People who are genetically and environmentally predisposed to be addicts are going to be addicts. That’s just human nature. There is no legalizing or changing or legislating addiction out of nature.
Indeed and no policy changes or police action is going to change that. What we can change is where those people obtain their daily fix of opioids. Do you want them committing crimes to fund dangerous criminals and terrorists by buying dangerously impure opioids? Or getting a clean cheap supply from the doctor (along with encouragements to get into rehab)?
The only people the companies are marketing to is doctors. If doctors’ decisions on what drugs to prescribe is based primarily on drug company advertising then this is a much bigger problem than what Purdue is doing.
As I mention above, regardless of how doctors generally choose what drugs to prescribe and what the drug companies tell them (and pay them), prescribing long terms opiates to lots of people and not expecting to end up with lots of opioid addicts is completely unconscionable. That is basic medicine. What the drug companies did is awful, but it is ultimately the profession that swore an oath to “do no harm” that bears the responsibility (and got off scot free)
Then you’re trying to solve a different problem from the one in the OP. The reason people are calling the opioid problem a “public health crisis” and an “epidemic” is not that the supplies are impure or that it’s sold in crime-ridden black markets. It’s that people are dying from it. People die of prescription opioid overdose every day. Look at these charts–more people die every year from prescription opioid overdoses than from heroin.
The deprecation of paternalism in medicine, the view of the patient as a customer, the rise of patient advocacy organizations and patients’ rights, with associated phenomena like considering pain “the 5th vital sign” play a role too. Doctors’ gut instincts might be to tell everyone they remotely suspect of being a drug seeker to just GTFO, but now they fear being sued for not adequately treating someone’s pain, especially when they have patient after patient all day long pleading to them, “please, doc, you’ve got to help me, the pain is unbearable! I tried that, Tylenol and Motrin don’t touch it! I can’t go back to work like this! What am I supposed to do?! You can’t leave me like this! Please, I’m gonna get fried from my job! We’ll be homeless, my kids will starve!”
Pharmaceutical companies have been doing direct product advertising to consumers in the US for decades now. As a result, I’ve had patients come in asking for drugs I hadn’t even heard of yet, but they’d seen on TV.
Purdue distributed an unprecedented number of brochures, videotapes and discount coupons for patients touting the benefits of Oxycontin for chronic non-malignant pain. I remember those days all too well. :mad:
The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy
And heroin addicts are doing more than dying of overdoses these days; they’re getting hepatitis C and passing it on to others. That disease causes serious chronic illness and even cancer in about 25% of the people who have it. It’s treatable, but expen$ive to do so.
Opioid abuse needs to be decriminalized; addictions are not best treated in prisons. More resources are needed for both outpatient and inpatient treatment.
And Naloxone rescue kits alone, without access to meaningful treatment, are about as helpful in the long run as installing emergency defibrillators on the trains to Auschwitz.
I’ve been an opioid addict (got clean in 1990, only took 4 attempts in 6 years to do so) and I’ve treated the medical complications of opioid addiction in literally thousands of patients since that time. I’ve seen some shit. 
But I’ve seen a LOT of people recover too.
So I’d love to see Purdue and other culprit companies get fined enough to fund more treatment facilities, to be sure.
Other have already addressed most of the points in this post. I want to tackle the snip above.
We already have a problem in this country that ex-convicts are essentially unemployable except in black market casual labor.
Your plan will ensure that anyone arrested (not convicted) for drug possession or intoxication would be branded as unemployable for life. *That *will certainly improve the overall situation.
It continues to astonish me how substantially all your suggestions for changes make the total societal problem worse, not better.
If you’re serious about your later claims that addicts are born, not made, and are inherently and irredeemably societally useless hopeless cases, then only logical solution for you to advocate is to do the full Duterte on them. Don’t be having the cops execute drug dealers on sight. Instead have them out executing the drug consumers.
Society has long embraced a theme of ‘punish the victim’. It’s a knee-jerk reaction that allows one to enjoy righteous anger and moral superiority without engaging in critical thought.
A lot of addiction begins with underlying psychological causes, like depression or emotional distress. I think what’s at the heart of the opioid crisis is a psychosocial crisis. We as Americans like to pretend that we’re happy, but I think the reality is that a lot of people in this society are just mentally broke. The American ‘nuclear family’ model has been a complete and total failure. It was an ideal that was driven mostly by corporate and capitalist ideals – more smaller families means more households and household spending to prop up the big banks and corporate America, which keeps sucking the heart and soul out of this country. We as a society ought to just learn how to appreciate our interconnectedness with others, have more family living closer together, and just enjoy doing more with less. In other words, less capitalist and more socialist.
Those charts clearly show the “epidemic” is in non-prescription heroin (and synthetic opioids) deaths not prescription opioids. Deaths from prescription opioids have been stable since 2011 whereas, non-prescription opiods deaths have increased 6-fold.
In fact it no longer the case that prescription opioids kill more people than illicits ones.
While the current epidemic started with prescription opioids, it is not an illicit heroin public health crisis, not a prescription one.
While it’s not related to OP, it is also completely mind blowing to me that the US healthcare system is so messed up that it is cheaper for people who have become addicted to prescription opioids to move to illegal supplies that pay US prescription charges!
Just a couple of quick comments:
When I was a teen in the mid-70’s everyone knew opiates weren’t to be fucked with. The pot heads, the acid trippers, even the coke users knew to never, ever try heroin. What happened to that attitude among youth?
As a LEO in a metro area I deal with addicts all the time. The very few heroin addicts I know of that actually kicked it did so by serving prison (not jail) time. I know of one who has been clean since 2004 who insists that the most loving thing society can do for an addict is lock him up. He did 4 years on a burglary stint. Told me that between withdrawals, detoxing, and time away from it had he done less time he’d of shot up the same day as his release. It took that long to get that poison and it’s cravings out of his system.
I’m not saying lock addicts up just for being addicts. I’m saying if an addict commits a crime imprison him/her for the full amount. I have yet to meet a heroin user that got permanently clean from rehab.
Except heroin is easier to get in prison than outside prison, and drug treatment (or any kind of psychological treatment or rehabilitation) in US prisons (overcrowded as they are by victims of the war on drugs) is a (sick) joke.
Doesn’t matter, it is really basic medicine. The results of sending someone home with repeat opioid prescription just because they asked for it, should be as obvious to anyone who has studied medicine as sending someone who doesn’t have diabetes home with insulin.
And to be clear the current epidemic was NOT caused by drug addicts seeking opioids from doctors. It was caused by doctors giving repeat prescriptions of opioids to people who were NOT drug addicts, but who had chronic pain, causing them to become drug addicts. And that result was the obvious and inevitable to anyone who understood how brains and chemistry work (which any doctor should really do!).
My question is:
What about all the young people hooked on Heroin?
I know of at least five or six people in my immediate circle who are, or were Heroin addicts, all under the age of 30. None of these people were administered or prescribed prescription Opiates at any point. All of them are either terribly addicted to Heroin, or use it as to them “drugs are the only thing which make (them) happy” while denying they have a problem.
Most of these people live in suburban or rural areas - several live in Maryland.
Two are former Heroin addicts who struggle daily with relapsing.
I have noted too, that of the Heroin addicts I know, all are female, save one.
While people above have stated much of the problem with Heroin addiction has come from people being prescribed opiates, what about in younger people?
Cite?
I’ve been told by numerous addicts that it’s false about being able to easily get it in prison. It’s not like what television and the movies show and then when drugs are available it’s very inconsistent at best and in tiny amounts.
A friend’s daughter got involved with heroin, did rehab informally and formally several times and eventually died of heroin related problems. She was 20 when she died.
When her heroin use was initially discovered she was a junior in high school. I was shocked, and asked her why. I told her I smoked weed, did some coke, messed with mushrooms and acid, but heroin scared the crap out of me. She explained that she wanted to party, and heroin was the easiest/cheapest to get.
I would have no issue in trialling this sort of stuff in certain US cities for a sustained period. It certainly shouldn’t be wheeled out throughout the US as a whole. I tend to be in favor of legalization of drugs, but I say that as someone who leans libertarian. I personally don’t believe legalization will significantly reduce the levels of drug addiction and problems that drug addiction brings.
Yeah, heroin is not readily available in MY prison system. Bigger problems are diverted hydrocodone and oxycodone (despite the fact that we watch them for 2 minutes after they put the pills in their mouth), along with smuggled in buprenorphine strips which get placed under stamps, or even fentanyl which gets mixed in with watercolor paints and getting painted onto a piece of paper by a kid drawing a picture, then mailed in. :eek:
Heroin is rarely found in our facilities.
As for the attitude towards opioids: The pharmaceutical companies got doctors to prescribe a TON of opioids for the mainstream working, churchgoing, voting population. So suddenly opioids were no longer for the bottom dwellers.
Your post seems to have a couple of typos or missing or extra "not"s in it. But your point is clear enough.
Ref the last paragraph, the issue today is not that street drugs are cheaper. It’s that current efforts to close down the pill mills and clamp on the pharmacies have reduced (not eliminated) the ability of individual addicts to get the volume of drugs they want. When the doc will write 30 pills a month and you want to eat 5 a day, the exess has to come from somewhere. That somewhere is the street.
And for the ever-growing number of addicts who the docs are now recognizing and shunning completely, 100% of their supply has to come from the street.
===============
IMO **asahi **mostly nailed it. We have a dysfunctional defective society that is creating people prone to mental / emotional problems, drug addiction, crime, etc., at an unprecedented and apparently ever-increasing rate.
Everything else we might do is simply treating a symptom, not a cause. The fix lies deep in the system. I have the good fortune to have none of those problems or desires. So do many of you. How do we make it so only 1 in a thousand have these problems rather than one in (WAG) 5 or 10?
For major social ills you need to treat both symptoms *and *causes, and you need to treat for a hundred years until the last children of the last defective person have died. Fat friggin’ chance of any thoughtful response even vaguely in that general direction by our current “leadership” and current culture.