
"If we, as a society, are serious about reducing use and traffic of illegal drugs, the *only* realistic solution is to stand users and trafficers against the wall and shoot them."
Fortunately for us, we are not--constitutionally--the kind of nation that would do this. Unfortunately for us, we seem to be evolving into the kind of country that might one day do that.
Look to Portugal for a "realistic" (in that it has actually been implemented and proven successful) and less "realistic" (by which you mean barbaric) solution.
Trumpit
I do not think addiction means what you think it means.
When did lefties lose nuance? Or did they ever have it?
Here is another example of why Walls don't work in this new age of drug movement:Tokyo Customs intercepted Japan’s single biggest haul of illegal stimulant drugs sent by international mail, weighing 64 kilograms with a street value of 4.1 billion yen ($38.5 million) last December.
A 25-year-old man from the United States has been indicted on a charge of violating the Stimulants Control Law.
The stimulants were hidden in packages disguised as powdered seasoning in four boxes posted from the United States and addressed to the suspect at a house in Tokyo’s Toshima Ward.
Where is the cost-benefit analysis in this whole process?
How many lives are ruined by illicit narcotics? A: A significant number.
How many dollars have been used to interdict illicit narcotics? A: trillions, so far
How many lives have been ruined because the drug trade has been pushed to foreign countries that sell it to the States? A: A nearly incomprehensible number.
What are the conditions by which we can declare victory in the War on Drugs? A: No such conditions exist.
If we, as a society, are serious about reducing use and traffic of illegal drugs, the *only* realistic solution is to stand users and trafficers against the wall and shoot them."
It didn't work for the Chinese.
The opioid epidemic mostly effects Trump voters, so no one cares. Since Obama took away their right to get black lung, they had to replace the toxic hole in their psyche with something warm and fuzzy.
tim in vermont said...
Thanks for the link to Wikipedia which is a sloppy mess of either intentionally deceptive prose, or just stupidity on a stick.
The main problem with it was that it was a bit out of date; now [2016] 'scripts are only involved in around 40% of narcotic overdoses.
"The CDC says there were more than 42,000 opioid-related deaths in 2016, including about 15,500 deaths involving heroin. About 19,400 deaths involved "synthetic opioids other than methadone," a category that consists mainly of fentanyl and its analogues, which nowadays are generally manufactured by drug traffickers rather than pharmaceutical companies. Prescription analgesics were implicated in about 17,900 drug poisoning fatalities.
Since some deaths involve more than one opioid, the total is smaller than the sum of the subcategories. But the CDC's numbers indicate that just two-fifths [40%] of opioid-related deaths in 2016 involved prescription analgesics, and some of those deaths also involved heroin, fentanyl, or its analogues."
Doc Mike: NSAIDs can be bad for bones and cartilage, not to mention heart and stroke risk. You might want to try CBD (the no THC extracts are legal everywhere) mixed with a slight amount of DMSO as an analgesic salve. Get the alcohol extract instead of oil extract because DMSO is a polar compound like alcohol.
"Here is another example of why Walls don't work in this new age of drug movement"
This is a problem. I have received many packages straight from China (many kinds of camera gear through ebay) and the direct sales service which is so convenient looks like it would indeed be very difficult to monitor for illicit imports.
What are the conditions by which we can declare victory in the War on Drugs? A: No such conditions exist.
Annexation of Mexico as a US Territory, completely outflanking the Mexicans in Southern California who believe they are reclaiming it for their homeland.
okyo Customs intercepted Japan’s single biggest haul of illegal stimulant drugs sent by international mail, weighing 64 kilograms with a street value of 4.1 billion yen ($38.5 million) last December.
Japan doesn't hesitate to go through any international package. They also don't hesitate to make you come in and open something in front of them.
If they aren't looking for contraband, they want to make sure they are getting the duty.
"I want the drug abuser/insane to die. It cleans out the gene pool."
No, it doesn't.
"Annexation of Mexico as a US Territory, completely outflanking the Mexicans in Southern California who believe they are reclaiming it for their homeland."
We already did that, to an extent. The annexed land makes up a part of the area now called Texas.
"Annexation of Mexico as a US Territory,"
There was a semiserious move to annex Baja California back in the 1950s.
It would have been a huge boom in that peninsula but it died out.
"Doc Mike: NSAIDs can be bad for bones and cartilage,"
A little late after 25 years but thanks for the thought.
Some people (like my wife) have no tolerance for NSAIDS but nothing bothers me.
"The stimulants were hidden in packages disguised as powdered seasoning"
They caught him, didn't they ?
After WWII the Japanese had a huge problem with amphetamines. Their army had used a lot in the war for night fighting.
Some interesting new drugs came out of those experiments to deal with it.
Japan doesn't hesitate to go through any international package. They also don't hesitate to make you come in and open something in front of them.
If they aren't looking for contraband, they want to make sure they are getting the duty.
Yes. We once missed two connecting flights in Tokyo while our bags were being examined, causing much concern by the party meeting us in Osaka. They are very, very thorough.
MayBee: "Are there other ways to manage pain? Other ways to manage anxiety?"
I have worked in a pain clinic for the last 5 years. Our physician (small clinic) is one of the most conscientious, thorough, and intelligent people I have been privileged to work with over my nearly 40 years in nursing. I've learned tons from him, but what has made the most impact recently is a podcast called Pain Reframed. It's hosted by a couple of Colorado physical therapists who interview a wide spectrum of pain practicioners weekly, as well as people who are managing their own ongoing pain well. Highly recommended as a resource for addressing your questions above.
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