Why do americans make so much use of opioids? For me it sounds like crack. No sane person tries crack, most people are already in the lowest point in their life when they are presented to the "opportunity". Is it similar with opioids?
If you're using "sane" as a limiter in your understanding, then you'll never understand.
There are many reasons people try opioids. A large percentage of opioid addiction came from being prescribed by a doctor. Some people try it because they are looking for a way to make their situation in life not hurt so much. It's what their friends/family do. I'm not going to attempt to go into all of the reasons any one has ever used, but you should be more empathetic than your use of sane
> because they are looking for a way to make their situation in life not hurt so much. It's what their friends/family do.
This part still puzzles me, because the opioid crisis is really well known about. How does "my life is shitty, I'll improve it by starting on the drugs that are famous for ruining lives" add up for anyone? Is "but cousin Bert does it and seems to be OK so far, so I can too" really that persuasive? Or maybe it's all ultimately down to prescription pills, except they might be somebody else's leftover ones, and starting there seems OK because it's medical and safe-looking.
From conversations I've had with users, when you have internal voice that you can't make stop without the use of drugs then you look for anything. My life is shitty has many meanings and might be difficult for someone to understand. If you have no personal experience, then I'd suggest using softer tone than trying to assume nobody else has problems because you can't empathize. Getting to the point of being comfortably numb so that you're not thinking about anything can be quite a relief
Well, telling me I can't empathize is irritating, and isn't much of an explanation. But, I'm not sure what I was asking. Well OK, I think it's this: I don't believe that statistically, people saying "I think I'll try opioids because I feel terrible" can be a driver of the epidemic, because on aggregate people wouldn't. Sure, some people feel more terrible than others, and some are more persuaded by circumstantial effects than others (including somebody I know who picked up an addiction from her boyfriend despite being a super-rational psychology student who should have known better). But these things can't be the main cause, because people in general do know better than to begin, and to have an "internal voice that you can't make stop", prior to addiction, can't be very common. Statistically, it's got to be something else. I'll go with the medical pill-pushing theory for now.
> From conversations I've had with users, when you have internal voice that you can't make stop without the use of drugs then you look for anything.
I present to you the definition of sane:
1. : proceeding from a sound mind : rational.
2. : mentally sound. especially : able to anticipate and appraise the effect of one's actions.
Being over-dramatic about it doesn't change the fact that the person doing the self-harm is not in their best condition. Yes, I have been there with alcohol and drugs abuse, I have lost friends and family members too. Treating them as people capable of deciding with their best interest in mind definitely didn't help me help them.
Over-prescription is/was bad. I have many friends who've had sports-related surgeries (ACL repair, joint replacements in their 50s, etc). Almost all received several weeks of opioids to take at home. Very few actually used them all, leaving them with a bottle nearly full of dangerous, addictive drugs.
Most of them transition to OTC pain management ASAP because they know the risks of addiction. I imagine people who don't know better take the full course, because that's what was prescribed, and end up at more risk for addiction?
> A large percentage of opioid addiction came from being prescribed by a doctor.
I think that's the main factor which differentiates the US from the rest of the world. IANAD, but as far as I know at least here in Europe opioid painkillers are reserved for the terminally ill (mostly cancer), and the US shows why "normalizing" their use is a very bad idea...
They’ve definitely been overprescribed here (and the drug companies making the opioids pushed them knowing they were addictive, and downplayed the risks). One of my best friends’ cousins died in his 20s of a heroin overdose. He got addicted to opioids after being prescribed painkillers following a shoulder surgery. He was a baseball player, in good shape, young.
To me, overdose deaths in people prescribed them by doctors are some of the worst. They’re frequently in younger individuals, meaning more life cut short; they were indirectly caused by a profession whose ethos is “first, do no harm”. To me, it is a sign that something has gone badly wrong in the medical profession and society at large and sows major distrust in our institutions.
Opioids aren't even used post-surgery for pain management? I have to think they are at least used in hospitals still. Maybe not prescribed as much for home use...
They are not, not even in other parts of the world. It is also very rare in Asia. Folks tough it up and are fine, as the risks of opioids are not worth it
There was a big push in the '90s (partly out of genuine concern for patients and partly as guerrilla marketing for pharmaceutical companies) for doctors to treat pain as the "fifth vital sign", i.e. assess it routinely and move quickly to address any issues with it. When Purdue Pharma introduced OxyContin, it was claimed to have low-to-no risk of dependence and abuse. This led to prolific use of prescription opioids for even minor pain.
The dangerous thing about opioids is that they're equally effective for both physical and emotional pain, and everything else we have to treat emotional pain might as well be a placebo by comparison. So some people with chronic emotional pain got prescribed opioids for their physical pain post-injury/surgery and found that the experience of life on opioids is just better, and the only immediate options they have at that point are either to manage chronic opioid use or go back to their life constantly sucking. In such cases it's tempting to pontificate about "root causes", but in my experience people tend to steer that toward their own political/sociological/psychological hobby horses and quickly lose focus on the problem at hand.
Also, while crack cocaine is far from harmless, its dangers have been overblown for political reasons, especially compared to the perception of powder cocaine.
That's the best explanation I've read so far, thanks for taking the time to explain.
> From conversations I've had with users, when you have internal voice that you can't make stop without the use of drugs then you look for anything.
Coming from a South american country I have to disagree. Cocaine is terrible (especially when is filthy cheap) and crack is even worse, because it costs like 1 dollar. Crackheads steal anything they can for crack and after smoking they terrorize the population like walking dead zombies, soon looking for more money, any money or anything that can be exchanged for more crack.
They are routinely administered in hospitals and for recovering from most traumatic injuries. For people who frame the use as episodic e.g. "until my leg heals" and try to get back to their lives as quickly as possible, there is rarely a problem.
For some people the drugs are better than the life they had before and so getting off them is very difficult.
They are a poor choice for chronic pain, since that population doesn't have particularly high life satisfaction. But they are an excellent choice for acute pain e.g post surgery, tooth extraction, etc. and people shouldn't be afraid of taking them in that context.
The epidemic you have heard about in the US is incentivized malpractice. Doctors giving a class of drugs which should not be used habitually to people with shitty lives.
Prescription opioids without good controls ended up with tons of folks addicted, then moving to heroine/fentanyl once doctors woke up and stopped further prescription. I don't think anybody can judge deep opioid addiction without walking the proverbial line, most folks fail to ever shed even cigarettes or alcohol.
Second reason, ie compared to Europe is that US society is much less social, much more focused on oneself and inward, and if you fail there, you fail hard and very easily end up on street even from good white collar life. Nobody really bats an eye. Once down, its very hard to ever get up from the street, misery compounds and hard drugs offer some form of temporary 'escape'.
We're fed this grandiose American dream (at least in my generation), and when we fall short of achieving that we feel like we've lost. Nothing else matters, we're not a part of the lucky. We're inherently unlucky. Then it starts as just taking the edge off, trying to cope with these feelings, and soon enough it spirals and builds momentum, then you find yourself losing your grip on why you even got up in the morning or wanted to pursue anything at all. What's the point in trying if you'll fail again?
But the escape offered by addiction outweighs any reasonable or rational thought, it's just a foot out of this hell of trauma, depression, guilt, and shame.
Our country doesn't have safety nets (for the most part) and is survival of the fittest. It's difficult to struggle constantly, knowing that what you want to be is always out of reach.
Thanks for the sincere reply. I hope, if you are struggling, you find the motivation to enjoy life. I have noticed a recent trend (after pandemic) of unhappy Americans moving to Rio de Janeiro looking for their lost will to live. And actually I have seen this working miraculously well for them.
There are excellent descriptions of a "sane" person becoming addicted to opioids even in classical literature. Start by reading Bulgakov's "Morphine" (1926) - and note that he wrote from personal experience with addiction.
I've used opioids twice in my life. First time was when I had ACL surgery. The pain actually wasn't that bad, but a few Oxy's help me sleep the first couple nights post-op until the swelling went down.
The second time is when I had a bulging disc pressing on a nerve. My leg felt like it was on fire 24/7. It was at this point I understood how people could get addicted. Luckily I only need the opioids for a few days until the anti-inflammatories did their thing.
There are some types of pain that are only dulled with opioids. With that said, the US overprescribed for many years. In both my cases I was given way too many Oxys that I eventually threw away.
The majority of opioid addicts in the US were legally prescribed them by their doctor. Oxycontin was lied about to medical professionals, so it was commonly prescribed in ways that significantly increase your likelihood of developing a dependence, which means following your doctor's explicit instructions could cause you to become addicted to Oxycontin.
> Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year, and as of 2016 more than 289 million prescriptions were written for opioid drugs per year.
I don't doubt that fentanyl kills a lot of people today, but a lot of those currently addicted got started on pills legally prescribed to them.
Pill mills notoriously maxed out count and dosage (per script) ratios. A single Rx could be for a jar of the highest dosage.¹ This was common.
Scripts written outside of pill mills were orders of magnitude lower in dosage and quantity. Lumping these very different numbers together paints a simplistic view of a complex issue.
> Between 1991 and 2011 painkiller prescriptions in the U.S. tripled
Years that include the rise/fall of pill mills.
> as of 2016 more than 289 million prescriptions
289M is a single broad number representing complex and distinct things. To determine opioid use trend, some of the things we need to know are count per Rx, dosage, med type and treatment type.
Institution (eg:ALF,hospice,VA) trends are distinct from public-facing doctors but we don't even look at them. We just lump their Rx #s into the pot.
An important number we don't have: Denial counts for reasonable need. Single-figure opioid views don't leave us room to consider it.
Chronic pain patients (who responsibly used pain relief for years) started getting shut out before 2016. That trend ratcheted one way. Their choice was losing what productivity they had or seeking illegal+risky options.¹
But as ever, the public and news orgs are much more interested in billionaires than vulnerable people in need.
Regular dental check-ups likely would have caught the tooth rot before it led to opioid addiction. Hopefully in time that a simple filling would suffice, but even a non-urgent extraction or root canal is better than months/years of chronic pain.
From what I can tell, chronic pain eventually morphs into "background noise" in a person's life. It's there, but similar to depression or anxiety, it just becomes a new normal and people develop strategies to deal with it. Often that's drug abuse.
> Regular dental check-ups likely would have caught the tooth rot before it led to opioid addiction. Hopefully in time that a simple filling would suffice, but even a non-urgent extraction or root canal is better than months/years of chronic pain.
...we found that limited information was reported on health outcomes in relation to quality of care within the context of UHC. In addition, there was a global lack of evidence on measures of quality of care related to UHC...
Anecdotally, I have had access to rather cheap healthcare almost my entire life, but opted not to visit a dentist for 15 years.
> From what I can tell, chronic pain eventually morphs into "background noise" in a person's life.
This has been my experience, personally and vicariously.
Edit: I realized the linked paper refers to lack of data on outcomes. That is not really the question here. However, it would be nice to get more data on outcomes. The question here is whether the individual would have visited a dentist without knowing there is an issue. I tried to find data on dental visits in universal healthcare systems vs non and could not find anything.
Brits have better dental health than Americans[1]. Both in measurements of decay, number of lost teeth, and unsurprisingly they visit the dentist more often.
A lot of the users are people who transitioned from other habits to Opioid use. Or it is people who started out being treated for some kind of pain and then cascades into a full blown addiction. I will say that there are people who have no bottom, they can just keep digging a hole deeper and deeper.
There is also the fact that China ships an enormous amount of drugs through Mexico into the USA. They use it as a weapon to weaken society. It's sort of a payback for their humiliation in the last century and it causes issues for everyone, not just the users. Police, regular people, jails, court system, strains society and the costs of dealing with it are enormous.
It's a cheap escape from the horrors of their lives. Most people in the US have amazingly shitty lives and it's a constant struggle, even without the drugs.
