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Thread: Heroin Overdose Epidemic - what is your perspective?

  1. #101
    Site Supporter misanthropist's Avatar
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    That is the origin of the precursors here as well. The Canadian government is trying to build closer ties with China, though, so they just announced that domestic supplies of the precursors will be more tightly restricted.

    This despite the fact that a journalist recently ordered 15kg of a precursor chemical from a Chinese lab over the internet, and when she said, "isn't this illegal though?" they just said "don't worry about it, we send hundreds of kilos a month to Canada and we just label it as other stuff. It always gets through."

    But hey, this is the excellent preferably lucky country that China uses to launder money, so why upset that applecart?

  2. #102
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    Quote Originally Posted by nyeti View Post
    With the current trend of legalize drugs, F the oppressive police, and a general negative attitude towards any level basic social decency and a required acceptance of everyone's special take on what society has to endure as a whole for "acceptance and tolerance", I simply cannot find it in my heart to give one iota of a care about folks dying of heroin overdoses that are self induced. For decades as a cop I rarely put much effort into heroin users as they were a self correcting problem. Short of jailing them for the crimes they committed to fuel their "victimless" habit, I was not one to be spending a minute of time arresting them for under the influence type charges.
    IMHO, this is getting to one of the main roots of the problem. Full disclosure, I am a recovering alcoholic. Been sober for a number of years, and do what I need to in a days time to stay that way. Locally, AA is much much stronger than NA, so we get a lot of folks with opiate addictions; I'd say probably 80% or more of the AA newcomers over the last few years have walked in with more than a bottle problem. I've seen people who make Kieth Richards look daisy fresh recover, and I've seen preppy college kids die a couple days after shaking their hands and them saying that they want to stop but can't.

    One of the greatest casualties of the "great society" era is resilience. You point out what I think are a couple of symptoms of this; negative attitude towards social decency, F the police, and overall acceptance and tolerance of any and everything. We've become an over regulated, let someone else do for me what I'm capable of doing myself, here's your trophy for "participation" / aren't you just a special snowflake, there's a pill for that society. The police what to hold ME accountable for MY actions? Oh nonononono, cant have that, clearly they're jackbooted thugs who want only to persecute me..... Here's the thing, recovery is an inside job; nobody can get anyone else clean or sober. Getting sober sucks, it hurts, it takes a lot of work and effort; it's not something that can be handed out. That's a stark kick in the nuts for someone who's basically had their every need met simply by waking up in the morning. We're just not a pull ourselves up by our bootstraps society anymore, and that's exactly what's needed to recover.

  3. #103
    Site Supporter Nephrology's Avatar
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    Quote Originally Posted by Kanati View Post
    IMHO, this is getting to one of the main roots of the problem.
    Without trying to ignite a firestorm of a debate (and I guess by prefacing my comment, I probably am anyway) but the idea behind legalizing controlled substances like opiates isn't to encourage their use, but rather to facilitate the ease with which addicts can seek help and recovery (in addition to taking narcotics revenue away from criminals).

    The assumption is that by decriminalizing their addiction problem, we can facilitate the entry of people into recovery programs like AA/NA and prevent end-users from getting a criminal records that will impair their ability to find or hold a job that pays a living wage, as spiraling down the socioeconomic ladder is only likely to further encourage substance abuse.

    Not stating my opinion one way or another as I am totally undecided on the matter; I used to be very Ron Paul "legalize all of it" but lately I do not suspect that is such a good idea. I am still OK with the legalization of some substances (like cannabis, which has been successfully legal here in CO for the last 4 years), but opiates, amphetamines, etc I am not so sure. Willing to abstain from having an opinion until I feel comfortable with what I know and what I know I don't know.

  4. #104
    Quote Originally Posted by Kanati View Post
    IMHO, this is getting to one of the main roots of the problem. Full disclosure, I am a recovering alcoholic. Been sober for a number of years, and do what I need to in a days time to stay that way. Locally, AA is much much stronger than NA, so we get a lot of folks with opiate addictions; I'd say probably 80% or more of the AA newcomers over the last few years have walked in with more than a bottle problem. I've seen people who make Kieth Richards look daisy fresh recover, and I've seen preppy college kids die a couple days after shaking their hands and them saying that they want to stop but can't.

    One of the greatest casualties of the "great society" era is resilience. You point out what I think are a couple of symptoms of this; negative attitude towards social decency, F the police, and overall acceptance and tolerance of any and everything. We've become an over regulated, let someone else do for me what I'm capable of doing myself, here's your trophy for "participation" / aren't you just a special snowflake, there's a pill for that society. The police what to hold ME accountable for MY actions? Oh nonononono, cant have that, clearly they're jackbooted thugs who want only to persecute me..... Here's the thing, recovery is an inside job; nobody can get anyone else clean or sober. Getting sober sucks, it hurts, it takes a lot of work and effort; it's not something that can be handed out. That's a stark kick in the nuts for someone who's basically had their every need met simply by waking up in the morning. We're just not a pull ourselves up by our bootstraps society anymore, and that's exactly what's needed to recover.
    Bingo. Here is what I learned about addiction. You stop when you hit rock bottom. Some folks rock bottom is almost nothing, others do not have a rock bottom.

    Quote Originally Posted by Nephrology View Post
    Without trying to ignite a firestorm of a debate (and I guess by prefacing my comment, I probably am anyway) but the idea behind legalizing controlled substances like opiates isn't to encourage their use, but rather to facilitate the ease with which addicts can seek help and recovery (in addition to taking narcotics revenue away from criminals).

    The assumption is that by decriminalizing their addiction problem, we can facilitate the entry of people into recovery programs like AA/NA and prevent end-users from getting a criminal records that will impair their ability to find or hold a job that pays a living wage, as spiraling down the socioeconomic ladder is only likely to further encourage substance abuse.

    Not stating my opinion one way or another as I am totally undecided on the matter; I used to be very Ron Paul "legalize all of it" but lately I do not suspect that is such a good idea. I am still OK with the legalization of some substances (like cannabis, which has been successfully legal here in CO for the last 4 years), but opiates, amphetamines, etc I am not so sure. Willing to abstain from having an opinion until I feel comfortable with what I know and what I know I don't know.
    I am for legalization, but it isn't for getting these folks help. With legalization will come with my gigantic you want freedom, be responsible and I have zero desire to pay for it. I also want to see huge consequences for screwing up using your individual freedom. Like cigarette smokers and higher insurance premiums for higher risk.....I expect the same. I expect the same government warnings and the same education about the ills. Then....put this crap in your body, and it is wholly on you. I also look at my kid going into the workplace as a non-minority. She has been heavily educated that not only is dope bad, but it will prevent her from reaching job and career goals. Not using will make her much more competitive. Meanwhile....I could give two craps if responsible folks fire up a joint in the jacuzzi once in awhile and aren't hurting anyone, or as a means to get off pain pills. Unfortunately, that is not how things usually go. I also like this as a State's rights experiment. Having federal de criminalization of dope (they should still be preventing illegal international smuggling and interstate transport) and letting the state's figure this out. If Colorado is happy with taxes in exchange for homeless and increased threats to their citizens on the road.....awesome for Colorado.
    Last edited by Dagga Boy; 09-01-2016 at 09:05 AM.
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  5. #105
    Quote Originally Posted by okie john View Post
    My fiance just got home from having her hip replaced. The first day she was back, she took a 5mg oxy every 90 minutes, or 16 per day on a 24-hour schedule. She's cut way back in the last couple of days, but I could see how someone with more severe/chronic pain might easily need that many or more. And given that I'm the only full-time caregiver at the moment, it would be very challenging for me to have to run to the pharmacy every few days to refill scrips. If that absolutely had to happen, I could do it because the pharmacy is half a mile from us, but someone out in the sticks without reliable transportation might have trouble.

    Of course, we don't have some little knucklehead stealing her drugs and selling them on the street, so that's a blessing...


    Okie John



    As I have posted elsewhere here, I have literally decades of experience with opiods, especially Oxycontin - not by choice. I have been extremely blessed to be able to stay controlled and functional for these many years, having been told I am very unusual because my dosages haven't changed in 4+ years. I'm not a Dr., but feel I'm eminently qualified to say the following. With all due respect, okie john, prescribing Oxycontin, a time-release med, for post-op pain is way out of line and is one of the main causes of folks getting hooked. Unfortunately, it happens all the time as Drs., even now, continue to write for Oxycontin, for situations just like your fiance - out of sheer ignorance. Oxycontin is a drug I am VERY familiar with and should ONLY be used in chronic (think never-ending here) pain control situations. The proper med for cases such as yours would be Vicodin, a short-acting med for short term pain control, or something in that same category.

  6. #106
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    Quote Originally Posted by nyeti View Post
    With the current trend of legalize drugs, F the oppressive police, and a general negative attitude towards any level basic social decency and a required acceptance of everyone's special take on what society has to endure as a whole for "acceptance and tolerance", I simply cannot find it in my heart to give one iota of a care about folks dying of heroin overdoses that are self induced. For decades as a cop I rarely put much effort into heroin users as they were a self correcting problem. Short of jailing them for the crimes they committed to fuel their "victimless" habit, I was not one to be spending a minute of time arresting them for under the influence type charges.

    I think DB has a valid point here, and I mostly agree with him. The issue I have, that LE has and that the Health care system has, is the stress that this current opioid increase is having on personnel who are already stretched to the limits. I won't speak for LE, because I don't do their jobs. I know the ER's are overwhelmed with addicts ODing on what they thought were "safe" quantities of illicit heroin (yes, I know how stupid that sounds), that are actually using lethal amounts of illicit fentanyl which is present. What is also very concerning is the presence of illicit fentanyl (illicit to distinguish it from diverted prescription drugs) in oral medications like Oxycodone and Xanax. Again, buying drugs on the street carries an inherent risk, and quite honestly, if you choose to make those choices, you live or die by the consequences. But, the trickle effect of the increase in OD's is very concerning.

    I'll talk about my little corner of the world, specifically. The death investigation system (Coroner/Medical Examiner) in the U.S. is overstressed. There are not nearly enough people doing the work, and because, with the exception of Chicago, dead people not voting, there is very little public recognition of the level of understaffing. The new fentanyl overdose deaths are quadrupling the number of OD's that we are seeing. Adding this number of cases, means we have less ability to do the work that we were already behind on, and increases the time it takes us to get cases finished. It's selfish, but I'd like to go back to the usual stupid people killing themselves on drugs, rather than the new stupid people killing themselves on drugs, because there were less of the first batch.

    Don't know how to fix the problem, and I don't think you can "fix" addiction, but getting the fentanyl out of the system would sure make my life easier. Course since that genie is out of the bottle, I don't suppose it's going back in anytime soon.

  7. #107
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    Quote Originally Posted by 11B10 View Post
    As I have posted elsewhere here, I have literally decades of experience with opiods, especially Oxycontin - not by choice. I have been extremely blessed to be able to stay controlled and functional for these many years, having been told I am very unusual because my dosages haven't changed in 4+ years. I'm not a Dr., but feel I'm eminently qualified to say the following. With all due respect, okie john, prescribing Oxycontin, a time-release med, for post-op pain is way out of line and is one of the main causes of folks getting hooked. Unfortunately, it happens all the time as Drs., even now, continue to write for Oxycontin, for situations just like your fiance - out of sheer ignorance. Oxycontin is a drug I am VERY familiar with and should ONLY be used in chronic (think never-ending here) pain control situations. The proper med for cases such as yours would be Vicodin, a short-acting med for short term pain control, or something in that same category.

    Oxy could be either Oxycontin, a specific form of long acting narcotic, or Oxycodone, the ingredient in multiple narcotic pain medications including oxycontin. Oxycodone can be a short acting narcotic used post surgically as well. I don't know which version Okie John's fiance was given, but it may not have been the long acting version you are used to.

  8. #108
    Site Supporter Nephrology's Avatar
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    Quote Originally Posted by 11B10 View Post
    With all due respect, okie john, prescribing Oxycontin, a time-release med, for post-op pain is way out of line and is one of the main causes of folks getting hooked.... Oxycontin is a drug I am VERY familiar with and should ONLY be used in chronic (think never-ending here) pain control situations. The proper med for cases such as yours would be Vicodin, a short-acting med for short term pain control, or something in that same category.
    As a quick commentary, it is worth clarifying that Oxycontin is simply brand-name extended release (ER) oxycodone. Vicodin is a brand name mixture of hydrocodone (a pharmaceutical opiate related to, but less potent then, oxycodone) and acetominophen (Tylenol, aka APAP). It's also worth mentioning that the extended release oxycodone (Oxycontin) was designed to be LESS addictive than the instant release equivalent; the idea being that if you take a given dose and allow it to be administered over time, you don't get the "rush" or "spike" that is associated with rapid absorption of an equivalent dose.

    Whether or not someone needs hydrocodone vs oxycodone and what kind of formulation they need (IR, ER, with or without an NSAID like APAP) is going to be a subjective decision based on the origin of the individual patient's pain and how well they respond to opiate analgesics.

    For example, not all post-op pain management is the same. Someone having their wisdom teeth extracted will most likely be in a LOT less pain than someone who recently had multiple rounds of orthopedic surgery. Similarly, patients often will respond very differently to opiate analgesia. As an example, I have always been highly resistant to opiate pain control and have always needed a higher than the average dose (which has always raised eyebrows with my MDs). Taken to an extreme, a cancer patient who fractures their leg will likely need heroic doses of opiates to control their ortho pain thanks to the tolerance that can develop with chronic opiate use.

    All this to say that there isn't a hard and fast rule regarding how to best write for opiate narcotics... it will always be a subjective decision, for better and certainly for worse.

  9. #109
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    Quote Originally Posted by Nephrology View Post
    . . . but the idea behind legalizing controlled substances like opiates isn't to encourage their use, but rather to facilitate the ease with which addicts can seek help and recovery (in addition to taking narcotics revenue away from criminals).
    I start from the reverse/mirror question: What is the purpose of prohibiting various drugs? I always start with that type of question for any law. Why is the state limiting my freedom?

    If the purpose is preventing usage (including the need to protect non-users from users), then we need to recognize that almost anyone who wants a prohibited drug can get it. Given the accessibility of prohibited drugs, I reject this as a valid purpose for the continued prohibition of various drugs.

    If the purpose is to discourage usage, I don't reject this purpose out of hand. I would like to see some analysis on how many people would start using drugs (after legalization) that would not have used the drugs but for legalization. I'm happy using some of the tax revenue to discourage usage. It seems to work with cigarettes.

  10. #110
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    Quote Originally Posted by Nephrology View Post
    Without trying to ignite a firestorm of a debate (and I guess by prefacing my comment, I probably am anyway) but the idea behind legalizing controlled substances like opiates isn't to encourage their use, but rather to facilitate the ease with which addicts can seek help and recovery (in addition to taking narcotics revenue away from criminals).

    The assumption is that by decriminalizing their addiction problem, we can facilitate the entry of people into recovery programs like AA/NA and prevent end-users from getting a criminal records that will impair their ability to find or hold a job that pays a living wage, as spiraling down the socioeconomic ladder is only likely to further encourage substance abuse.

    Not stating my opinion one way or another as I am totally undecided on the matter; I used to be very Ron Paul "legalize all of it" but lately I do not suspect that is such a good idea. I am still OK with the legalization of some substances (like cannabis, which has been successfully legal here in CO for the last 4 years), but opiates, amphetamines, etc I am not so sure. Willing to abstain from having an opinion until I feel comfortable with what I know and what I know I don't know.
    Well, I'd certainly argue that legally obtained opioids played a major role in getting to where we are now. Not a slam of the medical profession or anyone else; just an is what it is statement. Decriminalizing the addiction problem may reduce the prison population, and the socioeconomic problems that doing the states time brings, but it does nothing for the root of the problem....the addiction. I haven't noticed the ready availability of legal booze in any way facilitating the ease in which a drunk can seek help or recovery.....facilitates a lot of people going for a nice long swim in a bottle tho. The repeal of prohibition didn't cure alcoholism; I don't see legalizing opiates doing any good on the addiction front.

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