Thursday, June 22, 2017

Opioid Problem

     This country has one, and I'm not talking about a radio host getting nicked for popping pills.  Nope; from hardscrabble ex-factory towns and rural hamlets where the grain elevator is the tallest thing on the horizon for miles to the mean streets of the big city, people who can't get pills to pop are shooting up heroin (bad) or various versions of fentanyl (way worse).  A significant proportion of them are overdosing, too: it seems that while old-fashioned, street-grade heroin tended to a roughly consistent strength and was generally sufficiently diluted that rule-of-thumb dosage measurement was survivable, fentanyl's another thing.  From Wikipedia: "its extreme potency requires careful measurements of highly diluted fentanyl in solution."

     This is a high-falutin' way of saying that while a little dab'll do ya, an only slightly larger dab will do you in.  Working yesterday near a set of scanners covering police and fire in the Indianapolis city-county* only, I heard two "overdose" calls in the first twenty minutes -- with no "suspected" or "probable" tacked on, either -- and several more over the next hour.† 

     Opioids have a seductive allure (remember that radio host?).  If you're taking them for pain (and I have, quite long-term at times), they work great, but that warm & fuzzy feeling, a glow similar to a couple of mixed drinks in quick succession, is dangerous without the undercurrent of pain.  Oxycontin pipeline shut off?  Stronger drugs let the user clock out of life for awhile -- and the rest of the time, gives them something other than the grinding, hollow emptiness of a country with a shrinking middle class.  Not a good thing -- see William Burrough's The Junky's Christmas for a horrible-yet-sanitized version -- but a thing.

     I don't think we're going to fix this one treating it as a crime or merely addressing the overdoses by putting a supply of single-dose Naloxone injectors in the pockets of every police officer, fireman and paramedic in the country: by the time a user is standing on the threshold of death, it's been too late for a long while.  In conservative Indiana, a lack of needle exchanges has also led to clusters of HIV and hepatitis infections among users.  The state has -- finally -- been allowing counties to set up needle exchanges‡ for about a year now; it's not easy, and in in least one county, has been stymied by a severe "NIMBY" reaction.  So, Mr. and Mrs. America, is a dead junkie on the back porch a better solution?  Maybe it is; maybe the kindest thing to do is to let the addicts die off -- but there will be more, and their dying weighs on the tax rolls. 

     A comparative study of results in the United States and some country that treats use and addiction as public health issues might be informative; as it is, I have seen no more than anecdote.  Even that much has me wondering if something other than the present approach might offer improved results compared to making cops and EMTs haul people back from the edge of death time and again, until, inevitably, the day that help doesn't arrive in time.
* Back when Marion County was a thin and ugly doughnut and getting smaller all the time, city and county governments merged.  Except it was more like a hostile takeover.  This essentially replaced two tottering monstrosities drowning under their own paperwork with one; and that's progress.  Dick Lugar orchestrated the change and gave it the totally non-Soviet name, "UniGov."

 † Plus the usual things you hear over a police scanner -- a man who locked himself in a business's washroom for two hours, responding only "I'm in here!" when they got worried and knocked; an apparent hostage standoff at a motel complete with multiple officers and directions how to stay "out of the line of fire" that eventually ended without a shot being fired.  It also appears we have an officer who sounds exactly like the late Larry "Bud" Melman.  I'd like to think that somewhere in the city, a short, dumpy, white-haired policeman in thick-lensed hornrimmed glasses is plodding though the challenges of modern policing, gamely triumphing over the entire panoply of modern dangers with a faint smile.

 ‡ While this clearly runs counter to the "whatever you subsidize, you get more of" rule, with Narcan injectors, society is already subsidizing addiction and the choice becomes one of disease-ridden addicts vs. addicts without additional health challenges.  The latter group at least has long-term prospects.


fillyjonk said...

This is one of those things for which I see no good solution: not "crack down even harder," because that does seem to breed more violence/badly tainted drugs that kill their users fast (I have a relative who worked for the Illinois state bureau of investigation back in the early 2000s and even then they were finding heroin users dead because of what the heroin was cut with). I don't think "legalize it and provide care and feeding for the addicts, on the assumption they're not gonna be productive humans anyway" works, given how strained the national and state budgets already are (And also, I admit I would find it somewhat offensive, as a taxpayer). I do know pulling addicts back from the jaws of death when they OD is putting strain on EMT/police services. And an outright ban on painkillers is cruel to those who have chronic pain while probably making the problem of smuggled drugs worse.

I hate to say this but I think this is something that gets worse before it gets better. Perhaps the solution is something to change so that people lacking a sense of purpose (which I think contributes to this) are able to have one, and also some kind of new, non-addictive, non-befuddling material to treat chronic pain.

Guffaw in AZ said...

I'm given to understand that the vast majority of abuse is folks who stole it from legitimate users. Legitimate users (myself being one) do not abuse it, generally.
I think 'something' needs to be done, but what and by whom?
Certainly, putting further restrictions on doctors and patients (see gun control, Prohibition) will not stop the illegal use problem.

The current U.S. AG is not likely to be holistic in his approach.

It IS a conundrum.

rickn8or said...

"I hate to say this but I think this is something that gets worse before it gets better. "

With the .gov getting involved, I'm pretty sure that's exactly what's going to happen, especially (as Guffaw pointed out) with Jeff Sessions as AG. ("A hundred years of drug-control failure proves nothing!")

Anonymous said...

Fentanyl is now a problem because the chemists have now discovered a route to synthesizing the precursors easily.

They now have a substance worth hundreds of times the value of heroin by weight and no need to deal with the Taliban in the 'Golden Triangle' to get it.

Yup, we are now living in interesting times, with all of that Chinese curse's implications, since China is now the primary source of the building blocks of fentanyl (and its myriad of associated toxic analogues)...

Glenn Kelley said...

The Portuguese prosecute the suppliers and treat the addicts . Supplying the drugs is illegal but possession and use is not .
I understand that addiction rates are down because a significant number of users are motivated by the illegality of the activity .

pigpen51 said...

The way that I understand things, it will be nearly impossible to get a way to treat pain while at the same time getting rid of the so called high that comes along with it. This is because the method that is used are pathways in the brain that are receptors for both pleasure and pain, and respond to the same stimuli. I know that is a poor way to explain it, but kind of close. So for the time being, the drugs that are used are only going to work by that method, and will have that side effect. I don't know the solution to this serious problem, but being on the side where I have chronic pain, and am struggling to obtain treatment, it is disheartening at times, to have to deal with a government that knows no in between, only the pendulum type of reaction, that swings either completely one way or completely the other. In the 90's it was, pain pills for all, no matter if you only scraped your big toe, and no oversight. Now, it's more like, even if you have a terminal illness, you can hardly find a doctor who is not afraid to prescribe you enough pain medicine to keep you pain free, because of fear that the government will take his license to practice medicine from him, or her. There simply has to be some reasoned discussion soon, and a path that is workable for both sides, as the way it is being done now is not working for the side that is suffering, and it should not swing back too far the other way either, due to problems that we all know will result in more suffering by families and loved ones of dead overdose victims.