Heroin now kills more people than guns:

[Steeleballz 7,550]

6 minutes ago, IDWAF said:

Ever studied suicide stats?  Yes, most are from guns, like 50% for an easy “way out”.  But look at the number of asphyxiations... that’s a number that is large as well.  Not sure how someone could kill themselves that way.

 

   I know. My point wasn't about guns and suicide really, just that suicide, like drug overdoses, rarely makes the news. Unless it's someone famous I guess. They also don't talk much about the fact that double cheeseburgers kill more people in the long run than any of the other causes we just mentioned. 

 

   The media is focused on guns right now because that's what the latest mass murder involved. They are focused on guns a lot, because that's how the majority of mass murders have happened over the last several years. When someone uses a vehicle, that will be in the news. If someone used a lead pipe, I'm sure that would make the news. 

 

 

[Voice of Reason 10,298]

5 minutes ago, Steeleballz said:

 

   I know. My point wasn't about guns and suicide really, just that suicide, like drug overdoses, rarely makes the news. Unless it's someone famous I guess. They also don't talk much about the fact that double cheeseburgers kill more people in the long run than any of the other causes we just mentioned. 

 

   The media is focused on guns right now because that's what the latest mass murder involved. They are focused on guns a lot, because that's how the majority of mass murders have happened over the last several years. When someone uses a vehicle, that will be in the news. If someone used a lead pipe, I'm sure that would make the news. 

 

 

I know what you meant.  It’s the same with medical malpractice.  Or heart disease. Or... just about anything that is a boring form of death.  But someone who decides to hang or suffocate themselves... that’s hard core.

 

It never ceases to amaze me that so many youth seek to kill themselves.  Never in my teens nor twenties did I ever contemplate dying as an option to get away from life.  I get it for the terminally ill, and I would support that, our current laws be damned.

[TBoneTX 45,292]

4 hours ago, Steeleballz said:

someone used a lead pipe

Colonel Mustard did it in the library with the lead pipe...

[bcking 3,157]

10 hours ago, IDWAF said:

Ever studied suicide stats?  Yes, most are from guns, like 50% for an easy “way out”.  But look at the number of asphyxiations... that’s a number that is large as well.  Not sure how someone could kill themselves that way.

I know this isn't the topic of the thread but, to elaborate on this a little bit further -

 

Demographics of suicide would possibly change if we banned guns. Yes people would still have suicidal intent, just like murderous intent. However, there are studies to show that many people who fail their first attempt at suicide will not attempt again. That is not always true, but it's a significant number.

 

Because guns are an "easy" method, and relatively effective, they claim the lives of people who would potential fail in their attempt if they didn't have that option. How many of those would then never attempt again?

 

------------

 

As for the topic at hand -

 

My gut had a bit of a problem with calling people who overdose on heroin "ordinary people". I feel guilty for saying that, but I'm just being honest. I'm sure many were ordinary once, but still this point they are purchasing illegal drugs and self-injecting them. I don't really see that as "ordinary".

 

The accidental Vicodin/oxycontin overdoses numbers really struck me. Those truly were ordinary people prescribed a legal medication.

 

Fentanyl use as well is something that I wouldn't say is ordinary. That isn't a drug that is used in the out patient setting. I use it a lot, as a drip, but we're talking about mcg per hour. So obtaining that as an outpatient is likely through black market channels.

 

I guess it depends on how you use the term ordinary. It also doesn't really matter because ordinary or not, it's all a problem.

[Boiler 45,519]

Friend of mine is well was an Underground Train Driver and then an Instructor.

 

One of the things he had to deal with is Drivers coming back to work after people had committed suicide in front of them.

[spookyturtle 9,465]

There were 2069 opiate related deaths in MA in 2016. It’s epidemic. 

[bcking 3,157]

How I would approach the opioid problem (not actual solutions but how I would organise my thinking and delegate). I do a lot of quality improvement so this is like a massive country wide QI project.

 

Break it down into problem-based groups focused on several questions. First off some data -

 

92 million (38%) of Americans are prescribed an opioid

11.5 million (5%) misused a prescription they obtained illicitly (to me that is the entire population of users who obtained an illicit prescription. You can't "properly use" a prescription you obtained illicitly since it isn't a proper prescription.)

1.9 million reported full fledged opioid addiction

 

So break it down into key questions and each one should have a group focusing on collecting data for those questions and then instituting changes (PDSA cycles in the QI world)

 

1. Are Americans being appropriately prescribed opioids?

Just looking at the number (38%), your gut reaction would of course be "No". However that isn't necessarily true. If we assume at least some are improper, we need to know how many and work towards getting the number of prescriptions to an absolute minimum. Ultimately people will still need them, and we can't just cut it out completely. This would involve consensus guideline creation for different specialties, regarding when and how to prescribe. 

 

2. Why and how are Americans obtaining illicit prescriptions?

Some patients who obtain an illicit prescription will have a "true need" and should have been prescribed it in the first place. Take that group and ask why they aren't getting the care they need (chronic pain sufferers) in a more controlled setting (with their doctor, rather than hand me downs). The other group (don't actually need the meds) - break that into those who were originally in the top question (Part 1) and never needed it in the first place (which we would hopefully eliminate while trimming the unnecessary prescribing fat) and those who have never been properly prescribed, but still go out and find it illicitly. I'd bet that number would be extremely low. The second part of this would be the method of illicit prescriptions. One large portion is pill sharing, and we can ask ourselves how can we reduce that component (education for those we properly prescribe, also getting better access to care for everyone will help that because they won't feel they need to take their friends pills if they have a doctor they trust and can work with).

 

3. Full fledged opioid addiction

Unfortunately with a medication that has addictive qualities, but also real legitimate medical uses, we would never get this number to zero. The working group on this topic would look at resources for people once they are addicted, and ways to keep people "in the system" and away from illicit practices. We have ways to manage opioid addiction, we just need to improve access.

 

Each group works somewhat independently and is tacking a different smaller part of the larger problem. Hopefully there are people under Jared Kushner and Chris Christie (and the other commission members) who know what they are doing, because these issues aren't easy to tackle.

 

 

 

[Amica Nostra 4,803]

18 hours ago, Nature Boy Flair said:

Korea and Japan have some of the highest suicide rates in the world, no guns 

I am not really sure why we are comparing heroine and guns but Japan had one gun murder last year and 1/5 the murder rate of the US. 

[spookyturtle 9,465]

1 hour ago, Il Mango Dulce said:

I am not really sure why we are comparing heroine and guns but Japan had one gun murder last year and 1/5 the murder rate of the US. 

Yet Japan had over 20,000 suicides. 

[Amica Nostra 4,803]

3 hours ago, bcking said:

I know this isn't the topic of the thread but, to elaborate on this a little bit further -

 

Demographics of suicide would possibly change if we banned guns. Yes people would still have suicidal intent, just like murderous intent. However, there are studies to show that many people who fail their first attempt at suicide will not attempt again. That is not always true, but it's a significant number.

 

Because guns are an "easy" method, and relatively effective, they claim the lives of people who would potential fail in their attempt if they didn't have that option. How many of those would then never attempt again?

 

------------

 

As for the topic at hand -

 

My gut had a bit of a problem with calling people who overdose on heroin "ordinary people". I feel guilty for saying that, but I'm just being honest. I'm sure many were ordinary once, but still this point they are purchasing illegal drugs and self-injecting them. I don't really see that as "ordinary".

 

The accidental Vicodin/oxycontin overdoses numbers really struck me. Those truly were ordinary people prescribed a legal medication.

 

Fentanyl use as well is something that I wouldn't say is ordinary. That isn't a drug that is used in the out patient setting. I use it a lot, as a drip, but we're talking about mcg per hour. So obtaining that as an outpatient is likely through black market channels.

 

I guess it depends on how you use the term ordinary. It also doesn't really matter because ordinary or not, it's all a problem.

 Our perception about "ordinary" people using is being driven by the shift from drug use being perceived as a poor urban problem to an understanding that this is affecting rural,exurban and now suburban life to a greater degree.

 

Edit: took out the restated part that you outlined with excellent detail above. 

Edited March 10, 2018 by Il Mango Dulce

[bcking 3,157]

1 minute ago, Il Mango Dulce said:

I think what we are seeing with this epidemic is that the promotion of opiods by pharma has triggered addiction which has fed illegal drug use because heroin is cheaper. Blackmarket pharma is also flooding us with opiods and painkillers by mail. Our perception about "ordinary" people using is being driven by the shift from drug use being perceived as a poor urban problem to an understanding that this is affecting rural,exurban and now suburban life to a greater degree.

Addiction will always exist, until we develop a cure or a way to prevent it. Promotion from pharmaceutical companies hasn't created chemical addiction, it has just increased the pool of patients prescribed them, which in turn increases the number addicted.

 

Can you elaborate more on your second sentence? People receive narcotics from the black market in their mail box? How exactly does that work? I wasn't aware of that, to be honest.

 

This isn't a subject that impacts my career very often since my patients are newborns, so I admit I'm not completely knowledgeable in the area. It comes up with mothers who are addicted, but that's about it.

[Boiler 45,519]

Can we just not ban it?

[Amica Nostra 4,803]

7 minutes ago, bcking said:

Addiction will always exist, until we develop a cure or a way to prevent it. Promotion from pharmaceutical companies hasn't created chemical addiction, it has just increased the pool of patients prescribed them, which in turn increases the number addicted.

 

Can you elaborate more on your second sentence? People receive narcotics from the black market in their mail box? How exactly does that work? I wasn't aware of that, to be honest.

 

This isn't a subject that impacts my career very often since my patients are newborns, so I admit I'm not completely knowledgeable in the area. It comes up with mothers who are addicted, but that's about it.

I edited my original because you did a better job breaking down the path to addiction. Let me get more info on mail order supplies.

 

My main point is our perception of the disease is changing as it is more likely to affect our personal lives.

 

Edited March 10, 2018 by Il Mango Dulce

[Amica Nostra 4,803]

10 minutes ago, bcking said:

Addiction will always exist, until we develop a cure or a way to prevent it. Promotion from pharmaceutical companies hasn't created chemical addiction, it has just increased the pool of patients prescribed them, which in turn increases the number addicted.

 

Can you elaborate more on your second sentence? People receive narcotics from the black market in their mail box? How exactly does that work? I wasn't aware of that, to be honest.

 

This isn't a subject that impacts my career very often since my patients are newborns, so I admit I'm not completely knowledgeable in the area. It comes up with mothers who are addicted, but that's about it.

A good article to read about fentanyl by mail. 

https://www.vox.com/policy-and-politics/2018/1/24/16928986/fentanyl-online-orders-postal-service

Excerpt :

Using payment and shipment information that the sellers themselves provided, the Senate investigators identified 500 transactions in 43 states adding up to $766 million worth of fentanyl, going by its street value, just from these six sellers. They found people who were purchasing for personal use — including seven who overdosed and died — as well as the people buying to set up their own distribution network in America.

It became clear how adaptable the fentanyl sellers were. Now that shipments from China have come under suspicion, the sellers told the investigators that they preferred to ship through Europe. Even as the US worked with China to crack down on one fentanyl compound, the sellers simply tweaked their formula and offered to sell a new version in another email included in the report.

”They just made a derivative,” one investigator told us. “You schedule one, they change the chemical compound a tiny bit, another one pops up.”

[Amica Nostra 4,803]

2 hours ago, bcking said:

How I would approach the opioid problem (not actual solutions but how I would organise my thinking and delegate). I do a lot of quality improvement so this is like a massive country wide QI project.

 

Break it down into problem-based groups focused on several questions. First off some data -

 

92 million (38%) of Americans are prescribed an opioid

11.5 million (5%) misused a prescription they obtained illicitly (to me that is the entire population of users who obtained an illicit prescription. You can't "properly use" a prescription you obtained illicitly since it isn't a proper prescription.)

1.9 million reported full fledged opioid addiction

 

So break it down into key questions and each one should have a group focusing on collecting data for those questions and then instituting changes (PDSA cycles in the QI world)

 

1. Are Americans being appropriately prescribed opioids?

Just looking at the number (38%), your gut reaction would of course be "No". However that isn't necessarily true. If we assume at least some are improper, we need to know how many and work towards getting the number of prescriptions to an absolute minimum. Ultimately people will still need them, and we can't just cut it out completely. This would involve consensus guideline creation for different specialties, regarding when and how to prescribe. 

 

2. Why and how are Americans obtaining illicit prescriptions?

Some patients who obtain an illicit prescription will have a "true need" and should have been prescribed it in the first place. Take that group and ask why they aren't getting the care they need (chronic pain sufferers) in a more controlled setting (with their doctor, rather than hand me downs). The other group (don't actually need the meds) - break that into those who were originally in the top question (Part 1) and never needed it in the first place (which we would hopefully eliminate while trimming the unnecessary prescribing fat) and those who have never been properly prescribed, but still go out and find it illicitly. I'd bet that number would be extremely low. The second part of this would be the method of illicit prescriptions. One large portion is pill sharing, and we can ask ourselves how can we reduce that component (education for those we properly prescribe, also getting better access to care for everyone will help that because they won't feel they need to take their friends pills if they have a doctor they trust and can work with).

 

3. Full fledged opioid addiction

Unfortunately with a medication that has addictive qualities, but also real legitimate medical uses, we would never get this number to zero. The working group on this topic would look at resources for people once they are addicted, and ways to keep people "in the system" and away from illicit practices. We have ways to manage opioid addiction, we just need to improve access.

 

Each group works somewhat independently and is tacking a different smaller part of the larger problem. Hopefully there are people under Jared Kushner and Chris Christie (and the other commission members) who know what they are doing, because these issues aren't easy to tackle.

 

 

 

Focusing on the gateway to addiction,  I read somewhere that 1/10 of us should never take that first drag of tobacco because our genes have determined 1/10 cannot stop. If this extends to opiods, shouldn't we invest in determing who should not be perscribed and mitigate the risk?