Heroin Overdose Epidemic - what is your perspective?

[rob_s]

So, then, not to be overly cold about it, but...

Isn't the problem going to solve itself? By that I mean, if the predominate route to heroin addiction is people that can't get their pain meds anymore, and the over-prescribing of pain meds is on the decline, isn't the pill-junkie-turned-heroin-junkie population also going to self-eradicate?

Whether we blame the doctors themselves, "big pharma", the local pharmacist, or little green elves, is kind of irrelevant to me at this point, and also seems to take away a certain amount of self responsibility from the "victims". Understanding, of course, that the husbands, wives, parents, and children of the addict are the true victims. And, of course, the rest of us who are paying one way or another to try and recover and treat the addicts as well as deal with the aftermath of their problem.

To what extent does the old-school story still play out? I heard third-hand a story last week of a 20-something girl that had been strung out on something or other since taking up with a "bad boy" boyfriend in high school who got her started on something or other. Based on the death statistics I posted above that seems not to be the predominate story.

[scjbash]

Here in the overdose capital of the country the average age of someone dying from an overdose is 38. I'm 38 so I've known an absurd amount of people who have died, including yet another in recent weeks. I've seen addiction follow two main routes.

First is the one Nephrology gave a great explanation of. People went to the doctor for whatever reason and were over-prescribed. In some cases it's an acute injury, so maybe they sprain an ankle and are given a ridiculous amount of pills. In other cases they are dealing with some kind of chronic issue and instead of getting to the root of it the doctor treats long term with ever-increasing doses of narcotics. Either way they become addicted before they realized it. I've also seen people who are over-prescribed Xanax find their way to opiates. I think the only reason the Xanax problem isn't talked about more is because it's not directly killing people. Around here at least it's also prescribed like crazy, and that hasn't slowed with the reduction of opiate prescriptions. If anything it's worse.

The second route, and the one that hit my classmates hard, was the availability of pills in high school or immediately after. It's a problem when it's easier for 17 year olds to get pills than weed, especially when there wasn't much awareness about the problem at the time. A lot of kids who were at that age of experimenting were using pills when a decade before it would have been Bud Light and grass. Oxycontin was released while I was in high school and was everywhere. Instead of becoming your usual 38 year olds who could say they smoked weed sometimes in high school or college, they are 38 year olds who have been hooked on opiates for 20+ years.

Throw in a great decline in good jobs and government handing out money like Halloween candy and it's a recipe for disaster. Now with all of the suboxone clinics and no accountability it's turned into another street drug. Addicts are getting Uncle Sugar to pay for their suboxone, which they sell for $25 a pop to people trying to stay off heroin, then they use that money to pay for their own habit. Then when it's time to piss they just take someone else's in. Or they are only on suboxone, but can get by on half a pill a day, so they sell the other half of their prescription. Others have been on suboxone for so long that they need more than they are prescribed, so they are out stealing shit to buy more on the street just like they would when they were on other pills or heroin. It's a bizarre situation where the heroin dealers are also dealing suboxone. Eventually the person needing more suboxone isn't going to have the money for it or the dealer is out, so they end up using heroin again instead. It's madness.

[Nephrology]

So, then, not to be overly cold about it, but...

Isn't the problem going to solve itself? By that I mean, if the predominate route to heroin addiction is people that can't get their pain meds anymore, and the over-prescribing of pain meds is on the decline, isn't the pill-junkie-turned-heroin-junkie population also going to self-eradicate?

Whether we blame the doctors themselves, "big pharma", the local pharmacist, or little green elves, is kind of irrelevant to me at this point, and also seems to take away a certain amount of self responsibility from the "victims". Understanding, of course, that the husbands, wives, parents, and children of the addict are the true victims. And, of course, the rest of us who are paying one way or another to try and recover and treat the addicts as well as deal with the aftermath of their problem.

To what extent does the old-school story still play out? I heard third-hand a story last week of a 20-something girl that had been strung out on something or other since taking up with a "bad boy" boyfriend in high school who got her started on something or other. Based on the death statistics I posted above that seems not to be the predominate story.

The issue is that the problem clearly doesn't just self eradicate. As mentioned in my previous post, a big change in the illegal distribution of heroin that came about in the last ~10-15y or so is the deliberate targeting of suburban, middle/upper class America by heroin dealers. The more heroin is used, the more it becomes culturally normalized, and the more new users we have.

Just like scjbash said, people who might have experimented with weed and booze in high school now are being exposed to heroin, which is obviously substantially more addictive, thus increasing the pool of heroin users in the US. Addiction to heroin, in turn, causes great societal harm. Heroin addicts are more likely to engage in criminal behavior and to develop comorbid health problems, both of which not only contributes to the decay of general society but also often end up on the taxpayer's dime in some way or another. For these reasons, treating addiction in those who can and want to be treated is overall much less expensive than the cost of allowing them to continue to be a drag on the rest of society.

As for how often the "old school" story plays out, it still does, but obviously there are no numbers on this. When I was on OBGYN I took care of a pregnant woman who was on methadone assisted therapy for opiate addiction. Previously she had been a nurse at a good hospital - after her abusive ex-boyfriend concluded their relationship by driving the car they were in into a telephone pole, she required extensive surgery and was on pain meds for a while. Between the physical and mental damage she suffered, heroin was her recourse. I felt really terribly for her. Frankly, I do not think that I would have necessarily turned out better than she had if I was put in a similar position in life.

On a related note, I would strongly caution you against envisioning "junkies" as a monolithic group of people of weak moral character - opiates have gotten the best of a lot of very smart, driven and accomplished people; not just street rats. Anecdotally, this includes William Halsted, the grandfather of surgery in the United States. Nobody is immune, and it is dangerous thinking to believe that it couldn't happen to you or your loved ones.

[45dotACP]

The problem is that this stuff doesn't limit itself. My first ever encounter with a certifiable junkie was a 20 year old who had been using for the better part of a decade.

Said junkie's parents had been using their child to uh...pay...for things. In order to blunt the moral shock of prostitution at the hands of your legal guardians, said legal guardians got the kid using heroin at a very young age.

It ended poorly. That child never aged a day past 21, between the septic endocarditis, near immunity to conventional pain meds, and the purpura fulminans that caused fingers and toes to become necrotic, those "people" sure did extract a lifetime's worth of pain on their kid.

If ever dueling became legalized I know for a fact there are two people I would like to meet me on the lawn with nothing but bare hands.

Sent from my XT1585 using Tapatalk

[JRB]

This is an excellent thread, I really can't overstate that.

An anecdote I can share: a friend of mine worked as a bank teller in one of the nicest parts of ABQ for about 2 years, from 2012-2014 or thereabouts. The kind of bank where you see the lot full of late model German & Luxury cars.
She tells me she never went more than 2 weeks without having a parent come in to close a teenage or college kid's bank account following the kid's OD-related death. Almost all Heroin and Oxy.

[GardoneVT]

The problem is that this stuff doesn't limit itself. My first ever encounter with a certifiable junkie was a 20 year old who had been using for the better part of a decade.

Said junkie's parents had been using their child to uh...pay...for things. In order to blunt the moral shock of prostitution at the hands of your legal guardians, said legal guardians got the kid using heroin at a very young age.

It ended poorly. That child never aged a day past 21, between the septic endocarditis, near immunity to conventional pain meds, and the purpura fulminans that caused fingers and toes to become necrotic, those "people" sure did extract a lifetime's worth of pain on their kid.

If ever dueling became legalized I know for a fact there are two people I would like to meet me on the lawn with nothing but bare hands.

Sent from my XT1585 using Tapatalk

This right here.

We can cut billion dollar checks to task forces and health interventions all day,but it won’t solve the root of the problem. For a lot of folks, the beginning of their addiction was an abusive parent or spouse. This is not a happy thought, but the folks I’ve met who had a substance abuse problem usually had a good reason for it.

[NH Shooter]

This is not a happy thought, but the folks I’ve met who had a substance abuse problem usually had a good reason for it.

I generally find the "victim mentality" repulsive and therefore feel little compassion for those who think their problems are someone else's fault. Maybe it was my upbringing with parents who lived as young adults through the Great Depression who taught us the value of personal responsibility.

That said, I have never personally experienced the level of despair that is being discussed here. It is heart wrenching on so many levels and makes me realize how good my life has been...which as already mentioned all starts with having (and being) good parents.

[TheRoland]

I generally find the "victim mentality" repulsive and therefore feel little compassion for those who think their problems are someone else's fault. Maybe it was my upbringing with parents who lived as young adults through the Great Depression who taught us the value of personal responsibility.

That's actually what's so hard for me about this particular addiction crisis. For some portion of addicts in my neck of the woods (which judging by your name is also your neck of the woods), this isn't something they got themselves into intentionally. This was done to them; it literally was actually someone else's fault when they were originally injured or originally subscribed painkillers.

[NH Shooter]

That's actually what's so hard for me about this particular addiction crisis. For some portion of addicts in my neck of the woods (which judging by your name is also your neck of the woods), this isn't something they got themselves into intentionally. This was done to them; it literally was actually someone else's fault when they were originally injured or originally subscribed painkillers.

Understanding this is only a sample of one, I've been prescribed these medications on two occasions, both due to dental issues. The first time I took exactly one pill, which blurred the pain but I did not like the way it made me feel. Ditto the second time when a tooth abscess spread into a nasty (and very painful) infection in my jaw. I guess I'm lucky that I just hated the stuff, and I don't consider myself as someone with a high threshold for pain.

Based on the known addiction dangers, it seems obvious to me that there needs to be much tighter regulation of how and when these medications are prescribed. Both times in my case they were prescribed without me even asking for them.

[willie]

Drug abuse and illicit drug use no longer have the stigma that they once carried. For this reason, becoming a dope fiend(forgive the term)is easier. And when so many Americans, who are already smoking dope and tooting cocaine, are prescribed opiates, then they may not be using good judgment with these drugs either. I do agree that physician prescribing habits have contributed to opioid addiction. However, some responsibility rests with the patient. I'm overdue for a couple surgeries. My fear is that I might have pain complications and be subjected to a one plan fits all prescribing model.