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THE OPIOID CRISIS and the NEXT FUTURE CRISIS?

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ABOUT THE DOMESTIC OPIOID CRISIS and a FUTURE CRISIS? 

I grew up with - and I've treated drug addicts. And, I do know those who have been affected by drugs and the opioid epidemic in the USA. Very SAD!

Now, drug overdoses killed 70,237 Americans in 2017. Of these deaths, 47,600 (67.8%) involved opioids and 17,000 involved prescription opioids (24% of total overdose deaths). Legally prescribed opioids are killing 47 of us every day.

So, I now ask:

  •  How did we get here?
  •  Should we treat?
  •  What do we do for treatment?
  •  Who pays for treatment?
  •  What is the next drug epidemic on the horizon?


Any experiential or informed thoughts?
Many thanks.

opioid addiction
Drugs of Abuse
Heroin and Opiate Addiction
Dr. David E. M
2 months ago

5 answers

1

I work in the drugs field in the UK and can provide a view of the UK situation which may allow you to draw a comparison to the US:

  •  How did we get here?


A mix of social, political and economic factors all impact on the desire or need to use both illicit and prescribed medication.

In the UK, drug-related deaths linked to pregabalin and gabapentin have risen 2,675 per cent and 637 per cent respectively in just six years. 

Pregabalin and gabapentin prescribing in the UK has increased by 350 per cent and 150 per cent respectively in five years, and an increasing number are also being bought and sold on the streets.

The UK government has confirmed that they will become class C drugs from April 19.

  •  Should we treat?


Yes

  •  What do we do for treatment?


Offer a range of interventions based around the needs of the user. One size does not fit all.

  •  Who pays for treatment?


In the UK individuals can access treatment via the local drug service. However nearly 60 per cent of local authorities have slashed budgets for these services over the last year, amid government cuts to public health grants.

Some councils axed as much as a third of the money set aside to help users, and Birmingham reported the biggest reduction after wiping nearly £4m from its budget.


Experts are concerned the lack of specialist services means underlying addiction problems are not being addressed, leading to additional strain on the NHS.

The link below shows a report from The Independent, a national newspaper in the UK.

http://ow.ly/D2Jx30nEyFv

  •  What is the next drug epidemic on the horizon?


In the UK there has been a dramatic rise in the use of synthetic cannabinoids such as spice and also an increase in the use of Image and Performance Enhancing Drugs.

Mark Tudor
2 months ago
Amazing treatise and learning opportunity; many thanks for the update. - Dr. David E. 2 months ago
1

Reference post above titled: How many of these deaths are accidental and how many intentional?

Karel Petrak brings up an important point - one that I always wonder about when researching the opioid crisis.

Are there any stats that separate overdoses from opiate-related suicide? And to break this down even more, OD's in emergency rooms where the patients don't die, and attempted opiate-related suicides? They all seem to be lumped together. 

Suicide is a complex subject. I don't want to get into a long discussion about it. But if someone decides to end it all - and swallows a few mouthfuls of oxycodone, along with whatever else that happens to be around - he/she is not (necessarily) a drug addict, nor a victim of the opioid crisis. If you want to commit suicide, there are many other ways to do it.

I think I have enough medications around to do myself in - some leftover Percocet from the dentist, some leftover Xanax from years ago, and probably some other stuff. I'm not an opioid-addicted drug addict. Yet, if I down all of these to end my life I'll be considered an opioid-related drug casualty on all the graphs and charts.

This doesn't help solve or understand the opioid crisis, doesn't help to understand the causes of suicide. Apples and oranges.

Some good charts that, of course, mention every possible combination of drug overdoses - but has no information about suicide:

Overdose Death Rates
https://bit.ly/1znaUDW

Chuck Nyren
2 months ago
The crisis may actually be suicide - but not the method of suicide? - Dr. David E. 2 months ago
Dr. Marcinko - now you've opened up a real can of worms. That's too deep a subject for me to comment on... - Chuck 2 months ago
I know - me too - Sorry - Dr. David E. 2 months ago
Good sense of irony! - Dr. David E. 2 months ago
Sad Link from a collague: http://www.idealmedicalcare.org/why-happy-doctors-die-by-suicide/ - Dr. David E. 2 months ago
In the UK the ONS (Office for National Statistics) measures deaths as Drug Related Deaths and Drug Poisonings. The links shows the view from a UK perspective - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2017registrations - Mark 2 months ago
Interesting - many thanks - Dr. David E. 2 months ago
Interesting article in the NYT. And the comments are illuminating, so click that section: https://www.nytimes.com/2019/03/04/upshot/opioid-overdose-crisis-deaths.html Culled from the comment section: According to the Cochrane Review, about 0.5% of people who ever take prescription opioids end up using heroin. - Chuck 1 month ago
As a doctor, I know. Thanks - Dr. David E. 1 month ago
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How did we get here?
Out of desperation to solve the problem of drug addiction, politics and invested money.
 Should we treat?
What is the chance of recovery? A support system to get out of drug addiction does not suffice. We need to remove the access
 What do we do for treatment?
Out of charity and humanitarian reason, I guess/
 Who pays for treatment?
Taxes, people who work hard
 What is the next drug epidemic on the horizon?
Going higher and higher

Edna Cuaresma, MD, LlB
2 months ago
What is the next drug epidemic on the horizon? BUT- Exactly which drug or group of drugs, etc? - Dr. David E. 2 months ago
Anti depressants - Edna 2 months ago
I totally AGREE; many thanks. - Dr. David E. 2 months ago
Anything else? - Dr. David E. 2 months ago
0

How many of these deaths are accidental and how many intentional?

Karel Petrak
2 months ago
THINK about your question, please! - Dr. David E. 2 months ago
VIDEO LINK: https://youtu.be/NiV6RY5vRD0 - Dr. David E. 2 months ago
Related and very interesting: https://www.scientificamerican.com/article/how-to-prevent-suicide-with-an-opioid/ - Dr. David E. 2 months ago
What about the next drug "crisis"? - Dr. David E. 2 months ago
Scientific American link above by Dr. David E. Marcinko MBA : While anectdotal, I went through some physiological issues ten years ago. I took a percocet for another reason at the time, and the physiological issues vanished. So this article makes perfect sense to me. - Chuck 2 months ago
Pain meds cause "dissociation" so you are correct. They do not numb pain. - Dr. David E. 2 months ago
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WHAT IS NARCAN?

NALOXONE is a narcotic blocker. It is used to treat narcotic drug overdose. It is used to temporarily reverse the effects of opioid medicines. T

his medicine has no effect in people who are not taking opioid medicines.

Any thoughts?

Dr. David E. M
2 months ago
In the UK we have both intramuscular (Prenoxad Injection) and intranasal (Nyxoid) variants of naloxone. Under regulations that came into force in October 2015, people working in or for drug treatment services can, as part of their role, supply naloxone to others, if it is being made available to save a life in an emergency. - Mark 2 months ago
UK may be ahead of US in this regard; many thanks - Dr. David E. 2 months ago
Having experienced harm reduction provision in both the UK and US I would suggest that the UK is ahead of the US. Both Scotland and Wales have national take home naloxone programmes and in England take-home naloxone was provided in 138 of 151 local authority areas. - Mark 2 months ago
Interesting - Many thanks for the update - Dr. David E. 2 months ago

Have some input?