Source? From what I have read the major cause of the opioid crisis is doctors prescribing opioids for pain [0]. Even 2 week prescriptions have 25% chance of creating an addict [1]. Remember originally these were marketed to doctors as non-addictive.
The opioid crisis isn't related to the war on drugs. It was caused by doctors being misinformed about how prescription opioids worked by the drug manufacturers + widely disseminated (funded) research about pain treatment. This caused people to be prescribed opioids without a risk assessment for addiction or similar, and thereby lots of people got addicted after being prescribed for broken bones, surgeries, and general discomforts.
According to most of what I’ve read and seen, opioid prescriptions are contributing to the problem. It’s true that people aren’t overdosing when following their prescribed dosages, but some people are getting addicted.
A common story for opioid addicts starts with, “I was in a car accident, and they prescribed opioids to deal with the pain. Once the prescription ran out, I was in incredible pain, maybe even worse than before I started taking the pills. I started buying pills illegally. Once the pills got too expensive, I switched to heroin.”
I’ve seen far too many stories that follow that basic path. It’s definitely not the only way people get addicted, but it’s too common.
The thing that caused the opioid crisis was doctors and Purdue pharma. Some folks are bad at handling addictive substances, and they were prescribed these things.
Now this article is about something different - teaching doctors the warning signs of when already addicted patients are drug seeking, so they can avoid prescribing then. The key fact here is that almost all of the deceased had gotten prescriptions from multiple doctors.
You're describing the reasons for the opioid epidemic. First, get someone addicted to opiates for pain, then take them away when it's obvious they are, resulting in the heroin epidemic. There's always gonna be a black market for illegal intoxicants, and addiction is a nasty thing.
I believe that one of the primary causes is the overprescription of opiods by doctors in the USA, who were pressured by a patients (a generation of consumerism and instant gratification who expect doctors to provide instant treatment/remedy) on one side, and drug companies (who saw prescription painkillers as a sudden new cash cow) on the other. An article I've recently read in the Atlantic provides a perspective on this subject:
Opiates are also a fun and addictive drug. As long as they exist and are generally available, some percent of the sub-population will abuse them. We can try our best to keep them only for medical use, but once the prescription leaves the pharmacy there's not much you can do. You can't blame the legal manufacturer when that happens, if they took all required steps to keep their drugs in the legal channels. Maybe you think that's true, but that the opiate manufacturers have used their power and influence to over-prescribe their products. That assumes that opiates are over-utilized in American healthcare. And that's a narrative that simply isn't borne out by the data.
Only 0.19% of opiate-treated chronic pain patients without a prior history develop any form of abuse or addiction[1]. And remember these are chronic-pain patients who take tolerance-escalating doses over years or even decades. Virtually no one develops an opiate addiction from following their medically prescribed treatment regiment.
The death rate from prescription opiates has not budged since 2006[2]. The vast majority of opiate overdoses in America are not prescription opiates, but illicit fentanyl, and to a lesser extent heroin and methadone. Nor do chronic pain patients face any major risk of overdose. The fatal overdose mortality rate for long-term opiate-prescribed patients is 17 per 100,000[3]. And that number doesn't exclude the subset of the population engaged in abusive behavior like mixing with alcohol, snorting pills, or hoarding medication.
Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative. On the National Drug Use Survey only 18% of prescription drug abusers report doctors as their primary source. And among street prostitutes (a high at-risk group) only 5%[4].
All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America. To begin with the vast majority of the opiate crisis has to do with fentanyl, not prescription drugs. But even when it comes to prescription drug abuse, the intersection with medical users is vanishingly small.
However what there is a major problem in America is untreated chronic pain. 50 million American suffer chronic pain[5]. And 20 million suffer high-impact chronic pain which severely impairs normal life function. More than 10% of suicides are linked to chronic pain[6]. High-dosage opiates are absolutely essential for this group to live any sort of normal life. As long as there are such massive numbers of legitimate pain patients, the law of large numbers guarantees a large supply of diverted opiates. Even under the tightest controls. There's simply no way around that except by denying most of the legitimate patients treatment for their debilitating conditions.
> And remember - we did have a long experiment with legally prescribed opioids, and their widespread availability contributed to the current addiction crisis.
People couldn't just go to a store; trusted family advisors were overprescribing due to intentionally misleading advertising. The addiction crisis is what happens when insurance no longer covers the pills.
There are no statistics that show properly prescribed and taken opioids have anything to do with the crisis.
The crisis comes from illegal usage and tainted substances.
Sadly this is not clear from the statistics without digging into them, and few do.
That prescription opioids are significantly reduced, yet the death rate continues to climb indicates the focus on the current solution is in the wrong place.
No one, including me, denies "pill selling" is a problem.
However that has zero to do with the people with Chronic Pain that are doing everything within the law.
There are bad doctors, and other bad actors, they need dealt with of course. Not at the expense that need such medication.
Most people addicted to opioids started with legally prescribed meds. Those meds may not have been prescribed to them, but that's the problem with the fucking stupidly large numbers of opioids being prescribed in the US: there are very many meds lying around to be diverted to recreational use.
So far almost every point you've made in this thread can be directly sourced to Purdue propaganda. Doesn't that worry you?
Here's Purdue Pharma saying, as you are here, that pain meds aren't that addictive and don't we need to use opioids to treat pain (they are addictive, and they don't work for many types of pain): https://www.feinberg.northwestern.edu/sites/ipham/conference...
Simple economics: expensive legal prescription drugs drives people to source cheaper alternatives. Unfortunately, the cheaper alternative is also much more lethal.
I think there's a narrative that is the opioid crisis is driven by addiction, when it seems to be, and has historically has been, inefficient drug pricing.
The few articles I read on the subject are actually quite clear that the current crisis is due to the increased control on prescriptions, and some talk about the side effects on people with actual needs:
"The simplistic idea was, 'Oh, this is all about prescription opioids, and therefore that's all we need to do: reduce the supply of prescription opioids and we'll reduce all these deaths and people won't become addicted,'" said Alexander Walley, a physician and director of addiction consultation services at Boston Medical Center.
"Well, what we're seeing now is that even as you reduce access to prescription opioids, you're seeing an explosion of heroin use and heroin overdoses ."
Still, it's hard for someone that has not experienced these conditions to understand how prescribing these highly addictive substances could be justified.
Is it the only form of treatment ? How is treatment handled in other countries ?
Yeah, much of the 'opioid crisis' is entirely manufactured by how we've dealt with things. If doctors had recognized opioids as habit-forming and planned ahead of time to wean patients off of them with a long period of gradual tapering down in dosage (so if it takes 6 months or more, so what?) before quitting. Instead, they decided 'addiction' was a moral failing and simply stopping giving anyone prescriptions no matter how legitimate the need.
One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). Overdoses primarily happen with people mixing medications, trying to use unfamiliar medications recreationally (nothing can save a stupid person who wants to get high but can't be bothered to figure out what the right dose for that is for their body mass), or, most often now, having to get things from a black market where the supply is unknown potency or contents.
Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow. And they've been driving policy since the 80s, costing countless lives and monumental amounts of resources. Just to make sure no one has an easier time of life than they had.
[0] - https://en.wikipedia.org/wiki/Opioid_crisis
[1] - https://arstechnica.com/science/2017/03/with-a-10-day-supply...
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