7 ms·

> Fighting the "epidemic" at the supply level seems like a losing battle Kermit, West Virginia. Population 392. They received over 9 million hydrocodone pills

> Fighting the "epidemic" at the supply level seems like a losing battle Kermit, West Virginia. Population 392. They received over 9 million hydrocodone pills in a two year period. In a 6 year period, the entire state of WV received 780 million pills. Over 400 pills for every man, woman, and child living in WV. Seems like attacking the supply is great place to start. WV doesn't need this many pills.

pnathan 10y ago
> Seems like attacking the supply is great place to start. That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of limiting side effects.
- devopsproject 10y ago
  Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK. The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered. edit to add: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
  - rwmj 10y ago
    The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
    - devopsproject 10y ago
      They don't need to be given out like candy. That's the point. The supply needs to be drastically reduced to prevent new addicts and we should be looking at what other countries are doing for their existing addicts: safe injection sites etc.
    - DanBC 10y ago
      People with pain deserve treatment for that pain. For people with short term pain, or who are at the end of life, opioids can be a good choice. For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care. Most people with long term pain need variations of / combinations of: 1) Access to evidence based pain management specialist clinics 2) Graded strength building exercise (for musculo-skeletal, not for nerve) 3) Medication that isn't opioids Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction). Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can. http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
      - nyolfen 10y ago
        some possibly sunny news: experiments with a new fentanyl-derived opioid that acts only as a local analgesic and doesn't cross into the brain, meaning no high, non-addictive, and one can't overdose. this is very preliminary (rat experiments) but i'm hopeful: https://arstechnica.com/science/2017/03/tweaking-fentanyls-chemical-structure-may-create-safer-opioid/ https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
      - curun1r 10y ago
        I'm not sure if this is inherent in your #1, but there should be an increased focus on alternative methods for dealing with pain. For instance, since starting meditation training, I haven't needed so much as a single Ibuprofen. It's not that my incidence of pain has decreased, but my way of thinking about/reacting to that pain has changed dramatically and I can now make just about any pain quickly fade into the background. It's also helped me to clarify the difference between pain and injury to know when I can push through the pain and when I need to pull back and rest. I learned an important lesson, however. Doctors will frequently use the amount of pain someone is experiencing as a diagnostic aid when determining a patient's diagnosis. I had a ruptured eardrum that I saw a doctor for and that doctor misdiagnosed it because I wasn't showing any signs of pain and that injury is supposed to be excruciating. The doctor explained to me that if it was ruptured, I'd be near tears and screaming for pain medication.
  - johan_larson 10y ago
    > Had the drug companies been regulated in the first place, we might be OK. What are you talking about? Everything in medicine is highly regulated. Introducing a new drug is a very expensive process, run in the US by the FDA. It takes all sorts of expensive tests and trials to be allowed to sell a new medicine in the US. Maybe the process messed up in this case. Sure. Many things are possible. But this was regulated start to finish.
  - thearn4 10y ago
    > Had the drug companies been regulated in the first place Were they given out without prescription? If not, I feel like MDs have to share some blame on this.
    - cmdrfred 10y ago
      MD's are often compensated based on patient assessments. "Rate your doctor" sort of things. How do you think opioid addicts rate doctors who tell them they have had enough?
- XorNot 10y ago
  It has value at an individual level. Plenty of people get started into this by over-prescription by doctors and blind dispensing by pharmacists. In both cases, mandating a little common sense in how these drugs are used would potentially help a lot of people avoid a life they don't want.
  - pnathan 10y ago
    > a little common sense no argument there. :)
AaronFriel 10y ago
I agree with the substance of your comment - opioid over-prescription is a huge problem. The stat though about Kermit, West Virginia example has to be due to fraud and illegal sales, though? Or include vastly more people within the area covered by its pharmacies and/or doctors, which ever the data source used? Otherwise each person in that town is receiving (on average) 31 pills/day. Maybe I wildly misunderstand hydrocodone prescriptions, but dozens of pills per day seems to be an excess.
- devopsproject 10y ago
  We have the numbers because the DEA tracks it. Why they didn't look into the numbers is beyond me. Manufacturer seems to have played a role too by sticking to dosing they knew was ineffective and then pushing for higher doses which lead to big bonuses: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
- soundwave106 10y ago
  The Kermit example absolutely was due to fraud and illegal sales from a "pill mill", from what I can Google. Several people were thrown in jail for that. (https://archives.fbi.gov/archives/pittsburgh/press-releases/2012/mingo-county-pharmacist-sentenced-to-prison-time-for-conspiracy-to-acquire-controlled-substances-by-fraud https://archives.fbi.gov/archives/pittsburgh/press-releases/...). I agree that opioid over-prescription is an issue, but I imagine some of these numbers are being inflated by similar "pill mills" run by unscrupulous doctors.

pnathan 10y ago

> Seems like attacking the supply is great place to start. That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of limiting side effects.

devopsproject 10y ago
Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK. The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered. edit to add: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
- rwmj 10y ago
  The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
  - devopsproject 10y ago
    They don't need to be given out like candy. That's the point. The supply needs to be drastically reduced to prevent new addicts and we should be looking at what other countries are doing for their existing addicts: safe injection sites etc.
  - DanBC 10y ago
    People with pain deserve treatment for that pain. For people with short term pain, or who are at the end of life, opioids can be a good choice. For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care. Most people with long term pain need variations of / combinations of: 1) Access to evidence based pain management specialist clinics 2) Graded strength building exercise (for musculo-skeletal, not for nerve) 3) Medication that isn't opioids Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction). Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can. http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
    - nyolfen 10y ago
      some possibly sunny news: experiments with a new fentanyl-derived opioid that acts only as a local analgesic and doesn't cross into the brain, meaning no high, non-addictive, and one can't overdose. this is very preliminary (rat experiments) but i'm hopeful: https://arstechnica.com/science/2017/03/tweaking-fentanyls-chemical-structure-may-create-safer-opioid/ https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
    - curun1r 10y ago
      I'm not sure if this is inherent in your #1, but there should be an increased focus on alternative methods for dealing with pain. For instance, since starting meditation training, I haven't needed so much as a single Ibuprofen. It's not that my incidence of pain has decreased, but my way of thinking about/reacting to that pain has changed dramatically and I can now make just about any pain quickly fade into the background. It's also helped me to clarify the difference between pain and injury to know when I can push through the pain and when I need to pull back and rest. I learned an important lesson, however. Doctors will frequently use the amount of pain someone is experiencing as a diagnostic aid when determining a patient's diagnosis. I had a ruptured eardrum that I saw a doctor for and that doctor misdiagnosed it because I wasn't showing any signs of pain and that injury is supposed to be excruciating. The doctor explained to me that if it was ruptured, I'd be near tears and screaming for pain medication.
- johan_larson 10y ago
  > Had the drug companies been regulated in the first place, we might be OK. What are you talking about? Everything in medicine is highly regulated. Introducing a new drug is a very expensive process, run in the US by the FDA. It takes all sorts of expensive tests and trials to be allowed to sell a new medicine in the US. Maybe the process messed up in this case. Sure. Many things are possible. But this was regulated start to finish.
- thearn4 10y ago
  > Had the drug companies been regulated in the first place Were they given out without prescription? If not, I feel like MDs have to share some blame on this.
  - cmdrfred 10y ago
    MD's are often compensated based on patient assessments. "Rate your doctor" sort of things. How do you think opioid addicts rate doctors who tell them they have had enough?
XorNot 10y ago
It has value at an individual level. Plenty of people get started into this by over-prescription by doctors and blind dispensing by pharmacists. In both cases, mandating a little common sense in how these drugs are used would potentially help a lot of people avoid a life they don't want.
- pnathan 10y ago
  > a little common sense no argument there. :)

AaronFriel 10y ago

I agree with the substance of your comment - opioid over-prescription is a huge problem. The stat though about Kermit, West Virginia example has to be due to fraud and illegal sales, though? Or include vastly more people within the area covered by its pharmacies and/or doctors, which ever the data source used? Otherwise each person in that town is receiving (on average) 31 pills/day. Maybe I wildly misunderstand hydrocodone prescriptions, but dozens of pills per day seems to be an excess.

devopsproject 10y ago
We have the numbers because the DEA tracks it. Why they didn't look into the numbers is beyond me. Manufacturer seems to have played a role too by sticking to dosing they knew was ineffective and then pushing for higher doses which lead to big bonuses: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
soundwave106 10y ago
The Kermit example absolutely was due to fraud and illegal sales from a "pill mill", from what I can Google. Several people were thrown in jail for that. (https://archives.fbi.gov/archives/pittsburgh/press-releases/2012/mingo-county-pharmacist-sentenced-to-prison-time-for-conspiracy-to-acquire-controlled-substances-by-fraud https://archives.fbi.gov/archives/pittsburgh/press-releases/...). I agree that opioid over-prescription is an issue, but I imagine some of these numbers are being inflated by similar "pill mills" run by unscrupulous doctors.