Falling out: the opioid epidemic (or, fighting the war on the war on drugs)

[all swedes are racist]

So this is a subject that, like for so many others, hits pretty close to home for me, and I thought it deserves a topic here. 

I don't really have anything in particular to lead off with, but wanted to start a thread open to discussion, education, and debate. In the US in particular (though my understanding is this a global issue-- see the Philippines-- most of my reading/exposure is in regard to my home country) has seen a constant and rather dramatic rise in overdoses and deaths related to opioids and opiates over the past 35+ years, with overdose deaths surpassing motor vehicle related deaths for the first time in 2009. My home state of Massachusetts is, iirc, home to a few areas of the highest opioid/opiate usage per capita in the country (Cape and Islands)

While recent years have seen greater education on the subject and more widespread acceptance of the idea of addiction-as-disease, there still exists very real stigmas associated with addiction, especially opiate/opioid addiction... The very use of Narcan is extremely controversial in some circles. But there are still some very positive pushes towards humanitarian, therapeutic based programs (cf: Portugal, Gloucester PD's Angels program)

so yeah, this is a large, multifaceted, and is say very important subject. I know we have had threads in the past dealing with addiction, recovery, and political response; this is meant to be a broad forum to discuss any aspects anyone sees fit. I'd want any and all to feel free to participate in any way, but be mindful of the fact that there are many people who may be posting, or even just reading, that likely have a very close personal connection to this subject.

 

[all swedes are racist]

Not sure how many people have seen this case (it's all over my Facebook feed)  of a couple in Ohio in a van overdosing with a child in the backseat. (They were pulled over for driving erratically, and photos of the couple in extremis on the side of a highway have gone viral) There is even some backlash over the handling of the story.

Gotta say, I think there's a lot going on here, and not all of it is great (the posting of the minors face, and the apparent delay in care administered to the couple -- to say nothing of the ohgodhelpmethecomments) but I do think instances like this could provide pivotal watershed moments for PDs or other local poleis in really recognizing the problem at hand and the failure of policies to far in combatting it...

[Xray the Enforcer]

The other sorry side of this coin is, of course, the difficulty it is for legit patients in need of pain meds to get said pain meds because they're accused of being "drug-seeking." Instead, they're left to either 1) live in agony or 2) get painkillers via the black market, meaning that they then lie to their doctors and nobody is monitoring them to manage/avert an oncoming addiction. It's a self-reinforcing disaster.

[Xray the Enforcer]

Also quoting this: 

Quote

be mindful of the fact that there are many people who may be posting, or even just reading, that likely have a very close personal connection to this subject.

Consider this an official mod warning to keep things respectful.

[Lily Valley]

Thanks for starting this thread.  I am trying to sort out what I want to say here, it's going to take me some time.

I will open with stating that the epidemic and related crime and overdose problems have been terrorizing my little community.  My son buried three of his friends year before last.  Three.  All of them were overdoses.  This year, with Narcan available legally, he hasn't been to any funerals.  This doesn't mean that all of his friends that were addicts are now clean.  It means that they had access to lifesaving medication.

The opiate problem is two-fold here.  First, people are not warned when given opiate based pain killers that there are very specific warning signs to look for if they have a predisposition to opiate addiction.  Intake counselors ask how opiates make the patient feel.  In 100 percent of heroin addicts admitted to the facilities here, opiates will "wake you up".  There is a growing body of evidence that addiction is a genetically inherited disease.  Addiction counselors here are taking this body of anecdotal evidence of how opiates make addicts feel to suggest a genetic predisposition that has basic warning signs.  That patient history and these early symptoms are not discussed when prescribing powerful painkillers is reprehensible.  Follow up treatment should be available to patients who wind up struggling.  

Second, for our beautiful young people, the city is flooded with heroin and black market opiates.  They are the new party drug.  Most of the kids have fooled around with both.  A small handful have the predisposition become drug addicts, they do and there is very little help for them.  In New Orleans, there are no beds for detox that insurance or medicaid will cover.  The cost for 5-7 day detox is $5,000.  A patient cannot get into a 30 or 90 day facility until they have detoxed.  Heroin detox is not considered "life threatening".  So patients are expected to kick alone before they get into treatment.  Or, they can go through a methadone detox that requires them to get to a clinic at 5am every day.  The average teenager can't do this.  An addicted teenager has a greater chance of getting to the moon by himself than getting through a week of ambulatory detox.  If families have the resource to pay for hospitalized detox, then there are still only 10 beds in the facility here that treats for it.  Ten.  The wait times are sometimes WEEKS.  There are no beds for adolescents.  None.  The closest facility that takes private insurance for adolescents is 2 hours away.  

Kratom is extremely effective in helping with detox symptoms.  Addicts will often be able to raise $20-$30 for Kratom and be free of symptoms for 24 hours.  The FDA is now trying to turn Kratom into a Schedule I narcotic.  I will follow up and edit this post with links to information about this a little later.  The internet keeps trying to eat this right now.

I have also been stuck on the flip side of this argument.  I had an outpatient procedure that was extremely painful and wound up having to get pain killers on the black market.  Luckily they were only necessary for a few days and I was able to get them with little fuss.  Essentially, the pharmacist didn't like the way the prescription was written and it got held up for a week.  A week later I didn't need them and was able to replace a "borrowed" prescription.  I am one of the lucky people who has a normal reaction to opiates.  They make me feel sick, itchy and irritable.  I feel tired and also restless.  It is very unpleasant.  I understand that an opiate addict will feel better than they have ever felt in their entire life on the same medication.  It would take a doctor just a few minutes to explain to a patient how dangerous this reaction is and give some follow up information.

[Xray the Enforcer]

I've lost a number of friends and acquaintances to opiate overdoses (most while in my 20s). I'm sorry that your son had to go through that experience as well.  

[Martell Spy]

Quote

The other sorry side of this coin is, of course, the difficulty it is for legit patients in need of pain meds to get said pain meds because they're accused of being "drug-seeking." Instead, they're left to either 1) live in agony or 2) get painkillers via the black market, meaning that they then lie to their doctors and nobody is monitoring them to manage/avert an oncoming addiction. It's a self-reinforcing disaster.

 

Yeah, I've lived with pain more than once. I'm frankly afraid to ask doctors directly for pain meds, out of fear they'll label me an addict seeking drugs. I'm completely honest about what pain I'm in though.

Also, it always astounds me how easy it is to get pain meds when you are admitted. Not only do I get pain meds many times a day by request, and it's pretty much never questioned, but they usually prescribe me some to go when I leave as well. But outside the hopsital, they pretty much never prescribe them. The consequence is that I sometimes suffer. Also, I've been known to do things like take sleep meds to get through a hard night. I'm much too afraid to turn to the black market.

[Lily Valley]

48 minutes ago, Xray the Enforcer said:

I've lost a number of friends and acquaintances to opiate overdoses (most while in my 20s). I'm sorry that your son had to go through that experience as well.  

Thanks.  I lost another friend a few years ago.  He had been clean for 20 years.  Decided to have a party for his 50th.  The fentanyl got him.

Here's a link to kratom's wiki page.

https://en.wikipedia.org/wiki/Mitragyna_speciosa

Here's an article on the kratom ban that has links to outside sources.  It is biased, but so am I.

 

 

https://www.theguardian.com/commentisfree/2016/sep/09/kratom-ban-harmless-herb-heroin-users

Here's a white paper about the types of treatment that work and how they work.  I would specifically point people towards the therapeutic communties section which is also used with medicated assistance for opiate users.

Quote

Therapeutic Communities

TCs are intensive, long-term, self-help, highly structured residential treatment modalities for chronic, hardcore drug users who have failed at other forms of drug abuse treatment. More than one-third of all admissions (including dropouts) to TCs demonstrate long-term, successful outcomes 1 to 2 years after treatment. In addition, approximately 60 percent of all admissions show significant improvement on specific outcome variables 1 to 2 years after treatment. However, clients remaining in treatment longer than 12 months have the greatest likelihood of successful outcomes.

https://www.ncjrs.gov/ondcppubs/publications/treat/trmtprot.html

[/quote]

A benefit of these types of programs is that patients become healers.  People who go through this type of treatment often become committed to helping other addicts.  This is a case where a little money spent pays in dividends of decreased human suffering and additional resources to help our community as a whole.

Sadly, longer term care is often not covered or only partly covered by insurance.  Drug addicts seeking help usually have zero resources of their own.

[The Mance]

So I have two experiences with opiate meds in my life.  

 

The first was when I was 18 and had to have emergency go-now-do-not-wait-for-the-ambulance-to-get-here surgery following my wisdom teeth extraction (apparently having a face the size of a soccer ball is bad.  Like, really bad).  Anyway, my post-op scrip was for Percocet, and I remember following the dosages (more or less) and then getting about half way through the refill before they disappeared from our medicine cabinet.  

My immediate reaction was to angrily confront my mom (rather than, say, curiously inquire) about the missing meds.  She said simply that she didn't think I was taking them anymore and so got rid of them.  I was unreasonably pissed and spent the next few days with what I recognize now as mild detox symptoms: cravings, restless agitation, headaches, etc.  

This really stands out for me in retrospect, because of all of the various potentially addicting recreational drugs I was using on a fairly regular basis at the time, following the proscribed dosage schedule of an prescription medication was the only case of withdrawal symptoms that I can recall.  

 

The second instance was a few years later in Alaska when I pinched the very tip of my right ring-finger off in a freak work-related accident involving a forklift and 1500lbs of salmon.  After cleaning me up at the hospital they sent me on my way with a full months worth of Demerol and the promise of refills (s!).  Even at the time I remember thing "wtf, i took my arm off at the cuticle, not the elbow".  

And then, at the bus stop across the street from the hospital, is a guy just standing around waiting (he did not get on the bus back to town with me, at 2:30am) to offer to buy my scrip from me for $3/pill ("No?  Ok $5.  Hey, kid!").  I didn't sell, and only took a few pills over the first couple of days, after which my pain was all but gone from what, really, was an essentially minor injury.  And I still had almost a months worth of opiates with the option of more, apparently for the asking.

 

Anyway, these are my anecdotes.  But if my experiences are anything approaching common, the level of abuse and addiction in this country is no surprise at all.  My take-away is that but for the attentive eyes of my OR nurse mom and DMD DDS dad I might easily have been prescribed a lethal addiction to a Schedule II narcotic by the good doctors at Nationally Renowned Hospital in Boston, at the age of 18.  And that many hospital/ERs are essentially candy machines that release handfuls of highly addictive drugs straight into the black-market drug industry.

And my experiences don't even address the pressures that people with actual injuries and pain feel to risk addiction by taking these medications so that they can get back to work or else lose their jobs/houses/life. 

[Xray the Enforcer]

Thanks for telling us of your experiences, Mance. If you're willing, could you let us know approximately how long ago each of those things happened, because it'd be interesting to know how things have changed over the years. My friends' experiences recently have been very different from what you describe -- impossible to get decent pain medication even after major surgery. My own major surgery experience (in 2009) was that I got one prescription for a week's worth of opiates (IIRC Vicodin) with no refills. I took it as prescribed for three days and then quit because it made me uncontrollably nauseated. I threw the rest away.

[The Mance]

I was 18 in 1988, and then I lost my fingertip in '92 or '93.

[Lily Valley]

The Mance, that is really scary.  You were extremely lucky.

Sorry for so many posts all.  I tried to fix the quote malfunction above, but failed.  I was getting some help from my buddy, but he couldn't figure it out either.

Here's a link to the National Institution of Health.  They have a list of resources in every area for doctors who can prescribe medication to assist with opiate addiction.

https://www.drugabuse.gov/

I also want to post is an open invitation to anyone who has friends or family struggling with addiction to Al-Anon or Nar-Anon.

http://www.nar-anon.org/

The forum can be found here. Please read the guidelines as the forum stays healthy when everyone follows the rules.  They offer a couple of online meetings every week.  Most areas have lots of Al-Anon meetings, but few have Nar-Anon.  They are slightly different, but both are helpful.

http://www.naranon.com/forum/

Anyone curious about Nar-anon or Al-anon can order their books.  It's pretty cheap.  Both groups follow twelve step traditions to teach family members and friends healthy ways to cope with a loved one's illness, not on the loved one themselves.  I am active in both groups.  I am absolutely unwilling to discuss why.  

Here is some information about drugs being currently used to help with opiate cravings.  I have heard that Vivitrol is really effective, but can be dangerous for people who are not committed to opiate abstinence for at least 30 days.  It is expensive, but most insurance will cover at least some of it.

http://www.samhsa.gov/medication-assisted-treatment

For parents there is The Addict's Mom.  TAM is a national group that is politically active.   The group has offered strength and hope to a lot of parents in my community who's children are struggling with active addiction.  The effects on families are horrific.

Here is a link to their information page.

http://addictsmom.com/

They are slowly accumulating a list of resources that use tactics approved by the latest studies done by experts.  They don't have a list available for all states, because they take their review process seriously.  They are working on it as fast as they can.

Last of all, I would like anyone who is reading this thread to imagine a single day in the life of an addict.  Nobody in their right mind would go through that hell.  It is hell.  Addicts are terminally mentally and physically ill.  They deserve compassion.  They are human beings with families who love them and pray for their health and recovery like any other sick person.  They have left a hole in their community that can't be filled.  They are my friends' children.  They are kids I fed and watched and love.  Kids I STILL love, even though I no longer permit them in my home or around healthy children.  They are brothers and sisters of hard working good people.  They are incredible souls living through something so awful that it may kill them.  Have a little human empathy and thank whatever God you believe in that it isn't you.

 

[Ramsay B.]

I'm just gonna post my experience with this. In 2008 I started to take oxy's recreationally. I started slowly and it obviously escalated over some time. By 2009-10 I was doing like five 80's per day and my life basically revolved around it. I was lucky enough to have a decent job, that I still thankfully have, so the cost usually wasn't an issue. Whenever there was a down time with my dealers then I would take some suboxen so I didn't have to deal with the hell withdrawal. 

My first attempt to get clean was when I found a legit suboxen doctor around 2011. Every visit was $125 and I saw him every other week. I started on 16 mg's and dwindled down to 2 mg's over like a year. So after more than a year of being on subs, my doctor had some legal issues and was unable to write me scripts. After some horrible visits to the methadone clinics,  I just decided to stop everything cold turkey, and the next 3 weeks was probably one of the worst times in my life. I couldn't sleep, cold sweats, shakes, ridiculous anxiety...normal withdrawal symptoms until I couldn't take it and got back on oxy's. 

After another 6 months of the oxy use I went back on suboxen with the same doctor. I started on 8 mg and dwindled down to basically nothing over 6 months and kicked it all in 2012. So for me the suboxen worked when taken "correctly", but I can't stress enough how important it was to dwindle down in very small increments. I have friends still on it who are looking to get off and that is the biggest thing I tell them. 

A few months after I was off everything I fractured my L2 vertabrae. So I had my first test with taking painkillers, but everything went well and actually took them like you're supposed to. But that was when my opioid use was fresh in my memory. Now, from the way my back healed, I can have bad sciatic nerve pain that will wake me up from sleep but taking anything isn't really an option to me. I just don't trust myself still. 

[all swedes are racist]

3 hours ago, Xray the Enforcer said:

The other sorry side of this coin is, of course, the difficulty it is for legit patients in need of pain meds to get said pain meds because they're accused of being "drug-seeking." Instead, they're left to either 1) live in agony or 2) get painkillers via the black market, meaning that they then lie to their doctors and nobody is monitoring them to manage/avert an oncoming addiction. It's a self-reinforcing disaster.

Oh yeah, its nuts. In was reading this article last night while trying to put together my thoughts, and two things that really stood out were that African Americans and Latin Americans have actually been affected less so than whites and Native Americans, in large part due to doctors reluctance to prescribe fearing feeding the illicit trade in painkillers (yay, racism :/)

second, there are 12 states with more opioid prescriptions than residents. Holy shit. So it's definitely a geographical factor as much as a chronological one. 

----------------

@Lily Valley, thanks for linking those resources, if I could add one more http://paariusa.org, for anyone who might be looking to get themselves or a loved one into treatment and doesn't really know where to even start. It's basically a partnership of health/treatment providers and local police depts across the country that will help addicts get access to the help they need instead of facing criminal charges, and cutting through the redtape/ logistical nightmares like the type Lily describes that serve as barriers preventing many from accessing care even when they decide they need it

[Xray the Enforcer]

thank you for your account of how difficult it can be to get clean, Ramsay. I'm really glad to hear that you were able to make it. Good luck with the sciatic pain -- back issues are the worst.

[DunderMifflin]

20 minutes ago, R'hllors Red Lobster said:

Oh yeah, its nuts. In was reading this article last night while trying to put together my thoughts, and two things that really stood out were that African Americans and Latin Americans have actually been affected less so than whites and Native Americans, in large part due to doctors reluctance to prescribe fearing feeding the illicit trade in painkillers (yay, racism :/)

second, there are 12 states with more opioid prescriptions than residents. Holy shit. So it's definitely a geographical factor as much as a chronological one. 

Another thanks to racism silver lining is that the issue is effecting proper white famIies so the solution isn't to just throw everybody in prison. Can't very well go around locking up soccer mom's in masses for being drug addicts.

It's really forcing discussions and narratives into places where the police and politicians aren't the only generals and bosses of the "war"

[Dr. Pepper]

My connection with the opioid epidemic and war on drugs in the last year has been as a foster parent.  One of my earliest placements was a one-month-old, "John", who came to me with Neonatal Abstinence Syndrome (NAS).  His mom had been a heroin addict (and pills before that) for years.  When she found out she was four months pregnant, she immediately took steps to get clean.  For pregnant women, that means methadone because going cold turkey can cause significant harm to the fetus.  Babies born with methadone, however, are still addicted and still have the same symptoms as babies born addicted to heroine.  John's mom received this methadone and prenatal care and nothing else.  She had to find housing on her own, a job on her own, get baby stuff on her own.  She had no idea that she needed to prepare for an NAS baby because no one told her.  She was able to take John home from the hospital despite him being born addicted because it was methadone.  No one provided any supports.

Dealing with NAS babies is horrible.  I could barely do it and I'd taken multiple training courses and I'm financially, mentally, and socially stable.  John's mom was none of these things.  NAS babies scream, shake, have horrible reflux and diarrhea, a hard time gaining weight, and you have to be diligent with their methadone prescription.  Something happened that required John to end up in care, my home.  The hope was that he'd move on to a family member.  Several were identified and these were very good choices.  They were kin who had excellent jobs, beautiful homes in great school districts, and they'd quickly come up with a plan for John's medical care.  Only, in the 90's they'd had drug arrests which automatically disqualifies them, they weren't even allowed to be around John while he's still in the system.  CPS went down the list of kin, to worse and worse choices, but they all had drug pasts.  Didn't matter how many years they'd been clean and stable, it was a no.  The person they finally landed on was John's 75 year old great-grandmother.  She lives in a tiny town without the medical facilities to treat John's illness.  Despite protests from many sides, John moved in with great grandmother.  A short while later something happened as we all knew it would and he was admitted to the hospital where CPS took him into care again.  John's outcome is horrible.  He'll need 24/7 care for the rest of his life.  

His mother has now relapsed.  She asked me what the point of being clean was, besides the methadone clinic was too far away.  At least her dealer gives her food and shelter, she said.  Thinking about John and his mom kills me.  It's so infuriating how much the system failed them.  Every step along the way, there was something that could have saved this family.  Where are the treatment centers, where are the mommy-and-me rehab facilities, where is the training and education?  I tried to work it so that both John and his mom could live with me, but CPS doesn't allow that.  The parent under investigation can't be near the child except for court approved visits, which are too few.  John and his mom might have had a happily ever after if only they'd both been able to live with me for a couple of months while they recovered and his mom had a decent chance of getting firmly on her feet.  

The thing is, this story isn't uncommon at all.  A lot of meetings I have with other foster parents focus a lot on drugs and the families that are devastated by them and how those who are poor suffer the most.  That photo the Ohio city police department shared of the child angers me so much.  Not angered that the photo exists, but angered at the reason they posted the photo.  They posted it to 'be a voice for the child' and hope it prevents a user from using.  No other reason.  This is what we have - a system that just tells addicts to stop using right this minute or they will go to jail and have their kids taken away.  That doesn't work.  It's never worked.  It's never going to work.  And stories like John's will go on and on and on.

Now that I'm thoroughly depressed and crying, I figure I'll leave off with a video from the Liberal Redneck.  He discusses the kratom that @Lily Valley mentioned above.  I wanted to scream last week (actually I probably did scream) when articles about the DEA making kratom a banned schedule one substance started coming across my news feed.  It just doesn't seem real because it makes no sense, not even a little.   

 

[The Mance]

34 minutes ago, DunderMifflin said:

Another thanks to racism silver lining is that the issue is effecting proper white famIies so the solution isn't to just throw everybody in prison. Can't very well go around locking up soccer mom's in masses for being drug addicts.

That's kind of my take all the attention paid to the Ohio OD couple.

"OMG!  This problem is so bad it's even starting to affect white people!  We must DO something!!"

[DunderMifflin]

4 minutes ago, The Mance said:

That's kind of my take all the attention paid to the Ohio OD couple.

"OMG!  This problem is so bad it's even starting to affect white people!  We must DO something!!"

Specifically with the painkiller epidemic it's going across all classes. It can happen to the upper class mother or the blue collar factory worker. It's like wait a minute these are heartwarming stereotypes of Americana we can't just say they are criminals and be done with it.

[DireWolfSpirit]

From the NCADD (National Council for Alchoholism and Drug Dependence)-  https://www.ncadd.org/about-addiction/alcohol-drugs-and-crime

Some eye bleeding consequences linked to addiction discussed:

Economic-Related crime: These are crimes where an individual commits a crime in order to fund a drug habit. These include theft and prostitution.

Those with a drug use dependency are more likely to be arrested for acquisitive crimes such as burglary or shop theft, or for robbery and handling stolen goods -- crimes often related to “feeding the habit.” For example, in 2004, 17% of state prisoners and 18% of federal inmates said they committed their current offense to obtain money for drugs. There are also close links between drug use and women, men and children who are involved in, or exploited by, the sex trade, many of whom are caught up in the criminal justice system. However, there is evidence that drug use is both a pre-determining factor in such sexual exploitation and a means of coping with it.

Child Abuse: A 1999 study by the National Center on Addiction and Substance Abuse found that children of substance-abusing parents were almost three times likelier to be abused and more than four times likelier to be neglected than children of parents who are not subtance abusers. 

I think everyone understands theres this tremendous correlation to crime/incarceration and substance abuse. NCADD puts this relationship statistically as follows- 

Our nation’s prison population has exploded beyond capacity and most inmates are in prison, in large part, because of substance abuse:

• 80% of offenders abuse drugs or alcohol.

Nearly 50% of jail and prison inmates are clinically addicted. Approximately 60% of individuals arrested for most types of crimes test positive for illegal drugs at arrest.

The Crime related to substance abuse touches every corner of society, it effects all of us in some fashion, the victims are not confined to the addicts themselves.