Why is America the only country with an "opioid epidemic"?

[Bragi2]

This quote below is from a thought-provoking article I recently came across, which discusses the several "pathologies" afflicting America, and contributing to its decline...

"So there is of course also an “opioid epidemic”. We use that phrase too casually, but it much more troubling than it appears on first glance. Here is what is really curious about it. In many countries in the world — most of Asia and Africa — one can buy all the opioids one wants from any local pharmacy, without a prescription. You might suppose then that opioid abuse as a mass epidemic would be a global phenomenon. Yet we don’t see opioid epidemics anywhere but America — especially not ones so vicious and widespread they shrink life expectancy. So the “opioid epidemic” — mass self-medication with the hardest of hard drugs — is again a social pathology of collapse: unique to American life. It is not quite captured in the numbers, but only through comparison — and when we see it in global perspective, we get a sense of just how singularly troubled American life really is."

The full article is here:

https://eand.co/why-were-underestimating-american-collapse-be04d9e55235

I'm still thinking about it. This commentary is really about America's despair, and the unique pathological signs of its decline.

I'd be interested in any comments.

Regards to all.

[Dave Starsky]

1. I've always thought this was the reason.

American life is fucked up. We need anesthesia.

[Bragi2]

3. The author agrees with you

He raises the question of just how fucked up is America, and what does it mean? Is it fixable. His answers are disturbing.

[unblock]

2. there was a study with rats, i think, about self-regulation with opiates

maybe i'm mixing up a dim memory, but i seem to recall a study where rats in cages would starve themselves and/or overdose on narcotics if given the choice between food or drugs.

but if they had a wide open play area where they could run around and play with other rats, they were fine, even with the same access to endless drugs.


the analogy to the human condition may not translate, but i think there's something to it. having a healthy support network is key to managing addictive things, and america, the land of the long ranger and pull-yourself-up-by-your-own-bootstraps is probably not well set up for that....

[Bragi2]

5. Yes, the article makes that point

It is exactly the lack of healthy support systems, and a culture of apparent indifference, if not cruelty, towards the hardship of others, that leads to mass despair. (He doesn't talk at all about racism in this piece, but I think much of what's self-destructive about America today stems from the initial "original sin" of slavery, and its evolution into an abiding racism so dense that you can barely see it day-to-day, or even in social policy, but it sure is there when you look at who lives with the worst social inequalities and state violence.

[Mariana]

4. Can you buy heroin and fentanyl off the shelf in other countries?

Paracetamol with a bit of codeine is one thing, stuff like fentanyl and heroin (which is what is killing a lot of people in the us) is quite another. They're all opioids, but the effects and the danger are vastly different.

I wish the data were readily available about how many of these deaths are a result of mixing the opioids with alcohol or other depressant drugs. Mixing other drugs, especially alcohol with opioids make a very deadly combination, and that should be emphasized much more than it has been. It would save lives.
'

[Bragi2]

7. Heroin is legally available in many countries in Europe and elsewhere

I don't know a lot of about it, but if heroin is readily available as a medicine, then I presume there isn't much need for fentanyl. (I could be factually wrong on that.)

[Mariana]

19. The OP plainly said anyone can by "opioids" without a prescription.

I was trying to clarify, because some opioids are much more dangerous than others. The very weak stuff commonly available off the shelf in some countries isn't causing a much of a problem because it's very weak stuff.

[Aristus]

6. One culprit may be a fundamental misunderstanding as to the purpose of opioid pain meds.

The goal with opioid treatment is not to make the patient completely 100% pain-free. It's to make the pain (especially acute pain, which is what opioid meds are for) manageable until the resolution of the underlying issue.

I've had too many patients for whom the expectation was that they should not have any pain at all.

"It's been six weeks since your surgery. How are you feeling?"

"I'm still having a little pain. Could you give me something stronger?"

This is leaving aside the La Brea Tar Pit that is the discussion of opioid treatment for chronic pain. But American consumers (and patients are viewed as consumers of health care) are bombarded by TV commercials for medications that offer to treat every symptom known to humanity, and come away with the idea that every adverse symptom requires a treatment. Expense and side effects be damned, if I have an annoying symptom, I demand a medication to remedy it.

Direct marketing to consumers (and patients) doesn't happen in any other country that I'm aware of. It is patently illegal in most other industrialized nations. Advertising works. It wouldn't be a billion-dollar industry if it didn't.

[Bragi2]

8. Good article on this exact issue yesterday

I note that the NY Times had an article on the weekend about a post-op American woman living in Germany who wanted pain medication to take home, they said no, live with the discomfort, it's there for a reason. She eventually understood, and writes about, the wisdom in that approach.

https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html

[Aristus]

9. I'm not sure I'm comfortable telling my patients "Live with the discomfort".

That sounds unnecessarily callous. But I do advise my patients with joint fractures, especially of the lower extremities, that being pain-free until resolution of the fracture can be quite dangerous, as a lack of pain during ambulating on a fractured limb or joint can contribute to a re-injury the patient may not even be aware of until debilitating damage has been caused.

Pain let's you know when something's wrong.

[Bragi2]

10. True, maybe it's a matter of degree

For intense pain, relief is sensible. For moderate pain, maybe not, maybe it's better to know when and where you have pain. I occasionally have had minor back problems. When I have an episode, and I take an over the counter pain medication, it seems to take longer for the discomfort to go away than if I experience the pain and move and sleep more cautiously. (Okay, I know that's an anecdote, not a study that proves anything, but still.)

[customerserviceguy]

11. I see your Washington State flag

How does medical marijuana help these folks, or not? It seems that we might avoid a lot of problems with opiates if marijuana was of similar efficacy in dealing with chronic pain.

[Aristus]

13. I'm so grateful for the fact that I live in a state where marijuana is available over-the-counter.

So many of my patients are able to experience relief from chronic pain without the addictive and debilitating effects of opioids. I request that they use edibles or other non-smokable varieties, due to the health effects of smoking. I also request that they treat marijuana the same way as alcohol; use in moderation, don't drive or operate any heavy machinery, wait until you don't have to go anywhere or be responsible for other people, and use wisely.

If someone is able to post a study that correlates availability of cannabis to a decrease in opioid use, addiction, and overdose, that would be helpful.

[Bragi2]

15. There's this study

Legal marijuana is saving lives in Colorado, study finds

https://www.washingtonpost.com/news/wonk/wp/2017/10/16/legal-marijuana-is-saving-lives-in-colorado-study-finds/?utm_term=.7f6941cda3f6

The study is here:

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304059?journalCode=ajph

[GrapesOfWrath]

17. Ive seen a few articles on this topic

For example this one....

Legalizing Marijuana Decreases Fatal Opiate Overdoes, Study Shows

[link:https://drugabuse.com/legalizing-marijuana-decreases-fatal-opiate-overdoses/|

[Aristus]

20. Thank you both.

n/t

[kydo]

12. Maybe cause we have a pill for everything, & don't know the difference between pain and discomfort.

[Aristus]

14. Exactly. See my reply above.

[seaglass]

16. People have liked getting high for eons, this particular high happens to be more fatal and

addictive than many other options.

[WhiskeyGrinder]

18. Part of it is our terrible relationship with work, our lack of paid sick leave and the bizarre

preoccupation with personal productivity beyond all else. Most pain after surgery means "slow down, take it easy, let me heal." But because paid sick leave is such a rare thing, and because so many are in tight financial situations, people feel pressured to go back to work as soon as possible, without healing. So they need something to keep working. They never heal right, and then they're addicted.

[politicaljunkie41910]

21. Great article. Thanks for posting. I'm forwarding it on to family members and my adult children.

Perhaps the future generation can save themselves from ours and past generations mistakes.