It doesn’t even have to be that. Party drugs can be laced too.
I know people in Canada that have encountered cocaine that got laced with fentanyl. When drugs are unregulated, all drugs get affected when there’s a cheaper (but more dangerous) option.
Yeah, it could be anecdotal, but I think it’s also intuitive.
It’s a problem for workers comp carriers. “Injured party became addicted to opiates and seeks drugs, but we stop providing them” is more than anecdotal, it’s something we make policy around. Injured workers tend to be 25-64.
And this is all in the absence of other drug interactions.
Since you did point out the group 25-64, which is the primary party drugs user bracket, I am going to agree that they’re not the post-surgery opioid addicts. So while the dealer may not be supplying lethal doses of fentanyl, there’s a 99% chance that these people are also consuming alcohol/cocaine/weed and can easily throw them over the edge.
Ah, that’s a good point, and I’m remembering the research one of my ex-colleagues did on the impact of prescription opioids on WC. …and it’s research I can’t share, sorry.
(Of course, if the worker ODs on his prescriptions, the WC no longer has a claim to pay…)
Low. One of the reasons for the recent tightening up of opioid prescriptions is because a non-trivial number of the addicts dying of fentanyl were originally hooked by prescription pain killers. When I said that it was actionable to a WC carrier, one of the actions we took was to try to convince doctors to prescribe lower doses of opioids less often. FWIW, this is correlated with higher return-to-work rates, after adjusting for stuff like “more seriously injured people get higher doses”.
(It turned out that “common practice” as to handing out opioids varied quite a bit from place to place, probably much more so than “back injury from xyz event” does. So it was easier to normalize for degree of injury than you might have expected.)
The WC industry was one of the first voices pushing to prescribe fewer pain pills. (And not because the pills themselves are very expensive.)
I’m not saying this is the only way to address the opioid problem, but that’s the current dynamic.
If it’s legal in your state, you might try cannabis. My BIL had horrible back pain that only opioids helped with, until he tried cannabis – which gives him a lot of relief.
I think this is raw death rate, but it is interesting to look at the patterns. They push it back farther than I was looking at.
They refer to their own NBER paper:
Abstract:
The fivefold increase in opioid deaths between 2000 and 2017 rivals even the COVID-19 pandemic as a health crisis for America. Why did it happen? Measures of demand for pain relief – physical pain and despair – are high but largely unchanging. The primary shift is in supply, primarily of new forms of allegedly safer narcotics. These new pain relievers flowed mostly to areas with more pain, but since their apparent safety was an illusion, opioid deaths followed. By the end of the 2000s, restrictions on legal opioids led to further supply-side innovations which created the burgeoning illegal market that accounts for the bulk of opioid deaths today. Because opioid use is easier to start than end, America’s opioid epidemic is likely to persist for some time.
Of course, one should consider:
Authors’ note: Cutler is involved in the multi-district litigation regarding opioids as an expert witness to the plaintiff counties suing opioid manufacturers, distributors, and dispensers.
I assume this relates to what’s going on with the Purdue Pharma bankruptcy & lawsuits. So it’s good he discloses he has a direct financial interest in saying it’s the fault of Oxycontin.
Let us follow the logic:
But the national opioid epidemic cannot be explained by a secular increase in physical pain. The share of Americans reporting two or more painful conditions increased only slightly between 1999 and 2009. The number of emergency department visits for injuries declined over that period, and so did the share of Americans who reported moderate or severe pain. In our analysis, we estimated that changing levels of reported pain can explain only one-fifth of the increase in opioid use. If we control for pain that is severe enough to interfere with work, we find that only explains 4% of the rise in opioid use.
While opioids are meant to treat physical pain, many social scientists, including Case and Deaton (2020) themselves, have emphasised that economic dislocation can led to despair, which in turn can push people towards opioids. Yet opioid shipments were rising most quickly between 1999 and 2006, and Gallup data shows little change in life satisfaction during those years. Life satisfaction dropped during the Great Recession and then rose again after 2012, but those data don’t correspond to the time series for opioid shipments, which peak in 2010 and then begin a secular decline. Moreover, the flow of opioid shipments between 1999-2010 is uncorrelated with the share of people at the county level who report that they are dissatisfied with their lives. The great shift was not in the level of reported pain or in feelings of despair, but in the willingness of doctors to prescribe opioids for pain.
…
It did not take long for the first hints of failure to emerge. By the early 2000s, increased opioid-related deaths were noted in Maine, West Virginia, and Kentucky (Tough 2001), all areas with lots of manual labour and thus high rates of pre-existing pain. Deaths rose apace with opioid prescriptions throughout the 2000s.
The rising death toll eventually generated a regulatory response. Under pressure, Purdue Pharma produced an abuse-deterrent form of OxyContin in 2010 that made crushing and injecting the drug harder. As law enforcement cracked down on pill mills and doctors again became skittish about prescribing opioids, users turned to illegal drug markets. Entrepreneurs were more than ready to supply customers. Cicero and Ellis (2015) found that one-third of opioid users switched to other drugs immediately after the reformulation of OxyContin; the majority of those who specified a preferred alternative named heroin. Similarly, Evans et al. (2019) found no impact of the reformulation of OxyContin on overall drug-related mortality. An increase in the number of deaths from illegal substances offset the decrease in the number of deaths from prescription opioids. Quinones (2015) describes the highly efficient distribution network for heroin. Dealers used a system of drivers to carry Mexican-produced heroin right to one’s doorstep.
Nice for him to highlight the great service from illegal drug dealers. Way to serve the market!
The market serves the demand. Drugs are here to stay just like alcohol, nicotine, and caffeine. Taking away drugs is like taking away food, people will end up eating anything just to survive, even eating poison.
Two things converged to lead to doctors prescribing more opioid pain killers. One was a popular theory among physicians that pain was under-treated. This was well-intentioned, but didn’t play out well.
(Opioid manufacturers also pushed falsehoods about their particular pills being less addictive, especially when used for pain management. Perhaps they believed it, perhaps they were just pushers. Either way, they were wrong.)
The other is that doctors and hospitals started to solicit and publish patient satisfaction surveys around this time, as did third parties. And patients who are given opioids tend to be very satisfied, at least at first, which is the time frame when their satisfaction is measured. Conversely, patients who are denied pain killers tend to be unhappy.
I think chronic pain is undertreated, currently. I doubt it was much better-treated 20 years ago. Mainly because a lot of chronic pain can’t be treated effectively without knocking the person out. There aren’t a lot of good choices.
This rise in opioid overdose deaths can be outlined in three distinct waves.
The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 19993.
The second wave began in 2010, with rapid increases in overdose deaths involving heroin4.
The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl5,6,7. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.8
Many opioid-involved overdose deaths also include other drugs9.10.
This is not about pain medication, but psychoactive drugs.
In general, recreational drug users take their drugs at doses so much higher than psychiatric patients that they’re basically two different chemicals. A lot of our impressions of drugs, what side effects they have, and how dangerous they are, get shaped by the recreational users, not the patients. This is sometimes even true for the doctors who are supposed to prescribe to the patients and give them good advice. While studies of recreational user populations can sometimes be helpful in flagging an issue for consideration, we should be judging the clinical risks based on studies of clinical populations.
This isn’t medical advice. Don’t go out and take a mix of ketamine and amphetamine, then tell the cops that it was “just a clinical dose” and “this blog on the Internet told me it was okay”.
I’m not sure the amount of oxy prescribed for pain patients vs how much addicts like to use.
The issue with drugs isn’t really about dosage. Most recreational users know what their tolerances are. You don’t see dead people on the street often for that reason, nor do you see people die at music festivals (heck, 100k people go to EDC every year and almost everyone there is on drugs in 100 degree weather, every now and then 1 person dies from dehydration).
The issue is from mixing drugs, or having a sudden change in your dosage. Fentanyl preys on both of these effects because it’s so cheap and so potent.
Yeah, apparently it’s depressingly common for people to get clean for a while, then fall off the bandwagon and go back to their former dose, which their bodies can no longer handle.
Sobriety is often not a binary state of being, it’s a process and often involves success followed by relapse, and takes several tries.
I know too many stories of relapse, especially being involved in the foster system, and I think we need to teach people how to relapse more safely, because when it comes to heroin and fentanyl, something like 90% of people will relapse, sadly.
We also need to remove the shame and stigma from addiction and permit people the space to find support, and de-criminalizing drugs is an important part of that, in my opinion.
We need to stop thinking about drugs as some kind of terrible thing, and treating relapse the same.
People who are on drugs are scared of the concept of sobriety because nobody likes to hear the word “never”.
Imagine someone telling you that you can “never” go to Disney World again. That just makes you want to go to Disney World more, even though you might’ve never even gone in your whole life in the first place. Especially if you’ve gone as a kid, and have fond memories of it.
Being on drugs is an enjoyable thing, much like going to an amusement park. It’s an instant euphoric gratification, and the memory is locked in, exaggerated, imprinted.
Don’t tell people they can’t do something ever again. Tell them, you can do it, but you need to treat it as a reward. Doing it every other day is a problem, doing it once a quarter, or once a year, is like going to Disney once a year. That’s fine.
There are just as many high functioning users (music festivals, frat parties, wall street, techies, etc.) as there are poor addicts. The difference is, when you have responsibilities (AKA a job, or school), that keeps you in check. Everyone knows what people do when they or their kids go to EDC, Coachella, Burning Man. No one bats an eye.
My friend who works for Amazon does coke with his boss when they go out after work together. Completely normal. In fact, I don’t know anyone who works for the big techs that hasn’t done hard drugs at least once in their life. There’s a reason tech firms don’t do pre-employment drug screens. Because they wouldn’t be able to hire anyone.
Wholly, completely, viciously untrue. People literally lose their children over drugs and would never choose drugs over their kids if they had any real choice.
I have also watched people with jobs, security, families slowly lose control and end up homeless and hopeless because of drug use.
Some people don’t struggle with addiction. Some do. It’s not a class divide.