The Opioid Epidemic
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03-01-2018, 07:52 AM (This post was last modified: 03-01-2018 08:20 AM by Cypher44.)
The Opioid Epidemic
Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people (1) in 2015. Overdose deaths were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides. (2)

Opioids are a diverse class of moderately strong painkillers, including fentanyl, oxycodone (Sold in US as OxyContin or Percocet) and hydrocodone (Vicodin), fentanyl is synthesized to resemble opiates such as heroin and morphine, despite high risk of addiction and overdose, their potency and availability have made them popular as medical treatments and recreational drugs, they have a sedative effect on parts of the brain regulating breathing, so in high doses, they may cause respiratory depression and failure and death.

Drug overdoses have since become the leading cause of death of Americans under 50, with two-thirds of those deaths from opioids. In 2016, the crisis decreased overall life expectancy of Americans for the second consecutive year. Overall life expectancy fell from 78.7 to 78.6 years.

Opiates such as morphine were used as pain relief in the American Civil War and Bayer began marketing heroin in 1898, and in 1924, heroin was illegalized, heroin addiction began to make news when stars such as Jim Belushi, Janis Joplin all died of heroin overdoses

Vicodin and Percocet entered the market in the 1970s, doctors were at first, apprehensive about prescribing them, this all changed with a letter published in the New England Journal of Medicine in Jan. 1980,(3) written by Jane Porter and Hershel Jick, which concluded that patients treated with narcotics did not get addicted.

Oxycodone is the most widely-used recreational opioid in America. The U.S. Department of Health and Human Services estimates that about 11 million people in the U.S. consume oxycodone as a recreational drug annually and was introduced in the 1970s and originally classified as a Schedule II drug, indicating a high potential for abuse, in 1996, Purdue Pharma, released OxyContin, a controlled release version of oxycodone and then used a polymer to make the drug difficult to crush or dissolve in water to reduce OxyContin abuse, this version was relabeled as abuse-resistant by the FDA.

Fentanyl, a newer synthetic opioid painkiller, is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin with only 2 mg becoming a lethal dose. Fentanyl-related deaths increased by 540% across the United States since 2015.

Demographics of overdose victims:

[Image: US_map_of_drug_overdose_deaths_per_100%2...S_2015.gif]
[Image: US_map_legend._Drug_overdose_deaths_per_...lation.gif]

As of March 2017, President Donald Trump appointed a commission on the epidemic, chaired by Governor Chris Christie of New Jersey.

On August 10, 2017, President Trump agreed with his Commission's report released few weeks earlier and declared the country's opioid crisis a "national emergency."
Trump nominated Representative Tom Marino to be director of the Office of National Drug Control Policy, or "drug czar"

However, on Oct. 17, 2017, Marino withdrew his nomination after it was reported that his relationship with the drug industry might be a conflict of interest.

In July 2017, FDA commissioner Dr Scott Gottlieb stated that for the first time, pharmacists, nurses, and physicians, would have training made available on appropriate prescribing of opioid medicines, because opioid addiction had become the "FDA's biggest crisis".

In April 2017, the Department of Health and Human Services announced their "Opioid Strategy" consisting of five aims:

1.Improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid addiction and to enable individuals to achieve long-term recovery.

2.Target the availability and distribution of overdose-reversing drugs to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations

3.Strengthen public health data reporting and collection to improve the timeliness and specificity of data and to inform a real-time public health response as the epidemic evolves

4.Support cutting-edge research that advances our understanding of pain and addiction leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms

5.Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.

What do you think of the measures being taken, are they stringent enough or not, will they be effective?

1. CDC Report
2. Washington Post Article
3. NEJM Letter

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03-01-2018, 07:53 AM
RE: The Opioid Epidemic
Ok that won't post because it's too short so
Sux Dick.

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03-01-2018, 08:57 AM
RE: The Opioid Epidemic
I think the strategies would be at least somewhat effective, if they had a chance in hell of being implemented. They don't. Puppet has made clear that he doesn't want to pay for science or health care initiatives in general.

The administration is going to go with "just say no." Cheap and morally convenient, as it puts the blame for addiction on the victim. (No matter that many opioid addicts start on their path due to legally prescribed meds for pain from operations, etc.; facts don't matter.)

The department's analysis may be helpful to guide opioid initiatives developed by the states, though.
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03-01-2018, 09:45 AM (This post was last modified: 03-01-2018 09:49 AM by BikerDude.)
RE: The Opioid Epidemic
I believe it. Opioids used to be an inner city thing.
Now it's rural as well. I think the answer to a lot of problems is hope.
A future.

There’s a clear link between America’s opioid crisis and unemployment

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03-01-2018, 01:38 PM
RE: The Opioid Epidemic
I got five ideas, taken from the Health Strategy Group from the Aspen Institute, a non-partisan think-tank

1. Stop overprescribing, Nearly 250m prescriptions for opioids were written in the US in 2015 - far more, per capita, than in other countries. (1), and for simple things such as ankle sprains etc. Opioids are now are $10bn industry in the US (£7.6bn) (2)

2. Greater access to treatment, only one in four people with opioid addiction are actually treated, according to a survey (3), methadone, naltrexone are both drugs used to treat addiction, most effective when combined with behavioural therapy

3. Overdoses don't have to be fatal, naloxone, a drug can block effects of drugs on the brain when administered promptly, by injection or nasal spray, it can save lives. In 42 states, bystanders found with illegal drugs now have immunity from prosecution if they call for help, or administer Naloxone to someone who has overdosed and forty states now allow pharmacists to prescribe Naloxone, or a doctor to issue standing orders rather than individual prescriptions, so that it is easier to obtain. These efforts may be hampered by the price hikes in 2016 (increased from $690 - $4500 in 2016) (4)

4. Addiction is a chronic medical condition, but it is often viewed as immoral and a crime, a factor which can limit access to treatment. It can also be the case that drug users are not allowed to live in public housing which, in turn, makes their lives less stable and access to support like social services less likely. However, nearly all housing authorities "institute more stringent bans than required by federal law", a study by the US Department of Housing and Urban Development found.

5. The opioid crisis emerged from an incorrect understanding of how to treat chronic pain (see NEJM Letter in OP), therefore investment in research can help encourage appropriate use of opioids.

1. US uses more opioids than anywhere else
2. Lucrative Industry of Opoids
3.National Survey on Drug Use and Health
4. Who Should Be Saved?

PS. the 2nd source is an NY Times article focused mainly on how opioid prescriptions have declined from 2013-2015, however, there is a
section of the article which mentions the point I raised in this point, made by IMS Health, an information firm whose data on prescribing is used throughout the health care industry

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