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Old 29 August 2017, 05:37 PM
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Icon86 Fact checking the opioid epidemic

I am interested in understanding what is fact, what is fiction, what is spin, and what is media hype about the opioid epidemic.

There are aspects of what is being reported that remind me of the whole "crack baby" hysteria.

I've sought out some articles, but, for example, on the federal HHS site, there are articles that seem to me to lump relatively unrelated things together as part of the same statistic, which makes the statistics less useful to me, and also makes the site seem less trustworthy to me.

For example, it listed a number for something like how many people abused a prescription drug in 2015. The number included people who had taken prescribed medication for a nonmedical reason, and people who had taken a prescription drug that was not prescribed to them. While both are undesirable, the details of the latter could often have little to do with what is commonly thought of as drug abuse.

Other articles cite percentage increases in deaths over 30 years without giving the actual numbers, or providing the death *rate*. Looking up the numbers for the actual death rates, it looks like there has been a potentially large increase in the death rate from heroin in the past 4 years, and much smaller changes in the death rates from prescription opioids.

Anyway, I am hoping that there can be some discussion of the data and the reporting, and some serious Snopesing about what is true, what is hype and ideologically-driven spin, and what is still to be proven, etc.
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  #2  
Old 29 August 2017, 06:43 PM
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From this article
Quote:
Because his staff covers one-fifth of Ohio, he estimates that the state will see 10,000 overdoses by the end of 2017 — more than were recorded in the entire United States in 1990.
Just overdose numbers, but nothing about whether the drug was prescribed or not.

Same soundbites, different article.

More blowing it out of proportion? In opioid crisis, a new risk for police: accidental overdose

Interestingly enough the opioid epidemic isn't getting a lot of coverage here. I mentioned something to my coworkers about an article I read about the epidemic, and most hadn't heard anything about nor did they know, or ever knew, any users, as it seems to be less common here. At least in small town Switzerland, especially after the cleaning up the needle parks in cities such as Zurich. There are users, but they seem to be better taken care of, and maybe they aren't getting the high octane stuff here.
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  #3  
Old 29 August 2017, 07:06 PM
overyonder overyonder is offline
 
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This is a start, I think.

While I know this will sound very incidental and non-scientific, and it is, here are some of the events that have happened to me:

- I had to let go a cleaning lady because she had gotten into my medicine cabinet for stealing Oxycontin. She also did the same at a friend's place.
- I had a chat with an acquaintance at a bar where she worked, and she was discussing how many Oxycontin she took that week-end along with some booze.
- I had a coworker that asked me for leftover pain (opioid-based) medicine after I had knee surgery (he got none).

By appearances alone... there's a lot of people using that stuff.

OY
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  #4  
Old 29 August 2017, 07:14 PM
jimmy101_again jimmy101_again is offline
 
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There is no doubt some hype in the "opioid crisis", but that is pretty much always the case when there is a big push to change an entrenched system.

There is certainly lots of evidence that the number of pills being sold is way out of proportion to any reasonable medical need.

https://qz.com/866771/drug-wholesale...inia-pharmacy/
Quote:
As the number of deaths attributed to overdoses on legal opioid painkillers have quadrupled since 1999 in the US, pharmaceutical distributors have been quietly stocking pharmacy shelves with these pills in areas where addiction is the highest.
Nine million pills over two years to one pharmacy, that averages out to the one pharmacy selling more than 12,000 pills a day.
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  #5  
Old 29 August 2017, 07:32 PM
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[ slight hijack ] A few weeks ago, the Chicago Tribune had an editorial about our first Opioid epidemic. The late 1800s saw the invention of the hypodermic needle, and...
Quote:
An enthusiastic medical profession began injecting morphine on a vast scale for all manner of aches and pains, much the way that a more recent generation of doctors began prescribing Oxycontin and other legal drugs in a reaction against widespread undertreatment of pain. Wounded veterans became addicts, but so, too, did people suffering from arthritis. Women also became addicts en masse, thanks to the practice of treating menstrual cramps — or for that matter, any female complaint of pain — with injections of morphine.
Full article here

[ / slight hijack ]
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  #6  
Old 29 August 2017, 09:02 PM
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Certainly lots of people are abusing these drugs, and that abuse is detrimental. What I'm wondering is, comparing apples to apples, and looking at meaningful measures, how much is the current state of things different from the past?

Which ties in with the comment about changing an entrenched system--it can't be that entrenched. It seems very cyclical to me. People get up in arms about high prescription rates and abuse of narcotic medicines. There are new restrictions put in place and pressure on doctors not to prescribe them. It becomes extremely difficult to get effective pain medication for people with severe pain. There is a push to make obtaining effective pain medication easier for those who need it. Rinse and repeat.

I am not suggesting that the very real issues connected with opioid abuse be ignored. I just want a better understanding of whether there is really anything that different happening on this particular pendulum swing.
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  #7  
Old 29 August 2017, 10:21 PM
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Ah. So you're not asking only whether there's been a surge in, say, overdose problems recently; but whether such surges have happened repeatedly historically, perhaps not involving the exact same versions of the drugs as the most recent one, but with an overall similar pattern.

That is an interesting question. I'd like to know the answer; but don't really have time to do the research. There have certainly recently been deaths in my area from overdoses, and they hit the paper, and there's lots of commotion about it -- but would they have hit the paper in 1950, or 1920, or 1890? and, even if well recorded, where would the records be?

It does seem to me that there's an essential tension between attempting to prevent people who would be harmed by such drugs from taking them, and allowing people in severe pain to have access to relief. There's sometimes such a tension in an individual case -- many drugs and other medical treatments, not only opoids, do both good and harm to the same person. I'd like to see it dealt with by the person affected and their doctors, not by the law; but of course not all doctors are dealing with it well, either.

ETA: The deaths in this area seem to in at least some cases to be caused, to some extent, by the fact that the drugs are illegal, and so are often adulterated and/or the user has no reliable way to tell how strong the dose is.

Last edited by thorny locust; 29 August 2017 at 10:29 PM.
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  #8  
Old 30 August 2017, 02:56 AM
dfresh dfresh is offline
 
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Alcohol related deaths are about 88,000 per year in the USA, and in 2015 opioid and heroin related deaths were about 33,000, so alcohol is a much bigger problem. However, a LOT of people drink, and most of us have no problem with it, and frankly it is an accepted long term part of our culture. Opioids and heroin are new.

The second link says that the opioid and heroin deaths were about 28,600 in 2014, and about 24,000 in 2013. So, the deaths are increasing at a pretty good clip, about 38% from 2013 to 2015. (I couldn't quickly find 2016 data). I have seen anecdotal reports that some or much of the increase is that it this now a focus, so deaths that used to be called unexplained or something else are now being classified as overdosing.
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  #9  
Old 30 August 2017, 03:18 AM
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Defresh, a lot of what you said is exactly the kind of stuff I'm wondering about, or have been thinking as well.

My only quibble is that opioids and heroin are not new. They are just being presented as this big new problem, when I'm not sure how what is happening now compares to the historical data, including previous cyclical patterns.

In addition---I'll have to post the link later--a recent survey suggests that people using Rx painkillers for non-medical reasons (in this study, defined as being taken to experience the effects rather than for an indicated purpose) is declining. I found this data while poking around on a government data site that was very vaguely cited in the paper overyonder linked. I'll try to summarize and provide details later.

I don't have a set point of view on this other than curiosity and skepticism. Some of what I'm seeing and hearing just set my Snopesy-senses tingling.

Last edited by erwins; 30 August 2017 at 03:32 AM.
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Old 30 August 2017, 04:50 AM
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I lost a cousin in April to an opioid overdose. He started on them when he was prescribed opioid pills for pain relief following a severely broken arm. When the prescription renewals eventually ran out, he began obtaining pills elsewhere - first from friends, then friends-of-friends, eventually hitting the point where he would pop, snort, or inject whatever he could get his hands on. Despite the media hype, it's a very real problem.

We currently have 3 different bottles of opioids in our house that were prescribed by walk-in clinics or specialists (not our regular family doctors) for various complaints to my wife and myself. In only one of those instances did one of us actually feel the need for them (i.e., the pain was severe enough that an over-the-counter remedy was insufficient.) I was given an opioid prescription following a routine vasectomy, for instance - an outpatient procedure that resulted in a few days of mild discomfort. Doctors are being given incentives by pharmaceutical companies to prescribe these drugs, and in many cases are giving them as first-line options where something like acetaminophen (paracetamol) or ibuprofen might be more appropriate. We plan to dispose of the pills at the next local medication disposal drive.

And while opioids/heroin certainly aren't new, the more potent fentanyl and carfentanyl are fairly new, and are killing people that don't realize the tremendous difference in potency.
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  #11  
Old 30 August 2017, 05:03 AM
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Quote:
Despite the media hype, it's a very real problem.
Just to be clear, I am in no way suggesting that it is not a real problem, either on an individual level or on the societal level.

And I am very sorry for your loss.
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Old 30 August 2017, 05:52 AM
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Thanks. And no worries, I get the thrust of your initial post. On just about any topic, negative hype can have a way of backfiring along the lines of "the boy who cried wolf."
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Old 30 August 2017, 07:58 AM
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https://www.theatlantic.com/politics...idemic/533763/

Quote:
The article is an exemplar in a field of public-health-oriented writing about the opioid crisis—the most deadly and pervasive drug epidemic in American history—that has shaped popular and policy attitudes about the crisis. But the wisdom of that field has not been applied equally in recent history. The story of Jamie Clay and Jay’la Cy’anne stood out to me because it is so incongruous with the stories of “crack babies” and their mothers that I’d grown up reading and watching.
Sorry to make another post that doesn't address the OP question but I thought this Atlantic piece was an interesting (if brief) reflection the subject.
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Old 30 August 2017, 02:06 PM
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One of the things that's always worried me about opioids, is that people that misuse/abuse them seem to think it's not a big deal to do so. Much more so than hard-drug users. Many seem to see Oxycontin (etc) as "candy for adults". I've even heard doctors say 'I'll prescribe you the *good* stuff", without even mentioning side effects or risks.

My own mom is taking dilaudid (a morphine derivative) due to cancer, and I had to teach her the side-effects, and what not to do when taking such meds (in particular, driving). I've woken her up by phone unintentionally when calling her daily at the usual time (I check on her every day), when she had dozed off while watching TV after dinner. Keep in mind that this is a person that would get a serious buzz (and hated it) when having one single glass of wine.

OY
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Old 30 August 2017, 07:13 PM
jimmy101_again jimmy101_again is offline
 
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Quote:
Originally Posted by musicgeek View Post
We currently have 3 different bottles of opioids in our house that were prescribed by walk-in clinics or specialists (not our regular family doctors) for various complaints to my wife and myself. In only one of those instances did one of us actually feel the need for them (i.e., the pain was severe enough that an over-the-counter remedy was insufficient.) I was given an opioid prescription following a routine vasectomy, for instance - an outpatient procedure that resulted in a few days of mild discomfort. Doctors are being given incentives by pharmaceutical companies to prescribe these drugs, and in many cases are giving them as first-line options where something like acetaminophen (paracetamol) or ibuprofen might be more appropriate. We plan to dispose of the pills at the next local medication disposal drive.
This is what I meant earlier by "ingrained". Many health practitioners prescribe opioids more readily than they prescribe acetaminophen, ibuprofen, or even aspirin. Like Musicgeek, I have three or four old bottles of Oxycontin at home from wisdom tooth extractions and other dental procedures for my family. I suspect that a total of 3 pills were actually used out of more than a dozen in the prescriptions.
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Old 30 August 2017, 07:22 PM
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IDK how common this was, but when I was growing up/a young woman, the oral surgeon my family used would simply give the patient a packet of a few pain pills (maybe 5 or 10).

I've never filled a pain scrip that I didn't feel any need for, but I've never needed all of the 30 pills that every such scrip has been written for.
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Old 30 August 2017, 07:28 PM
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Quote:
Originally Posted by erwins View Post
My only quibble is that opioids and heroin are not new. They are just being presented as this big new problem, when I'm not sure how what is happening now compares to the historical data, including previous cyclical patterns.
I'm sorry, I didn't mean its new, just that it is The Big New Thing, and so there is focus on opioids now and attention paid that wasn't a while ago. I searched for older data on opioid deaths, and the oldest I can get is from 2002, and that shows that opioid deaths have gone up 2.8 fold from 2002 to 2015. Another chart on the same page shows that prescription drug deaths went up a LOT, but have stabilized since about 2011. My guess is that is probably due to more focus on doctors over-prescribing, and lower heroin prices. (Maybe we should encourage the Taliban to take over Afghanistan again and stop the heroin production?)

overyonder, I've heard very similar things about the doctors just pushing out drugs in the past. My friend's dad was given oxy with NO directions on when or how much to use, and darn near killed himself with it.
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Old 30 August 2017, 07:54 PM
jimmy101_again jimmy101_again is offline
 
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It is helpful to know what the similar named drugs actually are.
Oxycodone: Is a synthetic opioid similar to opioids like opium found in poppies.
Oxycontin: Is a particular formulation containing Oxycodone as the active ingredient. The formulation is designed to release more slowly than standard Oxycodone formulations.
Percocet (aka Endocet or Ratio-Oxycocet): Is a mixture of Acetaminophen (aka paracetamol) and Oxycodone. About 90% of the pill is Acetaminophen. Acetaminophen is a fairly potent liver toxin and people often cause significant damage to their livers by taking both Percocet and Acetaminophen.

And then there is the completely unrelated hormone "oxytocin".
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Old 31 August 2017, 03:28 PM
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Ganzfeld, thanks for posting that article. It is very interesting.

Dfresh, do you know if the 2.8 fold increase is in raw numbers, or in the rate? Because there's been a 14% increase in the population in that time period.

Also, did your friend's dad really not get even the labels on a pill bottle? No dosage instructions or warning stickers? I've never been dispensed medication without those, and in the past decade, I don't think I've gotten anything without the accompanying leaflet. I'm sure it could happen, but I'm curious if that's what you meant.

ETA: One big factor I've heard mentioned concerning current levels of Rx writing is that the maker of Oxycontin purportedly told doctors that Oxycontin was non-addictive because of its time-release property. Doctors then prescribed it more freely. If true, that seems utterly ridiculous to me, because the addictive nature of the drrug would not be eliminated, and the time-release property of the drug is trivially easy to defeat. Neither the maker nor doctors should have relied on those beliefs.

Last edited by erwins; 31 August 2017 at 03:34 PM.
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Old 31 August 2017, 04:50 PM
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erwins, it was a 2.8 fold increase in total numbers, not rate. I do not know what label came with the pills.
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