What should be done about the opioid crisis (Read Details)?

This is something I have actually thought about, as it sometimes seems to be more about punishing those who need rather than those who abuse.
Rather like the “quick-pass” (I can’t remember what it’s really called) at airports to by-pass regular security lines, one would think that a no-drug-arrest customer could be waived from that restriction (and, incidentally, could also buy cold meds, ffs.)
Better yet, put the offenders on a restricted list that can be checked before the prescription is written. With information so instantly available, there is no reason not to have access.

The problem is that the flood of opioids has reached a point where the only people requiring prescriptions are those too square to appreciate that there is probably a reliable source for what they require 24 hours a day within shouting distance.

I’m almost in despair over this and the broader question of drug abuse. Nothing seems to work, probably because addicts are so self destructive they don’t want to get better. Of course some people do recover. As far as I can tell the only thing that would really work is imprisonment for 5 years with mandatory treatment in an addiction hospital (not a prison). But taxpayers would howl about the expense. American society is fecked.

Why don’t we do what we did when we had a “Crack Epidemic” and just lock up all them junkies?

Oh wait, we can’t do that, the majority of them are white.this time.

There are two prongs in an appropriate response.

First is to stop the increasing addiction to prescription pain medications. I agree that the CVS idea is punitive. But there has been little consequence for doctors that freely give out scrips for stronger and stronger medications.

My ex was given increasing dosages of OxyContin by her doctor. When that got to the point where she was using her prescription in half the intended time, he put her on Fentanyl patches.

The patches are supposed to be good for 48 hours, she would put a new one on every 24 hours so she was always well dosed. But there was little if any pushback on her getting scrips from the doctor, until she was so strung out that she ended up needing hospitalization to get her weaned off the drugs.

I would recommend review of any case where Oxys or Fentanyl is prescribed outside of a hospital, and regular review of a doctor’s prescription pattern. That would mean doctors would be answerable for their behavior.

The second prong has to do with getting addicts into treatment and avoiding overdoses. One way that has worked well are safe injection sites. People can bring their drugs in, get clean needles, and have someone watching to make sure they don’t OD. Safe injection sites have a high rate of success in getting people to enter treatment.

We need to focus on solving the problem, not on punishing people.

The only people the war on prescription drugs is making this hard on is the people who actually need them.

I don’t use pills (I hate opiates and never fill a scrip when they’re offered), but even I know three or four different ways to get them illegally if I want to.

People who are less tech-savvy than myself, however, I’ve heard of severe pain patients turning to heroin because it’s easier to get than their prescribed drugs, and the pain is that intolerable.

So, great job, government, another failed war on drugs.

1. Legalize all “recreational” drugs – including opioids and hallucinogenics. This is without respect to their inherent danger. Highly addictive drugs as well as those that can easily result in lethal doses carry greater risk than cannabis – and even tobacco – but alcohol has those dangers, and is legal. Users have to be responsible, or die. Motorcycles are inherently more dangerous than private autos, which are also riskier than buses. I’m NOT advocating for more legal restrictions on those things based on their relatively increasing risk; what I do advocate is that people learn to take care of themselves when they can – and they usually can.

2. Enable nationwide manufacturing and distribution, even via the mail, of all of those drugs. There’s enough money – even in a “weed” drug like cannabis – to attract responsible growers, manufacturers, refiners and distributors. If alcohol were still illegal, then that would also be deadly – more deadly than it is, I mean.

3. Encourage and permit doctors to treat patients responsibly and well. Recognize that chronic and debilitating pain is something that has to be dealt with using strong drugs, and that opioids, even used correctly, require increasing doses as the body adapts to them. Not all doctors who prescribe increasing doses of opioids to long term patients are irresponsible. (In fact, some of those are the most courageous and caring doctors around, because of the hoops they have to jump through, the investigations they now face on a routine basis and the restrictions that they deal with state-by-state to treat patients who come to them from farther and farther away because their own doctors are too timid to prescribe effectively.)

4. Along with “legality”, “responsibility” and “effective treatment” also comes “accountability”. Drug manufacturers and distributors – and prescribers – must face normal legal consequences for bad acts, dealing in the light of day, same as any other legal business or distribution network.

5. In a culture like that described above, a pharmacy who wanted to be “responsive and responsible”, that is, responsive to the needs of legitimate customers, and yet responsible for careful distribution, could easily set up home (or office) delivery systems to be careful in how they distribute, to make sure that they’re not giving out uncontrolled or lethal doses of drugs without any oversight. If we can deliver pizza and sandwiches from dozens of outlets per metropolitan area to millions of customers on a randomized basis, daily, surely we can set up a “responsible” drug delivery network that would function at least as well – and with more regularity. And with the obscene profits (and violence) removed with the illegality gone, then drug deliverers would face no greater peril than pizza deliverers. (Which is to say, not “no risk”, but “less risk” than legitimate users face now.)

Legalize every governmentally controlled substance.

Like Plutonium and smallpox?

It’s a problem here in the UK also and the Medicines and Healthcare products Regulatory Agency has made these recommendations:

• A change in some medications’ indication (i.e. what the drugs are recommended for) to remove references to colds, flu, coughs, sore throats and minor pain. This will also add a clarification that these types of medicines should be used for short-term treatment of acute or moderate pain that is not relieved by paracetamol, ibuprofen or aspirin alone.

• Clear information on the labelling and in the patient information leaflets that come with the medications. These will include warnings that the products are for short-term use only (up to three days) and that overuse can lead to addiction or ‘overuse headache’.
• Manufacturers will need to display on the front of the pack the specific warning: “Can cause addiction. For three days use only”.

• Packs containing more than 32 tablets (including water-soluble effervescent formulations) will not be available over the counter.

• Advertising for the products must be updated to reflect the new indications and warnings. Advertisers will not be allowed to refer to the painkilling power and strength of the drugs, and adverts should include the statement ‘Can cause addiction. For three days use only’.

Painkillers are generally not considered a primary way to manage long-term pain. You may be referred to a pain clinic or to complementary therapies such as acupuncture.

By the way, legalized cannabis has had a positive effect on reducing overdoses.

Without the boring details, I have suffered a dozen injuries and wounds and at one point or another been given about every opioid pill known to man. Other than producing a buzz, they are no more effective at knocking down pain than a big dose of ibuprofin taken with extra strength tylenol, both or which are available OTC.
So the answer is use these easily available drugs routinely unless they are not indicated for one reason or another.
Just sayin…

@josie, with all due respect for your own personal experiences, different people react differently to medications. I too have taken opiates for severe pain following my surgeries and they have been highly effective for levels of pain that OTC options couldn’t touch. They allowed me to function during weeks when I would otherwise have been able to do nothing but lie in bed.

Don’t vote to take medical options away from others just because those options didn’t work for you.

@Mariah
Thanks for the reply. I appreciate your input. But…

Please note that I made a qualifier-“unless they are not indicated for one reason or the other”.

I didn’t say take options away.

I said that in a lot of cases OTC works well. And I am not alone in saying it.

So use OTC in as many cases as possible instead of reaching for the Rx pad.

But if it doesn’t work for you, it doesn’t. But you probably don’t represent the numbers that are the basis of the crisis based on over prescribing.

OK, sorry for misunderstanding. I thought you meant that you thought opioids should never be used except in the situation that one is physically unable to take OTC meds.

For the chronic pain patients I was speaking of in my OP, please rest assured that these are people who are desperate for relief and have already exhausted simple options like OTC meds. Patients don’t reach for addictive and dangerous meds if safer ones are working.

Drugs are drugs. People will try to do them, and that demand will make them available some how. Making them harder to get, or punishing people more for being caught with it, will simply make lots of criminals richer, and more prone to use violence to control whose selling it. It will also mean that the product will be susceptible to quality/safety issues, as it won’t have any oversight.

As long as the raw materials exist to create something desirable, someone will make it. As long as people know how to make something, they will. That’s why we can’t really control who has nuclear weapons. While much harder to make than meth, it just takes materials and knowledge.

I guess I’m saying that no method of “control,” will likely be effective.

Legalizing everything seems like the only reasonable option. At least then it could have government oversight, have money involved be taxed, and keep street dealers from getting rich, and killing each other over territory or product.

For sheer entertainment, I would say that we could develop a disease that wipes out all opium producing plants, and unleash it on the world. Any remotely effective strategy would have to be amazingly extreme…

The problem with opioids as pain treatment is that too many people get addicted to them. When that happens, they start adding addiction craving to actual pain. And they start going for stronger and stronger pain killers. That is frequently how heroin addicts start. The super high caliber pain meds are too expensive so it is cheaper to get heroin.
My first order of business in battling the opioids would be to develop non-narcotic pain meds and treatments. Start phasing out the opioid pharmaceuticals. Stop the cycle of addiction at the front end. Next would be to crack down on heroin usage and distribution. @rojo makes the comment about why don’t we just lock up all them junkies. I suggest that is a really good start. Not as a punishment, but as a first-step treatment. I have first hand experience with this. My daughter got hooked on heroin after stepping up opiate pain meds. Her life had degraded to where she was living on the street and stealing to support her habit. We eventually had her arrested and she spent 50 days in jail. It was enough time for the heroin to work its way out of her system and to let her start looking at how to turn her life around. Today she is wonderful…working, going to school, interacting with people like a real human. So don’t rule out jail as something that can help. Making penalties for heroin distribution extremely harsh might help a few of the dealers rethink their path. Too many addicts die from the products that are being sold…we ought to treat these people the same as if they were selling loaded guns to children.

^Good points. I would opine that temporary/reasonable imprisonment is not a bad thing. But many people are locked up for many years for just possession. That is extremely counter productive. Imagine if your daughter was locked up for 10 years, instead of 50 days. That’s closer to the reality of many. Being imprisoned for extended periods is not a way to rehabilitate people. More often than not, it sends a person further down the wrong path. In most prisons, drugs are easier to find than on the streets. I know several prison guards, and many people who have spent extended time imprisoned. Making a bad situation worse is no solution.

^Many counties are doing away with the jail-forever-for-possession thing. Possession of paraphernalia is a ticket. Possession of heroin is a couple days in jail and being sent to a rehab. We actually had my daughter jailed for grand larceny which is why she spent any time at all in jail. The courts are looking at heroin addiction as a disease instead of a crime and they believe that the addict needs counseling and treatment instead of incarceration. They are partially right, but way wrong in this thinking. Addiction is a disease and it does need counseling and treatment. However where they are way wrong is that counseling and treatment only work if the person wants to end the addiction. As a result we now have a revolving door. Addicts get arrested. They get sent to counseling/treatment. They do the sessions and are back on the street. They get a score and are back on the drugs. They get arrested and the cycle begins all over again. They recently did a documentary of the heroin issue in our town. They talked with addicts, sheriffs, judges and lawyers, health care and social workers…the gamut. And what I found the most telling was that they talked with 7 addicts. All 7 had been through the system multiple times and all were still using. in fact, one of the guys they interviewed had been through it 7 times. and sadly, by the time the documentary was aired, he had overdosed and died. So somewhere between a day or two and a year is where we need to establish mandatory sentences. I would suggest 45–60 days. THEN send them to rehab.

There is no question that there should be some serious updating on the labeling and regulation of “vices”. Our laws lag precariously behind attitudes and technical developments at the heart of our society.