Street drugs can be extremely dangerous for several reasons:
I am “Addicted” to both opioids (morphine and hydromorphone) AND benzodiazepines (Temazepam, others over the years).
I am “addicted” because I:
Yes, I take an “overnight” cocktail which sounds like what the Medical Examiner finds in a suicide.
At least I no longer add vodka to the mix.
I am not the person the DEA/FDA needs to protect. I have had an obscene tolerance to CNS depressants as far back as I can remember -
“Thanks for the aspirin, mom - do you have anything for the pain?” - that kind of tolerance.
I wouldn’t call you an addict without knowing you, but mixing those drugs is never safe.
That is what addiction is. Both Prince and Michael Jackson were addicted in the same way. They had medical care and still managed to die from it. It is very easy to do with opiates, especially heroin once you are addicted and people often resort to it if they get cut off from a legal prescription and have to resort to an illegal supply to function. They don’t have the option to stop for a day or two once they are physically addicted. It sends them into withdrawal that is truly debilitating and lasts for days and generally requires an extremely expensive inpatient hospital stay. It generally won’t kill you but it it make you wish you were dead and that is only acute withdrawal. The rest of the withdrawal lasts for months or years if you can ever overcome it at all and many people can’t.
I have never been addicted to opiates but I have witnessed many people going through withdrawal and its after-effects. Most of them didn’t make it and died after repeated tries to stop even with multiple detoxes and rehabs. Some of the few that are functional still take Methadone which is just an extended release opiate that helps addicts remain functional indefinitely but requires a clinic visit every day that interferes with all other life including work and family.
I irritates me to no end when people say that opiates should be legal for everyone. I am not mad at them. I am angry that such ignorance exists among people that should know better. I am mostly a libertarian and I don’t even begin to think that. Addiction is the ultimate slippery slope and you certainly do not want to make it easier for more people to fall down it. It has nothing to do with choice, education, willpower or any other virtue.
Doctors and nurses are some of the groups prone to opiate addiction simply because they have access to them. All of that education about risks and addiction is no match for opiates. Even extremely knowledgeable people can find themselves losing everything just because the opiate addiction overrides the rest of their judgement and experience. If they can do that to medical professionals, I think it is a terrible idea to make them more available to the general public.
Yes, opioids when used in proper dosages and not combined with contra-indicated drugs are not that deadly. Most of the narcotic problem is due to its criminalization.
(I hope everyone takes the time to watch Michael Moore’s “Where to Invade Next.” There is mention of one country where drugs are decriminalized … leading to a reduction in drug usage!)
I’m not at all sure that legalizing all drugs is a good idea. Methamphetamine in particular is a very nasty drug. But identifying problems is the first step to designing solutions ,and a key fact is that
Most of the problems associated with use of opioids is due to their criminalization.
Some claim that drug criminalization was a deliberate ploy to repress black people. The wide disparity in penalties for the elite drug cocaine and the ghetto drug crack cocaine gives credence to this view.
I’ll let the MD who is prescribing all my meds know of your analysis, Professor. :rolleyes:
Look at China and Opium dens - way back when.
It was a problem and China decided to ban it as being the best solution. Seems to me that is necessary to protect STUPID people from themselves.
The evidence is clear, when more prescriptions are written for opioids in the US, there are more unintended deaths from opioid overdoses. Last CDC statistics showed 9 deaths per 100,000 persons. That’s persons in general, NOT persons prescribed opioids. That rate was under 2 per 100,000 in the 90’s, before we started the whole “our patients need more opioids” push, at the behest of the drug companies.
These deaths occur not just in the people prescribed the opioids, but also in the population at large. Quite often family members, especially young people, who divert parents/grandparents drugs into themselves. In addition these meds get diverted into the general user population too.
Many of the folks using the diverted drugs and dying of them are not addicts, they’re young, stupid, and using them recreationally. They don’t develop addictions, they just develop death. That makes it a significant public health problem.
So, the CDC and other health professionals have recommended some common sense measures to address this, and as usual a ton of people have misinterpreted those measures, misapplied the, or ignored them in general while building straw men to rail at.
Recommended measures are:
Sensible stuff, and effective where applied. Reduces diversion and overdoses, etc.
They also count one person who is on a monthly regimen as 12 prescriptions
Those are good measures. Limiting supply and forcing patients to pay for an appointment every month are not good measures.
Monthly appointments should not be necessary for established, stable patients. But every 3 month appointments are not unreasonable. 4 visits a year to monitor a condition severe enough to require continual opioid use is the standard of care.
Giving only one month’s supply at a time, with room for exceptions for up to 2 months at a time is perfectly reasonable.
Those are standard recommended practices.
There’s an ancient unciteable pearl of Iranian wisdom that says “Opium will cure everything, but there’s no cure for opium.”
A medical adage from the 19th century USA notes that if you give the patient enough opium, he’ll agree that he’s feeling much better even as he’s dying.
One of the mixed blessing aspects of opioids is that it can make you feel good even when you have absolutely no reason to feel good. Which is fine when you’re dying, but not so hot when you should get off your butt to go to work so you can pay bills and feed your family but choose to use and feel good while you get evicted and everyone else is hungry.
Oh, and to address this thread’s question: Yes, opioids are fairly deadly. As I noted earlier, they presently cause about 9 deaths per 100,000 population. Given that the overall death rate in this country is 821 per 100,000 that amounts to a significant contribution to the total mortality. Call it around 1%.
You may have already answered this before, but I can’t recall – is that opioids alone, or does that include every death where opioids are a contributing factor? I’m curious as to how dangerous opioids are to people who aren’t also drinking or taking stimulants or any other drugs.
Not very. If 90% of opioid deaths only occur when mixed with other drugs, then that means the death rate from opioids alone is less than 1 per 100,000 population.
You are only counting in ways that are favorable to your conclusion and that isn’t a fair way to do it. I think it is perfectly fair to count any death where opiates were a major contributing factor. You also need to count suicides, homicides and accidents as well as deaths from associated diseases like HIV and Hepatitis C.
I take it you aren’t personally familiar with many opiate addicts including Heroin and Oxycontin. I have known plenty of them with an emphasis on the past tense because most of them are dead, completely disabled or in prison now. Most of the ones that aren’t are still on Methadone and will likely never be free of it.
My nephew started with Oxycontin, became a heroin addict when Oxycontin became hard to get and eventually went to prison because of the thefts he was committing to support his addiction. He got out of prison and things were looking up at least a little until he suddenly relapsed. He told his wife he was going outside to kill himself one night while they were arguing and she didn’t take it seriously so she went to bed. She woke up the next morning with the police breaking down their door because he hung himself from their second floor balcony and wasn’t found until someone got an extremely unpleasant surprise during an early morning jog. He was a sweet kid in general (only 22) but opiates ravaged his life so badly he couldn’t take it. Accounts like that are hardly uncommon. It is a quickly growing problem in many non-poor Boston suburbs just like it is all across the country.
It is true that not everyone becomes addicted but it is extremely hard to tell who will and the downside risks are infinite and dire once someone is. It often starts with a simple prescription and starts to spiral down from there because tolerance builds fairly rapidly. It becomes more and more expensive until the addicted person has to resort to extreme measures to get more including doctor shopping or switching over to the illegal versions. You can’t just yell at them and tell them to quit suddenly. It doesn’t work that way. They generally have to go to detox and then rehab but those don’t work like the movies suggest. The relapse rate is atrocious even for people that really want and need to be off of it for good.
It is certainly possible to break an opiate addiction. Some people do it successfully but it generally takes a whole lot of time, money, work and a lifetime of constant vigilance to prevent it from coming back. The more common story for people that have a long-term opiate addiction is to try to stop for a while, their tolerance drops and they simply drop dead when they miscalculate their dose when they relapse.
There was also pharmaceutical company malfeasance in the sale and marketing of OxyContin. Some executives were actually found criminally guilty.
http://www.nytimes.com/2007/05/10/business/11drug-web.html?_r=0
Really? I take vicodin 4x a day for chronic pains. Been taking them since 91 and I never got high, just relief. Mine was 5/500 now 5/325 so maybe it depends on the dosage. maybe those with 30/325 probably get a buzz.
That is a reasonable use of a moderate opiate and I certainly don’t fault you for taking it. However, what would your response be if you were suddenly cut off from your legal supply for some reason?
And also, y’know, since some of them have admitted to it.