The New York Times assembled a committee of “30 experts” to come up with ways to “solve the opioid crisis” (report) by spending $100 billion in tax dollars.
None of these folks offered the idea of “stop creating new addicts by buying opioids with tax dollars”! They don’t like opioids, but they want the U.S. government to keep buying them.
I find this interesting as an insight into the cognitive processes of Americans.
Related:
I understand that some of these opioids are so strong that they’re actually difficult to self-administer (you pass out before you can press the needle all the way in). It’s surprising to me that no one is seriously advocating that we move one of the lower-grade ones (perhaps raw opium) to O.T.C. status and let the addicts do their thing cheaply and relatively safely. (and on their own dime)
superMike,
You mean the way it was done for hundreds of years?
That would be too simple. We need rules dammit! Lots of em! And $100B to administer them all. Can’t let people just live and make decisions on their own. Large sections of the middle class would lose all meaning and purpose as they could longer commodify the misery of the less fortunate and retire at age 50-55.
Hmmm, my mantra has been, for years, that the average person is an idiot. However one of my cousins, who holds a PhD and much smarter that I, tells me that it’s 80%. I have been wrong all these years.
Unless you are very rich, you will change your opinion immediately when you fall ill with e.g. a difficult cancer. Opioid medicines (Oxycontin/Oxynorm) are quite expensive. When you suffer from _severe_ pain and can not afford the pain relief Oxys provide, you most likely will turn off the main switch of yourself, a way or another.
Oxys are a very narrow fraction of opium, Oxys do not provide euphoria, they just provide pain relief for specific type of pain (and as a side effect a horrible constipation). In addition they can help with withdrawal symptoms that are due to hard drugs. Oxys do not provide any kind of a “high”, they put the users in bed.
This crusade against of an extremely good pain killer is only possible because of the social media, it is a media sexy issue and the better people now have an easy method to lung out about their superiority. I almost hope that everyone of them would get a bone eating cancer.
Phil, how would your very attractive and simple proposal work out in practice? Do you think that Medicaid should stop subsidizing pain relief medications, as Polka pointed out? Pain relief, like kids and shelter, should be a luxury?
Are there other examples in the past where the solution of “taxpayer dollars are making this problem worse, let’s stop funding it all together” have led to an overall better situation?
@Poika – that’s not the case. Even if it’s not for the high, these drugs are extremely addictive, and were recklessly promoted by the industry. Doctors were very reluctant to prescribe them and the industry convince them it was safe. It’s still amazing how my American friends tell stories of receiving “buckets” of opioid pain killers for what’s considered minor inconveniences. No one is denying these drugs aren’t useful and don’t have a place in medicine. The question is how to do it safely. Do you think Europeans don’t suffer from pain? Why is it that there’s about 10x less amount of drug related and significant lower consumption of opioids? (https://www.vox.com/policy-and-politics/2017/6/28/15881246/drug-overdose-deaths-world). Not that it can’t move to other places, but currently it’s clearly a major problem in North America.
@philg – No one also referred the moral and legal/criminal aspect of of drug usage (not specifically for medical drugs, but in connection with other opiates, like heroin). We the Portuguese haven’t done much worthy of being proud of in the last 500 years, but dealing with a heroine epidemic is one of the few things worth publicising. The nineties were catastrophic in terms of heroine addiction, along with the public safety and public health (HIV) issues that happened concurrently.
It’s been mostly solved, in a non-violent, human way. Part of it was admitting you can’t eradicate addiction, but you control and minimise it. Other aspects were eliminating the moral judgement and treating addicts as patients, not criminals. Finally, it requires constant work on the ground. This is not something you just see in the statistics – any Portuguese that that lived through the late eighties to early two thousands will tell you how dramatically effective the measures were.
http://www.cbc.ca/news2/interactives/portugal-heroin-decriminalization/
The U.S. consumes about 80 percent of world opioid supply (https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html ) with 5 percent of population. Unless we are smarter than everyone else on the planet, we are doing something terribly wrong.
According to the stuff that I’ve read, the U.S. government is simply incapable of controlling its spending on opioids through Medicaid. While this can enrich physicians, pharmacists, drug vendors (opiates would be ridiculously cheap absent government regulation and then purchasing), et al, it has been harmful to citizens who aren’t part of the health care and drug treatment industries.
So yes, as a first step, we have the government go cold turkey on buying opioids for non-hospitalized patients. Copying the Portuguese for dealing with the addicts we’ve already created is probably a reasonable step as well. If when it all shakes out there are Americans who need opioids and can’t afford them, Yz, you can start a Gates Foundation-style non-profit org (without the focus on shipping American cash to Africa!) and become the big hero.
Are there examples of situations getting better after the government stops trying to make them better? See
https://en.wikipedia.org/wiki/Airline_deregulation
(part of a generalized program started by President Nixon: https://en.wikipedia.org/wiki/Deregulation#Deregulation_1970%E2%80%932000 ).
I don’t think that the Socialist-era Eastern European or Soviet governments ever did anything as dumb as buying huge vats of opioids for their citizens, but generally these countries scaled back their governments quite a bit in the early 1990s. So you could ask whether today’s Estonia and Lithuania, for example, are in better shape than when the government controlled a larger percentage of the economy.
What is the difference between The New York Times and The Pravda? The latter was just 3 kopecks: no wonder Russia is screwing “our democracy”.
IMHO, The NY Times panel is not worth much. The basic idea of substituting confidence for competence has worked out for them.
Propaganda wants to be free, and it does not even matter where on the ideological spectrum it is.
@philg:
> I don’t think that the Socialist-era Eastern European or Soviet governments ever did anything as dumb as buying huge vats of opioids for their citizen.
Hm, did they have to? The Kalashnikov worked just fine.
Francisco, Oxys are _not_ addictive at all (e.g. full Opium is). Oxys do cause physical dependancy but that is very very easy and quick to wean out. Normal tobacco is extremely strongly addictive for every smoker since the addiction is psychological (and the same goes for alcohol but only for a portion of drinking population).
If Oxys are _misused_ (crunched, extracted and then injected) then the physical dependancy is of course higher and one can die if the injected dose is too high. But Oxys are tablets, when they are used as prescribed they are very very safe and really effective medicine without other major side-effects than a constant severe constipation.
Nearly everything can be misused. But it is wrong to make the legitime patients to suffer because of some drug junkies. Already, people who suffer from severe pain are harassed in many ways, they would be able to live a so so decent life (what is left from it) with proper dosing but they are (1) confined to their home country, it is nearly impossible to travel with Oxys and (2) they get only a very small amount of the medicine per visit to the pharmacy so they are forced to make tens of trips to the pharmacy per year (and those years are most often very limited). People who suffer from severe pain are not criminals. If a doctor prescribes Oxy’s incorrectly then that doctor is a criminal.
The idea to dump/confine all the people who suffer from severe pain into hospitals is not from this world, it is a cold/brutal idea.
Will I still be a big hero if my Gates-style private foundation refuses to provide opioids to people whose skin color I don’t like?
Yz: If you hate white males and discriminate against them by giving aid only to women or only to non-whites, I think you’re okay. But if you discriminate against officially favored classes of U.S. residents then I think that you lose your non-profit status as being “against public policy”. See https://www.irs.gov/pub/irs-tege/eotopicj85.pdf
See also http://time.com/3939143/nows-the-time-to-end-tax-exemptions-for-religious-institutions/ (cutting off organizations that do not support same-sex marriage; I think it would be okay to have a church that refused to perform mixed-sex marriages)
(There is, of course, the risk that any non-governmental enterprise, for-profit or non-profit, will discriminate against groups with a favored status. Thus the fairest way to organize an economy is by having the government plan and run everything.)
@Poika
While I agree with your overall point. I do have to question where you’re getting your data regarding the non-addictiviness of oxys.
from wikipedia: “Oxycodone, like other opioid analgesics, tends to induce feelings of euphoria, relaxation and reduced anxiety in those who are occasional users. These effects make it one of the most commonly abused pharmaceutical drugs in the United States.”
There is every indication in the literature that Oxy causes both physical and psychological habituation. This is confirmed by anecdotal reports I’ve heard that says that it’s definitely a good time.
And again, personally, I agree with you that is a very effective medicine when used carefully and according to guidelines. But, to categorize it as non-addictive is untrue.
Anonymous, I have over 6 year experience in palliative care. Not all the “knowledge” that is in Wikipedia is true/correct/honest knowledge, and not all the “documents” on the TV are true/correct/honest documents, most are just plain entertainment/fiction dressed and advertised as documents. I try an other way:
1) A healthy sane person who has no history of drug/medicine/substance abuse falls ill with cancer. Gets Oxys. Not a single one of such persons get hooked up with Oxys, they will not abuse the medicine, they will not experience any other kind of euphoria but real relief from pain and they wean out of the Oxys very easily, in a week or less, without any trouble or horrors (that the TV “documents” are teaching).
2) A drug junkie who is sweating and hallucinating due to graving for heroin, meth or any other such hard drug that the junkie is not able to get hold off at that moment, but gets Oxys, will most likely tell you that Oxys do provide a sort of “high” or euphoria, but the truth is that Oxys just provides the junkie a relief from the withdrawal symptoms that the junkie is suffering from (and does it much better than Buprenorphine (Subutex)).
3) A drug junkie who is already under massive influence of a hard drug (i.e. “high”) will not want Oxys, and if such a drug junkie takes Oxys it will cut the “high” / euphoria that the junkie is experiencing and most likely puts the junkie into bed.
With full Opium and its most strong alkaloid fractions the wean out phase is more difficult, Oxys are a very very narrow fraction of an alkaloid. Even with full Opium it is highly unlikely that people who suffer from severe pain and are in need of the medicine would misuse it. Trying to cope with the illness takes a huge toll and all that they want is relief from the pain, also they will not take the risk that such an effective medication is taken away from them because of misuse.
The Oxy crusade is a goldmine for the media and the advertisers. And it makes the life of severely ill people miserable as they are being treated much worse than the criminals/junkies. Common people have been watching TV entertainment about drug abuse for decades and therefore they are now fully qualified professionals and are lunging out about their superiority and knowledge everywhere they can. Also, amazingly many doctors have absolutely no real life experience in this field, they too base their stance (mostly) on what they have “learned” from the TV entertainment.
@Poika
Thanks a lot for that perspective. I totally agree we do more harm than good by restricting drugs to those who need it, simply because a minority of the population insist on abusing the drugs.
Poika: I don’t think that what you’re saying is inconsistent with the original post. OxyContin can be helpful to some patients. A year of OxyContin is not helpful for a patient with minor back back. Due to the fact that government spending on OxyContin is limited only by the greed of doctors, pharmacists, etc., it is impossible to rely on government-run programs such as Medicaid to distinguish between cases where OxyContin is helpful versus harmful. Therefore the government should withdraw from this area and leave it to private individuals and charities, etc.