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America’s opioid epidemic is driven by supply

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ashbird in reply to jouris

jouris, Re keeping SSA solvent, rampant addiction (not just to opioids, but all other classes of drugs as well - stimulants, CNS depressants, polysubstnace abuse....), the picture is mutivariate. (cf. previous reply to you on different classes drugs that are addictive)
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Following is a bit of info re Methdone Clinics for addressing treating opiate addiction. The funding for Methadone clinics, to my knowledge, comes from Medicaid for the medically indigent, which in turn comes from SSI which in turn comes from SSA.
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A link follows after the bit. Materiall in link should be perused from start to finish in order to avoid incomplete information.
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"A methadone clinic is a place where a person who is addicted to opioid-based drugs, such as heroin or prescription painkillers, can receive medication-based therapy. Patients receive methadone, or the brand name version known as Dolophine, which is an opioid analgesic. This treatment is often referred to as replacement therapy.
According to the Substance Abuse and Mental Health Services Administration, methadone can be administered as a pill or in liquid and wafer forms. It is used to block the effects of opiate pain medications, including morphine, codeine, oxycodone, and other semi-synthetic opioids. Although the treatment must be prescribed by a doctor, it is not a cure for addiction issues. It is nonetheless considered effective during the treatment and rehabilitation process as part of a comprehensive treatment program...................." Most dtug addicts are poly-users. Chief in the "poly-" is Alcohol.
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https://americanaddictioncenters.org/methadone-addiction/clinic-facts/

jouris

the initial ninety-day opioid public health emergency declared by Donald Trump in October will close this month without the introduction of any significant federal initiatives or funding.
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Why is anyone surprised by this? The declaration of a public health emergency got a big publicity splash. That was its purpose, not actually doing anything to address the problem.
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Besides, the parts of the Federal government which would need to act to do something about the problem are being industriously gutted by the Trump appointees running them. So, nobody to work out answers, and nobody to implement them.

R77wYfR8Qw

There is no doubt that some physicians are guilty to the core for this tragedy. Unfortunately the guilt is not evenly distributed. The vast majority was never excited about prescribing opioids and this is why they are so eager now to limit it maybe excessively, hence the complaints even on this forum about pain being undertreated. The most guilty are the pill mill operators and even more, those on medical boards, university centers, who committed high treason of public trust by accepting fake safety studies and generating guidelines coercing primary care docs to "manage pain aggressively". They even coined a term opiophobia. That was late 80's. The pharmaceutical companies and in particular Purdue pharma worked maliciously behind the scene to bribe, cheat, mislead doctors and regulators of influence to make aggressive treatment of pain with opioids a physician's duty. Joint Commission (accrediting body for hospitals) introduced pain scale and recommendation that pain is another vital sign. There is some evidence about nefarious links between Purdue and Joint Commission in early 2000's. As medical boards started to recommend this approach, there was not much room for primary care doctors to wiggle out. On one hand demanding patients reporting pain (and how do one tell that someone does not have 10/10 pain if they say so) and licensing boards stating the pain needs to be treated or we can always take your license.
I personally know a "refusnik" who got talked to for saying - "Nobody dies from pain in contrast to opioid induced respiratory arrest". This insensitive attitude needed to stop or else was his supervisor's conclusion.

Here is a very interesting article from MN. I pasted few excerpts to illustrate the point
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The Opioid Epidemic and the Minnesota Board of Medical Practice

Steven J. Waisbren

Those of us who applied for our medical license 25 years ago remember having to trudge over to the offices of the Minnesota Board of Medical Practice (BMP) for an in-person interview to confirm that we were indeed the person who appeared on our application. We also may recall being required to watch a 15-minute video encouraging us to be more aggressive in treating patients who complained of pain
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2007 publication of a Minnesota BMP Work Group’s report “Appropriate Prescribing of Controlled Substances for the Management of Pain.”13 The language in this report was extreme in concluding that “undertreated or untreated pain when controlled substances are indicated is a public harm, a serious departure from the prevailing standard of care, and a violation of the Medical Practice Act.”
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Furthermore, the report discouraged “interventional techniques to manage pain as a substitute” to pharmaceutical management because they carried a far higher dollar cost and a “significantly higher risk of complications.”13 The report went on to say that such a shift from the use of pharmaceuticals to interventional techniques constituted a deviation from the standard of care and would subject Minnesota physicians to CORRECTIVE ACTION.
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Basically the licensing board was telling doctors - treat pain aggressively or lose your license.

http://pubs.royle.com/article/The_Opioid_Epidemic_and_the_Minnesota_Boar...

Sense Seeker

Wait a minute! Surely these are Americans, and if they buy opioids, it's because they have made a rational decision is that this will maximise their welfare. They will have weighed all the consequences of use versus non-use, including the risk of death, and clearly, for many the decision was to buy and consume. It's all for the best in this best of all possible nations.
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The market always knows best, and government's role is to enforce safety and protect the profits - sorry, I mean property. Trump understands that and has exactly the right policy: none.

Tom Meadowcroft in reply to Tokarian

Statistically, the US stacks up very well against Europe and the rest of the world for life expectancy if you only include deaths for medical reasons; the US has the best cancer survival rates in the world, for instance. It's the accidental and violent deaths that skew the American life expectancy down. Gun deaths, car and motorcycle accidents, and drug overdoses kill a disproportionate number of Americans because we own more guns, drive more miles, and use more dangerous drugs recklessly. Life expectancy is only loosely related to the quality of medical care. The things that determine life expectancy are more a function of personal choices and public health issues (diet, exercise, sanitation, childhood vaccinations) than medical care. Good medical care tends to lead to better lives, not longer lives. Doctors do little to extend lives other than offering advice that is freely available elsewhere.
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While I agree that there is a lack of equal access to quality medical care for poor people in the US, I hate it when people use life expectancy to try to show the effect of that societal shortcoming. If you look a little deeper at the statistics, the linkage between quality medical care and life expectancy really isn't there. Quality medical care allows children to become more productive adults, and adults to lead more productive and happier lives, but it doesn't improve life expectancy. Antibiotics and vaccines are the only 'medical' inputs that affect life expectancy, and those are available at a very basic level of health care which is available to all.

teacup775

But but markets and the profit motive lead to the best of all possible worlds. Markets simply optimize on a system’s incentives.

Whites have been telling themselves they are morally superior. They still make the choice to go to pill mills.

R77wYfR8Qw in reply to Hippogriff

I think criminal charges would be much more of a deterrent but I do not have high hopes. No money will bring back the hundreds of thousands, who died. Purdue will take a slap on the wrist and go back to business.
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I think this disaster illustrates that it was mainly driven by the supply side of the equation, considering how strong were the efforts to open the flood gates and expose as many potential addicts as possible.
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Unfortunately, I do not see a clean solution to this tragedy. It seems that Portugal's approach with decriminalization, legalization of softer stuff, controlled distribution of harder drugs to registered addicts is most likely to minimize casualties. Paradoxically in medium term it would have powerful effect on dropping supply as profitability would drop reducing incentive to illegal supply chain.
Clearly Portugal has 3 x lower fatal overdose rate even comparing to relatively low numbers in the rest of EU.

CA-Oxonian

Medical doctors are by and large well-meaning people who want to help. But this desire to help has caused a great deal of mischief on several occasions. Due to doctors handing out anti-biotics like candy for over four decades ("Yes, you have a viral infection, here's a course of anti-biotics...") we now have drug-resistant bacteria. Prozac was "mommy's little helper" for a couple of decades because doctors prescribed it for practically any emotional discomfort. And today we have opiods and Ritalin likewise prescribed at the drop of a metaphorical hat.
It's about time doctors stopped prescribing just for the sake of keeping patients quiet and feeling as if they're doing something to help. While medical science has progressed immensely over the last century, medical practice has not. Time we changed the paradigm.

Sense Seeker

After the Soviet Union collapsed (and Gorbachov's alcohol restrictions ended) in the 1990s, Russian life expectancy plunged because of economic turmoil and a lack of perspective among the people, especially working-age men. They used vodka.
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In the US, it's prescription opioids.
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Back in 2005, Olshansky was widely criticised for his prediction that obesity might causing a decrease in life expectancy in the 21 century. That was deemed inconceivable - life expectancy going down.
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Well, just 10 years down the line, it seems he was right, though it's the combination with opiods and not obesity alone.
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Following earlier ideas from Rudolf Virchow (Prussia/Germany, 1821-1902), epidemiologist Geoffrey Rose spoke in the 1990s of 'sick individuals and sick populations'. In their view, just like individuals can be sick if the cells in part of the body are malfunctioning for some reason, so populations can be sick if some of the citizens do not function well. Epidemics are signs that something is wrong in the population. People are not coping, with something. From that perspective, the reduction of US life expectancy, for two years in a row now, is a sign that the US are sick.
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Opioid abuse is one cause. Obesity is another. Both have underlying 'supply-side' issues. Growing inequalities, a dysfunctional health system that combines the worst aspects of market and regulation, and the dysfunctional governance system that is captured by wealthy vested interest groups surely also have a place in the causal chain.
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One thing is certain: so long as Trump and the GOP are power, this problem isn't going away.

R77wYfR8Qw in reply to guest-lsmssae

There is no doubt that some physicians are guilty to the core for this tragedy. Unfortunately the guilt is not evenly distributed. The vast majority was never excited about prescribing opioids and this is why they are so eager now to limit it maybe excessively, hence the complaints even on this forum about pain being undertreated. The most guilty are the pill mill operators and even more, those on medical boards, university centers, who committed high treason of public trust by accepting fake safety studies and generating guidelines coercing primary care docs to "manage pain aggressively". They even coined a term opiophobia. That was late 80's. The pharmaceutical companies and in particular Purdue pharma worked maliciously behind the scene to bribe, cheat, mislead doctors and regulators of influence to make aggressive treatment of pain with opioids a physician's duty. Joint Commission (accrediting body for hospitals) introduced pain scale and recommendation that pain is another vital sign. There is some evidence about nefarious links between Purdue and Joint Commission in early 2000's. As medical boards started to recommend this approach, there was not much room for primary care doctors to wiggle out. On one hand demanding patients reporting pain (and how do one tell that someone does not have 10/10 pain if they say so) and licensing boards stating the pain needs to be treated or we can always take your license.
I personally know a "refusnik" who got talked to for saying - "Nobody dies from pain in contrast to opioid induced respiratory arrest". This insensitive attitude needed to stop or else was his supervisor's conclusion.

Here is a very interesting article from MN. I pasted few excerpts to illustrate the point
-
The Opioid Epidemic and the Minnesota Board of Medical Practice

Steven J. Waisbren

Those of us who applied for our medical license 25 years ago remember having to trudge over to the offices of the Minnesota Board of Medical Practice (BMP) for an in-person interview to confirm that we were indeed the person who appeared on our application. We also may recall being required to watch a 15-minute video encouraging us to be more aggressive in treating patients who complained of pain
-
2007 publication of a Minnesota BMP Work Group’s report “Appropriate Prescribing of Controlled Substances for the Management of Pain.”13 The language in this report was extreme in concluding that “undertreated or untreated pain when controlled substances are indicated is a public harm, a serious departure from the prevailing standard of care, and a violation of the Medical Practice Act.”
-
Furthermore, the report discouraged “interventional techniques to manage pain as a substitute” to pharmaceutical management because they carried a far higher dollar cost and a “significantly higher risk of complications.”13 The report went on to say that such a shift from the use of pharmaceuticals to interventional techniques constituted a deviation from the standard of care and would subject Minnesota physicians to CORRECTIVE ACTION.
-
Basically the licensing board was telling doctors - treat pain aggressively or lose your license.

http://pubs.royle.com/article/The_Opioid_Epidemic_and_the_Minnesota_Boar...

R77wYfR8Qw in reply to Melissia

You just flushed you brain down the toilet? I guess it stunk and was not salvageable. I wish I could feel sorry for you.
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And maybe no action from supermajority side was because Purdue Pharma owns both home state senators from CT. Both Democratic senators.

Tokarian

Odd then the highest death rates and biggest increases in death are in the most economically depressed and socially disadvantaged areas of the USA, and among the segment of the population whose plight is worsening fastest - white, late middle-aged, working class males.