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America’s opioid epidemic is driven by supply

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WT Economist in reply to guest-aaawwwmj

I had a relative who was a paramedic in NYC. While the heroin addicts lingered for years, the crack addicts died in months.
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The height of the crack epidemic was the early 1990s. And Afro-American life expectancy fell, just like White life expectancy today.
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Realize

As a ex drug addict, and a guy who has been around or worked with addicts and alcoholics since "84, most guys don't give up. Substitution with Grass is being promoted. Sad, 'cause this shit causes psychosis in some people for the rest of their lives from an early age. Screwed for Life. That's the promise of Addiction. Forget about the pain of the family. They are advised to ditch the guy or gal, unless they have got a hell of a lot of money or property, and if there is a chance of inheriting all that. The guys and gals who do make it need to attend the NA or AA meetings all their lives to keep off the stuff, and see that they don't have a relapse. They have all kinds of emotional, physical and mental problems for the rest of their lives. The ones who recover remain difficult people, without the substance. Even when they take the stuff, they don't get a high. The brain pumps dopamine even when they think about substance abuse, when all its going to do is get them stuck in a greater nightmare. They want to give it up even when they are using the shit. This is a living Hell. Trump has the right attitude. This stuff gets you into a living nightmare, regardless of your wealth.

Realize in reply to jouris

You are a brilliant person. I love your analysis. I love you too. What an F*****ng analysis. Yes, the damn thing helps the good but lazy and stupid semi educated unskilled folks, who don't save money 'cause they have no goddamn self discipline (you are not one of them). You should write a goddamn thesis on this. Make a study. Give us the bloody statistics on how this SHIT is saving all the good people on Social Security. People with insights like you are why I pay money to the TE. God bless you. I hope you have some progeny too.

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.

Realize in reply to Sense Seeker

You talk rubbish. Anyway even if I take you seriously, there are all kinds of reasons why people do it, and I assure you none of those decisions is based on any kind of rationality. If you took a rational decision, you would touch it. Unfortunately, weaker folks are incapable of giving it up. They then concoct amazing "rational reasons" to continue using it. The AA folks believe all these addicts are insane, so there is no chance of giving it up, unless they go to God. My dear friend, most guys just don't have the willpower or can't think straight, i.e. they are MAD (AA: Bill W and Doctor Bob). Get it, Pal? Honcho or whatever you are.

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/

WT Economist in reply to guest-aaawwwmj

The problem is, opposition to the "war on drugs" is based on the belief that the issue is demand, not supply. Now that a corporation is involved, rather than illegal drug cartels, the assertion is the opposite.
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Debt is driven by supply? People do seem to respond to it, combined with advertising, the way ameboas respond to stimuli and dogs respond to ringing bells.

EZTejas

And in prior generations, it was Valium and martini's. Unbreakable trail all the way back to rum and hard cider. Its just some thing in the American psyche that lends itself to being the worldwide trendsetter in getting a rush. The Yin to the rest of the American Yang.

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.

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.

WT Economist in reply to Realize

It's not a punchline. Crack made cocaine much more deadly. The death rate among urban Afro Americans soared. The same thing is happening with fentanyl and other opiods.
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The reaction at the time was the impose vastly greater penalties for crack than for regular cocaine. A consensus had just formed that this was the absolute wrong thing to do. But if the problem is the supply, not the demand, then perhaps it wasn't wrong after all.

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.