How to kill 300,000 Americans - Review

#61
yes please.

More on the Opioid addiction epidemic

Lawmakers struggle to get to grips with America’s opioid epidemic




Background note for Non-UK perss: :

Unlike the UK's Guardian or Daily Mirror newspapers or large state broadcasters, , The Economist is not Main Stream Media.

Nor is it generally felt to be either Left Wing or notably alt-Right.

The current Editor was drafted in from the International Monetary Fund.
Can't get to your link, unfortunately. However, the extract looks like the Darwin effect is really kicking in. People know the risk of taking this shit, but they still do it. There is something in them that drives them to take the first shot.
Reading some of the links on here it isn't all down to poverty. It's down to risk taking. Perhaps we could just legalise it and leave the solution to natural selection, because there doesn't seem to be any law enforcement solution.
 
#62
The fact I have no idea is a bit of a comfort to me. I know spice is an issue but only because we had a slow news week. If we where having an overt issue with drugs I'm sure it would be more in the public consciousness.
I'm not saying we don't have big problems with drugs, just not to the level America does.
It may be that our social security net catches a lot of people who would be susceptible to drug abuse if they slid further down the slippery slope to real poverty. It may just be we don't have as many destitute people who see no other way out of their shitty situation. Per 1000 of population we have, I'm sure, considerably fewer junkies than the States. Other than the social safety net I can't see any reason why it would be.

https://files.digital.nhs.uk/publication/c/k/drug-misu-eng-2018-rep.pdf

I don't think you folks are sadly that far behind us in some aspects.
 
#64
God help the U.K. if meth ever gets popular; Tweakers are akin to the living dead with Velcro fingers and paranoia. Rots the brain and the teeth.
 
#65
From what I understand about the issue, there are multiple facets.

One side of it is that the newer opioids are a lot more addictive than the pharmaceutical companies were admitting to. They were being sold as having a lower risk of addiction than traditional versions while they in fact were far more addictive.

Another is that pharmaceutical companies in the US will pay or otherwise bribe (e.g. free vacations disguised as conferences) doctors to prescribe their product. This results in doctors being given incentives to write unnecessary prescriptions.

Still another facet is that doctors in the US hand out pills in general like candy. Part of the reason for this is the above mentioned incentives from the drug companies, but part is just the medical culture there which sees there being a pill for every problem. Patients come in with minor complaints and demand a pill for it, for which the doctors provide a prescription.

People who want more pills than their doctor will prescribe will simply go to multiple doctors and get prescriptions from all of them which they then take to multiple pharmacies.

There are also ways of making the standard forms of the drug more potent (which I won't go into) so that what should be a normal safe dose can be a fatal dose.

The problems are amplified by the fact that with these newer opioids the difference between the effective dose and the fatal dose is much smaller than with many other drugs. Also, what will get one person mildly stoned will kill someone else. Death is generally from the breathing system being suppressed so the victim simply stops breathing and asphyxiates.

The problems affects different classes of people. Many are just normal patients who have genuine problems with chronic pain. They take what they thought was a "safe" drug and rapidly get addicted. They now find they can't quit. They build up a tolerance to it which means they have to keep taking more to get the same effect. People have a very wide range of responses to opioids, so what some people find to be safe ends up being fatal to someone else.

Some other users are just traditional drug addicts. They use modern opioids the same way and for the same reason that similar people use heroin. These cases are typically the ones that authors will use as examples when they want to talk about how deadly opioids are. There are many forms of synthetic opioids and when bought on the black market the users may end up with a much more potent one than they expected and so overdose on it.

One form is intended for use as a tranquilizer for elephants and other large animals and is extremely potent. It has legitimate uses, but will get sold on the black market and used by people.

Another way they get used are as additives to other recreational drugs. Since some of the modern synthetic forms are so potent, it can be cheaper to dilute the non-opioid drug which is supposedly being sold and then add a synthetic opioid to add back in some sort of effect to make the user think he's getting what he paid for. This can readily result in overdoses when someone receives a different drug than they were expecting.

There are many ways the drugs end up being available to be abused. Some of it is with people who get prescriptions they don't really need and sell them on the black market. Another is steal them from pharmacies, hospitals, or homes of patients.

Some also comes in from overseas, ordered from legitimate pharmaceutical suppliers who don't ask for too much paperwork from their foreign customers. I don't know how prevalent this really is compared to the other sources, but it does exist.

There is a campaign by various do-gooders who want to get the production and sale of all opioids completely banned. You have be careful when reading about the subject as these people will mix multiple issues together to provide a misleading picture of the overall situation to try to steer you to the outcome they want to see.

There seems to be no question that opioids are indeed over-prescribed in the US. The figures that I recall seeing are that the US consumes 4 or 5 times as many opioids on a per capita basis as the UK.

However, banning them completely as being demanded by some people isn't realistic either. There are people for whom the alternative to pain killers isn't "man up". The alternative for many people with chronic pain would be suicide.

So overall it is a complex problem with no simplistic solutions, but there are things which can be done to address some of the issues around the margins.
 
#66
Its not just rubbish electronics and garden ornaments that come from China. It is Fentanyl which is low mass and can be highly cut, Or badly cut so you quickly end up dead.



Then there is this shit...

Carfentanil
 
#67
Perhaps we could just legalise it and leave the solution to natural selection, because there doesn't seem to be any law enforcement solution.
Natural selection wouldn't kick in for a very long time in the UK. We have the NHS to keep people alive with no expense spared.

I know a nurse who works in Glasgow. She says the hospitals are filling up with junkies and alcoholics, some of whom have taken to drinking the alcohol hand gel. £350 quid a night for a bed, we'd be cheaper putting them up in 5 star hotels.

Then there are the other costs. Full blown junkies will not be holding down jobs as brain surgeons. They fund their habit through theft and begging with varying degrees of aggression. That costs police time and court time.

I've heard some of them described as "stealing machines" shoplifting over 100 times a week. When Jack Straw was in cabinet, he commissioned a report into the cost of crime. It was produced by one of the big accountancy firms.

The cost of a basic junkie in the wild was £60,000 per year. That triples to £180,000 if their kids need to be taken into care. Add on a couple of attempts at rehab, social workers, long term medical care for hepatitis, HIV or their willy being savaged by flesh eating bacteria and you don't get much change out of quarter of a million pounds a year.

I can't see any sense in making it easier for people to cost us that amount of money.
 

Goatman

ADC
Book Reviewer
#69
@terminal - thanks for a useful and sensible post
( @twentyfirstoffoot - plse note. If you want to get into a pixel punchup with @Anonymous Yank kindly take it here )

One of the stupidest things about health reporting in the UK is that NHS central stats usually cover England and Wales only. Thanks SNP.

Be interesting to know whether Scotland has a higher per capita death rate from synthetic opioids such a Oxycodone/,Fentanyl etc in the past 5 years ?

( The heroin addiction issue in Edinburgh explored by Irvine Welsh in 'Trainspotting' was an eye-opener for a lot of Westminster chatterati .)

934 drug-related deaths were registered in Scotland in 2017, 66 more deaths, (8% more) than in 2016. This was a record level for the fourth year in a row, and more than double the figure for 2007. At 279 deaths per million people (age 16-64), Scotland’s drug death rate is now nearly fifty times that of Portugal’s, at less than 6 deaths per million.
Source


US govt piece here on how this issue affects serving and ex US military:

Military

The US VA has issued a cautious note to clinicians on the use of Opioid pain relief - the shortened version (!) is here:

https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPGPocketCard022817.pdf


[ Cultural note for non-UK readers: Britain does not have any equivalent of the VA system. Military perss injured in the line of duty are treated in NHS hospitals. For amputees, the involvement of the military in their treatment ends when they are discharged from service.]

UK has 17 surviving tri-lateral amputees from Ops Telic and Herrick...I don't know how many single and bilateral amputees.

Given the levels of pain management involved most of them will have had opioids at some point.

@dingerr may be able to give first hand experience - and know others who have had issues.
 
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Auld-Yin

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Kit Reviewer
Book Reviewer
Reviews Editor
#70
Well, the book dropped into my mat this morning, which is bloody quick but welcome.

This has generated quite a bit of discussion so I am happy to consider anyone who wants to take this on, they don't need to be current reviewers, but need to be able to read, and write a review in a reasonable timescale.

If you would like to give this book a go, then PM me and I will chose one and get out to a reviewer.

@Goatman this includes you! ;)
 

Goatman

ADC
Book Reviewer
#71
Thanks A-Y - very prompt. I think the reviewer should have some relevant personal experience, either as a clinician or a patient who has been prescribed long-term high level pain relief, ideally with a military background.

This book is a story of contemporary America - it doesn't matter to me if it's reviewed by a Brit or an American , but that might be born in mind.
 
#72
Thanks A-Y - very prompt. I think the reviewer should have some relevant personal experience, either as a clinician or a patient who has been prescribed long-term high level pain relief, ideally with a military background.

This book is a story of contemporary America - it doesn't matter to me if it's reviewed by a Brit or an American , but that might be born in mind.
Would be great if reviewed by both sides for a balanced perspective.
 

Auld-Yin

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Book Reviewer
Reviews Editor
#73
Would be great if reviewed by both sides for a balanced perspective.
I think the balance needs to come from tinterweb and we just do our normal book review. We must bear in mind that the reviewer needs to be in the UK, or BFPO otherwise it would be cheaper for someone to buy the book rather than me send - postage overseas is horrendous.

Also we review books not to decide on the veracity, although that can be part of any review, but we do it to let our members know what good or otherwise books are on the go.

Ocassionally books with a specific agenda/theme come along, like this one, but we don't have the research material or background that the author has so the review needs be a general one not an authorative one.

Hope this clears up things.
 

Goatman

ADC
Book Reviewer
#74
Would be great if reviewed by both sides for a balanced perspective.
As an American long term resident in UK - would you be interested?
 
#75
(...) UK has 17 surviving tri-lateral amputees from Ops Telic and Herrick...I don't know how many single and bilateral amputees.

Given the levels of pain management involved most of them will have had opioids at some point. (...)
These are exactly the sort of persons who could be negatively affected by the misguided campaign to ban the production and use of synthetic opioids. The problem is the over-prescribing and unsupervised use of them. They are a legitimate medication but must be used carefully and only by those for whom there is a genuine need.

People need to be aware that some of the people publicizing the "opioid crisis" have an agenda that revolves around either banning them completely or othewise making them unavailable for legitimate medical uses.
 
#76
One of the stupidest things about health reporting in the UK is that NHS central stats usually cover England and Wales only. Thanks SNP
It predates devolution. The NHS in Scotland has always been separate and treated as such. Similar for the NHS in Northern Ireland - always separate, always treated as such.

One of the many good reasons for reporting them separately is that Scotland and NI cover social care through the NHS rather than local authorities, so there's no easy comparison in cost/outcomes.
 
#77
Difficult to read the PDF on my phone. I'll have to wait and have a look on my laptop
It predates devolution. The NHS in Scotland has always been separate and treated as such. Similar for the NHS in Northern Ireland - always separate, always treated as such.

One of the many good reasons for reporting them separately is that Scotland and NI cover social care through the NHS rather than local authorities, so there's no easy comparison in cost/outcomes.

Which makes it really hard to compare the US and the UK, because two countries are not included in the data. Odd and a great way to make the numbers look better.
 
#78
whilst in hospital with 20 + broken bones and other stuff (rta) in the mid 80s i was in dire need of pain relief morphine saved me. 2 months later when i asked for it. i was refused as a:i was addicted and b: i didn't need it. i was completely hooked and didn't know. weaned off with codeine. very easy to learn to like it if you are in a bad place. i had no idea i was hooked but realised immediately when Dr told me.
 
#79
Which makes it really hard to compare the US and the UK, because two countries are not included in the data.
If you picked parts of the US for the healthcare comparison and regard that as the figures for 'the US' it wouldn't be accurate, would it?

Two countries are included in the data, just not the data for entirely different parts of the whole.
 
#80
If you picked parts of the US for the healthcare comparison and regard that as the figures for 'the US' it wouldn't be accurate, would it?

Two countries are included in the data, just not the data for entirely different parts of the whole.
It's false advertising, and I want my Cadbury bar!
 

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