Is this opiod crisis another example of the cocaine vs crack cocaine scenario?

[Baitball Blogger]

Not that I disagree with providing the necessary help to the afflicted areas, but, it just surprises me to see the testimonials and the pouring of compassion for their plight. Without fault people are blaming the lack of jobs for the slide into addiction. No disagreement here. Why didn't they come to the same conclusion decades ago with the crack cocaine situation and the plight of urban areas?

[leftstreet]

1. skin color n/t

[HAB911]

12. +++++++++++

[MrScorpio]

20. Bingo! nt

[femmocrat]

2. I don't know the answer, but I wonder....

Where are all these opiods coming from? And how do they end up in the rural areas? I find this shocking as hell:

In Kermit, West Virginia—with just 392 residents—a single pharmacy received roughly 9 million pills over the course of two years.

https://qz.com/866771/drug-wholesalers-shipped-9-million-opioid-painkillers-over-two-years-to-a-single-west-virginia-pharmacy/

I wonder what percentage are prescribed "legally"? WTF?

[Baitball Blogger]

5. Looks like a social engineering strategy that may have backfired.

My biggest pusher is CVS. Damn. I had a doctor that prescribed medications very liberally, which I would usually taper off on my own. But then CVS started this automatic service, which involves an automatic call when it is time for a refill. At first, I went by to pick up the prescriptions until I realized that I had more bottles than I needed. But, even though I asked them to stop calling, on the next refill time I got a call saying that my refill was READY FOR PICK-UP.

I was wondering, hmm, that doesn't sound right. I called them up and inquired and they said the doctor refilled it by phone. I plan to ask the doctor how that transpired because I suspect that it was CVS who called her without my permission!

So, I think the pharmaceuticals might have some blame. I can understand how the automatic calls make sense for something like cholesterol pills, but if they are also doing it for pain pills, BINGO, we may have the source of a problem.

[femmocrat]

9. Wow. That is crazy.

No wonder so many pills are out there!

[Kaleva]

13. I don't think you are correct about CVS calling your doctor

My wife gets her psych meds from CVS automatically as long as there are refills. When the last of the refills arrive, she has to call her doctor to send CVS another script. In all these years, CVS has never initited contact with her doctor about refills.

[Baitball Blogger]

15. What you describe is as it should be.

Something went awry and I will find out who is telling the truth the next time I see my doc.

[ProfessorGAC]

14. Yikes!

That's 26 pills a day per person for 2 years. My wife is on those for chronic back pain and it takes her at least the full month to go through the amount given, usually more like 5 weeks. And she doesn't renew the scrip if she still has some left, so she's not stockpiling.

That's a preposterously high number in that report.

[mr_lebowski]

27. For all we know, they're the only pharmacy stocking opioids for a 100 mile radius ...

And 50K people use it for their pain meds every year.

IOW, the physical 'town population' doesn't really mean much, not w/o addt'l info.

That's a perfect example of how 'statistics' can be manipulated.

Or ... maybe there's a problem. That's also possible.

But it's not an absolute.

[jberryhill]

3. It's a lot of things...

I'm still trying to understand what was the therapeutic need for opiods, and what, if any, advantages they confer over opiates.

Part of the distinction between the opioid situation and any other illicit drug, is that the initial part of the supply chain is legal and politically powerful.

[Bradical79]

6. I don't know the difference

But the painkillers my doctor prescribed me when I had kidney stones felt amaaaaazing! If I was more prone to substance abuse, I'd have kept taking those pills and probably be out trying to get another fix right now.

[marylandblue]

7. The newer opioids were marketed as being less addicting

This was based on very thin evidence and turned out to be false, but a generation of doctors has been trained to think it.

[jberryhill]

8. Is there any significant therapeutic difference?

The drug companies have made a mint off of the diversion of these drugs.

[marylandblue]

10. I think some are stronger than others

But all of them are addicting. I think is going to be like tobacco and asbestos -- major lawsuits based on their continuing to market the products as safe long after they knew the truth.

[LeftInTX]

24. Sustained relief opioids - Oxycontin

I believe it was marketed by Purdue pharmaceuticals.
They were adamant that break through pain be controlled by increasing the dosage. This is awful.
Often these pills wear off before 12 hours. It is better to take a short acting med for break through pain instead of increasing the dosage.

[mr_lebowski]

29. To clear things up ... 'opiates' used to be the class derived DIRECTLY from the Poppy ...

Last edited Tue Jun 27, 2017, 12:20 AM - Edit history (2)

Codeine & Morphine are the 'opiates' present in the poppy ... so those two were 'opiates' ... AND any made through very simple chemical reactions DIRECTLY from them, such as Heroin, with is Di-Acetyl Morphine.

Whereas 'opioids' were 'more-complicated-to-make derivatives' such as oxycodone and hydromorphone. These two are 'semi-synthetics', they CAN be made directly from Codeine or Morphine, but it's cheaper to make them from Thebaine, with is another chemical of the Opium plant that is chemically opiate-LIKE, but not actually a useful 'opiate' in terms of being an analgesic. Basically thebaine is a by-product of the processing of poppies to make 'opiates' that turned out to be useful in making drugs with VERY, VERY similar qualities, with minor changes. Something of a 'opiate-precursor' you might say.

NOWADAYS ... the distinction between 'opiate and opioid' is considered 'medically meaningless', and EVERYTHING that is a mu-receptor agonist in nature (everything from opium itself to morphine to fentanyl) ... is now called 'opioid', because there's inherently no major difference between ANY OF THEM in terms of 'how they work'.

Fentanyl is a 'fully synthetic' opioid (so is Demerol, btw) in that it can be made w/o ANY opium-derivatives.

Might be helpful to think of it like this: 'opiate' means 'of opium', but 'opioid' means 'opium-like', and the latter has become the preferred nomenclature to describe the wider class, as the distinction of the chemical processes involved in their production has very little or no 'practical' meaning. But in the 1930's - 1990's roughly, 'medicine' technically considered them to be 'different', thus the two terms.

[LeftInTX]

30. Thanks, I didn't know this about the synthesis of oxycodone and hydromorphone

It makes sense considering their names closely resemble codeine and morphine.

And thanks for the terminology regarding opiate and opioid.

[jberryhill]

35. I get the nomenclature distinction

What I don't get is the therapeutic distinction.

What is the advantage of opioids versus traditional opiates? Is it therapeutic or economic?

[mr_lebowski]

37. There ISN'T one, it's a medically meaningless distinction, that's why they're all called opioids now

There are therapeutic reasons for choosing one drug vs. another ... they vary how well they control pain in a given person, there's time-release vs instant release for some but not all opioids, there's cost (often tied to generics availability), there's "what's in your Ins. Co's list of approved pain meds and in what formulations for what conditions"

Also to be considered is that the very strongest in terms of analgesia also tends to be the most euphoric and addictive, with worst withdrawal effects ... for chronic pain, you don't start someone out on Opana (time-release oxymorphone, about the strongest stuff there is, HIGHLY addictive with brutal withdrawals) normally, you start them on oxycontin (time-release oxycodone) or time-released fentanyl 'patches'.

If those stop working well, or don't work well from the start ... either in terms of side-effects or lack of analgesic effect ... from those they might go to Time-Release Morphine ... they don't usually keep you on morphine for TOO long, something about the by-products of metabolization being bad for you after years of being on it.

So then it's maybe Opana ... or maybe methadone.

Sometimes you switch from one to another because the one you're on for a long time just stops working, but you can 'restart' (somewhat) the analgesic effect of opioids generally by switching to a different one.

Acute trauma or post-op pain OTOH is usually treated with instant release formulas like vicodin or percocet, maybe dilaudid if the pain is expected to be very severe (that's IR hydromorphone, very close to the addictiveness of oxymorphone).

[dixiegrrrrl]

18. Opioids are used for intractable pain, like when Mr. Dixie broke his back.

They work when other pain relievers don't, plus they do create a relaxing effect, which is actually not a bad thing to have, since pain knots muscles.
Of course if you take enough at one time, you can get high.
Well, in my case on the several times I had to have them, a nice relaxing buzz followed 10 minutes later by a very very long sleep.

Mr. Dixie's doc actually suggested Fentanyl, since he had been using opioids for over 6 months.
We decided not to go that route, due to danger of accidental overdose if family members unintentionally came into contact with the stuff.

[Bradical79]

4. Sort of?

A different aspect of that racism, but defenitely related. We know better how not to deal with the problem (mass incarceration), but mostly seem to apply those lessons only when our whiter communities are affected.

I think it's still a major problem that needs dealt with as a health crises though, as the OD rate is scary. Lots of really nasty concoctions going around.

[Sen. Walter Sobchak]

11. I think the path to opiates is a little more complicated

I think we have a confluence of existing addicts who have switched to something a lot more potent and lethal.
We have people who have become addicted after abusing prescriptions and we have new abusers looking for something stronger and cheaper than marijuana, cocaine and alcohol.

I know a pretty senior UN narcotics official, the thing that they can't stomach is just how cheap the fentanyl coming from Asia is. It is incomprehensible to them. Price has always had a way of moderating more casual drug users but this stuff is so cheap that you can get blasted to within an inch of death several times a day.

[NightWatcher]

16. Cocaine was a party drug of white people while crack was viewed to be used by poor blacks.

Crack was given a harsher prison sentence than cocaine, this the racist overtones of the disparity between the two.

What is the something vs something from the current opioid crisis?

My take on the bulk of the opioid problem is that people of all ethnicities are getting hooked on pain meds and when they cannot get the prescriptions anymore they turn to street dealers and ultimately to heroine or some other street fix that usually ends up with a fentanyl overdose.

I know of many rich white people who go round and round with this as well as the poor people who get hooked on heroine via pain meds.

[Johnny2X2X]

17. Spot on

I personally know several people who had surgeries or other issues that they needed Oxy for, this was back when the drug companies were still telling people Oxy was a non addictive alternative. All of these people became addicts without even knowing it. Then they would lose their prescriptions and have to find it on the street, well that stuff went for like $50 or more a pill depending on the size, so they were now trapped in a vicious cycle. They had to take Oxy to keep from being sick so they could go to work so they could buy more Oxy to keep from getting sick. Of course the Oxy hookup always runs out eventually (Unless you're Rush Limbaugh) and then you have to turn to heroin, just to be able to go to work and lead a semi normal life.

The stigma attached to this drug has to be torn down, this is a disease and heroin addicts needed to be treated like patients of any other disease.

Of course Trump and Sessions just want to throw more people in prison. And it would not surprise me if Right Wing forces are behind the Carphentynol laced junk that is killing so many people. Where is all this Carphentynol coming from? Anyone adding it to H is absolutely trying to kill people.

[mr_lebowski]

33. It is important to recognize that it's 'stronger by weight' ... which is not AT ALL the same as

A '10,000X stronger high', nor does it mean '10,000x more addictive'.

That is absolutely not the case.

Fentanyl is actually a pretty crappy 'high'. Half-life is uber-short, and it's not terribly euphoric. Oxy/Percs are just as good, and Dilaudid, Opana, and Heroin ... blow fentanyl away, high-wise.

But it'll get you outta being dope-sick ... for an hour or two.

It simply means this: the therapeutic (or euphoric) dosages of morphine and most other opioids is measured in 'milligrams' ... aka thousandths of a gram ... whereas dosages of Fentanyl are measured in Micrograms, or millionths of a gram. It might take 8mg of Hydromorphone to equal 20mg of Oxycodone is to equal 30mg of Hydrocodone to equal 60mg of Morphine (these are just rough numbers) ... but those are the 'scales' ... they're all REASONABLY close to one another ... whereas any of those ... is equal to like .002mg of Fentanyl ...this is a HUUUUGE scale difference. Orders of magnitude, IOW.

The problem arises because so few people have the proper measuring equipment to 'deal' in micrograms. That's 'high-end lab level' instruments you need, not 'the triple beam at the head shop, dude' level.

That is what 'the problem' with Fentanyl ... really centers around.

[SaschaHM]

28. 100:1; now 18:1 were/are the federally mandated sentencing disparities.

Those were the weight ratios required to trigger certain federal sentences i.e. someone with 10 grams of cracked would serve a mandatory minimum of 10 years while it would take 1000 grams of powdered cocaine to trigger that.

[pnwmom]

22. Partly. But another problem is that doctors used to so freely prescribe this stuff,

for real pain issues, so many people got hooked on opioids through legal channels.

[lunasun]

26. Because you know they are concerned now that it is close to home. Somewhere else not so much

[LeftInTX]

32. Good point

[LeftInTX]

31. All I know is I have been taking codeine (tyl #3) for back pain for over 20 years

I can't imagine getting addicted to the stuff. I take a very low dose. I'll go for weeks without it.

It is pretty gross stuff. When I was at my maximum dose, I averaged no more than 1 or 2 tablets in one day. Right now if I take it all, I take 1/2 tablet per day.

I have sort of a weird reaction to it It tends to give me energy and tends to make me a bit anxious. It also causes hypergraphia. (another reason to avoid it) It can cause pretty bad insomnia in me.

I think the constipation would be the one thing that would be the worse aspect of addiction.

[mr_lebowski]

34. The real problem with it is ... MOST people ... like the effect ...

It's very much a mimic of ones own natural 'endorphin' i.e. 'reward' system ... they actually provide quite a 'natural' high, and they're relatively non-toxic AFA drugs go as a result (not 'vicodin', of course, I mean like pure opioids).

Problem is our bodies quickly adjust to their presence and STOP making our own 'feel good chemicals'.

So when you get onto opioids consistently (daily) for 'awhile', then you take them away ... you feel like absolute DEATH. And it takes 1 week to 1 year to get 'back to normal' depending on dosage/length of time/which drug(s).

Anyways, most drugs aren't 'enjoyable' to nearly as many people as opioids are, %-wise of the population, and most aren't nearly as brutal to stop taking in terms of how it makes you feel, so ...

[BumRushDaShow]

36. Black vs white.

The end.

[mr_lebowski]

38. It's not ONLY that, it also the recognition that many end up addicted through 'legit' means ...

A LOT of people addicted to opioids started to (or still do) take them due to legitimate pain conditions and opioids being the only treatment that actually works ... there's more sympathy generally for such people than there ever will be for cocaine and/or crack users. In those cases, nobody started taking them for a legit medical condition.

Also its very rare for people to OD from cocaine in any formula. Opioids OTOH aren't just addicting people they're killing in large numbers.

A big reason that's happening (aside from adulterants like fentanyl) with opioids is people's lack of education about 'tolerance'. Opioids basically have no 'upper limit' to tolerance. What this means is that if you increase dosages slowly enough, you could continue to take more and more WITHOUT OD'ing ... without any limitation (unless your liver starts failing, probably).

So there's people out there who've been on opioids for 5-10-20 years even ... that can take enough opioids in one go ... that the same dose would kill like 2, 5, maybe even 10 or 20 (not kidding, it can get that extreme) ... first-time users. And you get THOSE people selling to and/or 'advising' others, or maybe even 'fixing' them up if you catch my drift ... based on THEIR dosage levels.

There's also a lot of drug substitution that happens with addicts ... your regular supply of 20mg time-released oxycontin runs out, you come across instant-release dilaudid instead ... and take the same MG as what you usually take ... and wind up OD'ing because 20mg of dilaudid in one go is a TON stronger than a 20mg 12 hour time-release OC.

Then there's the synergistic effect of alcohol that people often forget or don't know.

A LOOOOOOOT of "opioid ODs" are actually alcohol/opioid (and sometimes benzos too) ODs. WAY easier to OD on opioids when you already been drankin' ...

[BumRushDaShow]

39. Addiction is addiction

When heroin was rampaging through the black community in the '60s and '70s it was ignored, their concerns were ignored and the users were locked up and/or allowed to die. Eventually as more and more came back from Vietnam addicted, the methadone clinic was born.

However the problem also eventually lead to the rise and spread of AIDS through shared needles, and only in the past decade or so do you have the "clean needle" initiatives.

The crack epidemic was something that happened in the '90s as a "cheap" high, often for those also in pain but without a doctor to prescribe them anything. Once it was tried that first time, they were addicted and of course in this capitalist country, people could make money off of selling it.

What you see with this latest opioid thing is because a community that was hooked on meth, a problem that was pooh-poohed because the users were mostly white, has had that drug source getting shut down more and more due to modifications made to the OTC pharmaceuticals that were originally used to synthesize the stuff, along with restrictions for purchasing those OTC products. So now there is a substitute.

Because whites are still the majority population in this county, when it negatively impacts them, they eventually make sure that something is done about it when people complain. Anyone else and they end up in jail or dead in the streets.