Opioid Addiction Drives Grim Business

[Broomstick]

Actual Drug Rehab Clinics cost too much. It's a never-ending cycle of helplessness.

No, they do not cost "too much" - what they are is underfunded. Our society is happy to pay more for prisons but won't pay for treatment. It's cheaper to rehab than incarcerate either in prison or in a hospital. It's not the resources don't exist, it's that they are sent elsewhere.

[Lord Revan]

Actual Drug Rehab Clinics cost too much. It's a never-ending cycle of helplessness.

No, they do not cost "too much" - what they are is underfunded. Our society is happy to pay more for prisons but won't pay for treatment. It's cheaper to rehab than incarcerate either in prison or in a hospital. It's not the resources don't exist, it's that they are sent elsewhere.

it seems this "punish don't treat/rehabilitate" way of thinking that seems prevelevant among the americans in general even if people who have to deal with fallout have differing opinions.

I don't have the actual stats in hand at this point but IIRC in finnishing prisons the rehabiliation chance is much higher and there's less repeat offenders.

[PainRack]

Well..... harm mitigation strategies and then actual rehab can work, but I forsee people being upset at clinics giving addicts shots of morphine and methadone...


Although in a comprehensive care scenario, you're going to need to insitutionalise some addicts at least, to cut them off from satisfying their cravings.

[Broomstick]

Methadone is an oral medication.

I take it you're not familiar with it's use in treating addiction.

[Highlord Laan]

Actual Drug Rehab Clinics cost too much. It's a never-ending cycle of helplessness.

No, they do not cost "too much" - what they are is underfunded. Our society is happy to pay more for prisons but won't pay for treatment. It's cheaper to rehab than incarcerate either in prison or in a hospital. It's not the resources don't exist, it's that they are sent elsewhere.

But rehab doesn't keep the lesser masses in easily accessible groups for prison labor, Broomstick. We have to out the economy first, after all. Anything else would be socialism.

[LadyTevar]

In the US, poverty and addiction wouldn't happen "If you worked hard enough". That is the basis of US mentality -- the only way to get something is to work for it. If you're poor, it's your fault for not working hard enough. If you're an addict, it's only because you failed to work hard enough to stop. It's All Your Fault.

Oh, and if you're rich, then you obviously must have worked hard to gain that ... even if you're a 4th Generation heir to the family fortune.

[Broomstick]

Of course, there's no explanation for an unemployed rich addict - but then, if you're that wealthy it doesn't matter if you're high as a kite.

[Flagg]

I remember Rush Limbaugh getting caught with tons of pills. But he’s rich, so no action needed!

[Simon_Jester]

And here I am again, lending my few years experience to the thread.

I worked four years at a clinic that offered methadone as the default treatment for opiate addicts. Yes, medications like methadone and suboxone can help an addict and they are a useful tool, but they are not miracle cures. It's not enough to give them alone.

Opiate addiction is often compared to diabetes and there is some validity to the comparison. You don't simply hand a diabetic a box of medication and expect everything to be alright. Diabetics need to make lifestyle changes along with the medication. So do addicts. Just as 12-step programs can become dogmatic and used one tool on all problems so too can methadone or suboxone be used as a blunt instrument without the additional tools that make them most effective...

...Tools in a toolbox...

Well yeah, and the existing stance of the government and much of the "twelve-step" community is basically saying "okay, we're going to build these houses without using fasteners, because those are unwholesome tools in our toolbox. We're going to build houses, but everything needs to be done with mortise and tenon joints!"

Sure, success is theoretically possible, you could build a house without using nails, screws, or bolts. But you're opening yourself up to a whole array of disastrously bad outcomes that just plain couldn't happen if you weren't pointlessly throwing away a huge category of your potential tools.

It's not a physical pain, it's a mental pain, but it's still real pain. Asking an opiate addict to do it with a 12-step program is like asking a diabetic to overcome an insulin deficiency through sheer willpower and self-discipline. Yes, for a very few diabetics whose internal systems aren't too askew diet and exercise alone can control their disease, for a very few addicts willpower will work, but for the majority more is needed.

So basically, this.

But simply giving out drugs is not going to work either. It is vital to combine it with counseling because an addict does require new coping mechanisms, does need an understanding of what addiction actually is (which is all too often not provided information), often has other problems outside of addiction that need to be addressed, and does need psychological support during a recovery that takes years - Reports that a celebrity addict has done a 30 day detox program anger me, because that's not a cure it's at best just a beginning. You don't get over an addiction in 30 days. My clinic used to mandate two years minimum treatment before even considering tapering a person off methadone, which might take six months to two years to get that done.

And, sure, fine, this- but the point is, WITH the magic pill, your addiction patient needs two to five years' psychiatric care to patch them back together. Without the magic pills, they need two to five years and a miracle to occur.

The fact that the magic pill is not sufficient without the two to five years' psychiatric care is not a relevant criticism of the magic pill. Its role is not to replace the 2-5 years of care, it's to replace the miracle that would otherwise be necessary.

There is ENORMOUS pressure not only from other addiction groups but also state and Federal agencies to get addicts off ALL drugs, permanently. We had to justify people who weren't doing the program fast enough to satisfy the Powers-That-Be. We had some addicts who were long-term maintenance folks (some having been on low-dose maintenance for thirty years and more) that were highly functional in their lives, paid as private patients out of their own pocket, stayed out of legal trouble, etc. yet rather than let these people continue there was continual pressure on the clinic to get them off drugs. Most of them, when taken off methadone, would relapse. Put them back on and they're fine. My theory (which of course counts for nothing as I'm not an "addiction specialist" or MD) is that the brain changes were such that either they could no longer manufacture adequate endogenous opiates or normal levels no longer worked effectively so a low steady dose of methadone restored function to a normal level. Take that away you have problems, just as taking away a diabetic's medication results in a rise in blood sugar.

I also saw another phenomena coming out of the radical "NO DRUGS!!!" sobriety crowd - they didn't just preach no opiates or alcohol, they preach no drugs whatsoever, even medically necessary ones. They'd want the addict to also give up things like blood pressure medications and yes, even diabetes medication. This is horribly dangerous. It's 12-step as religion rather than a tool. Over the four years I worked at the clinic we did have a couple people wing up in the hospital after being convinced to give up medically necessary drugs by 12-step folks.

Also, this.

Finally - methadone and suboxone are also merely tools in the toolbox as well. They don't work for everyone. They have side effects. There are addicts who have methadone as their primary poison who can't be managed on a methadone program. Even if every opiate addict had access to these medications without waiting we're still going to have a significant number of relapses and a number of those relapses OD'ing and a subset of those will die from that OD. Addiction is a disease, a malfunction, and it's not always fixable. That doesn't mean we shouldn't keep trying, but realize there is NO magic, easy, simple cure for this problem. At the deepest level it's a brain malfunction. It can be managed but very few people will have a true remission.

Part of the point of suboxone is that it has less side effects than methadone, as I recall...

[Broomstick]

Keep in mind that most discussion of "side effects" tend to focus on the physical - there can be psychological problems with these drugs as well, and that shouldn't be ignored though it often is. Addiction is physical AND mental.

Aside from that - suboxone does not mix well with liver disease, which affects a certain number of addicts due to needle sharing spreading hepatitis and organ damage from drug contamination.

Of course, all of the above can be managed or worked with, but it's important to keep in mind that there isn't a quick or certain cure for any of this.

[Flagg]

Yeah, I’m actually on suboxone for treatment of my chronic abdominal pain (without pain medication I’m in constant agony and can’t eat anything but thin soup and can only drink water and even with those the pain spikes) as a substitute for hydromorphone which is very similar chemically yet much safer. It works just as well and instead of living on a 4-hour schedule I take it once a day

The sad thing is, I wouldn’t be addicted if it hadn’t been for a 6 week hospital stay and gutting over a misdiagnosis. Before that if I broke bone I never took narcotics. The first night I had the floor nurse, charge nurse, and 3 RN’s come into the room and demand I take pain meds every 4 hours, period.

[Broomstick]

In mild defense of the medical personnel ('cause I wasn't there so I don't know all the details) there is evidence that preventing breakthrough pain by having a constant and consistent dosing schedule is less likely to result in addiction that having longer intervals between dosing, where the pain comes back before the next dose and the body is "trained" to associated pills with feeling better. One issue is that "less likely" does not mean "prevent in all cases", it just means... less likely. The bad effect can still happen.

1) It may well be that will that philosophy works for some people, or even a majority of people it does not work for all

2) It may well be that for some circumstances it is not the ideal approach

3) Some people might wind up addicted no matter what we do or how we approach their pain

4) We need to see such addiction cases NOT as moral failing but medical side effects.

Because, really, that's what it is in your case - a side effect of medical treatment. One hell of a side effect that is further complicated by societal prejudice.

Except I question if you're actually an addict - if you're taking pain medication for actual pain that's not addiction, that's treatment. If you're taking it to get high, then you're an addict. Of course, the two can overlap as well. People are complicated.

[Flagg]

I don’t take it to get high and I can’t recall the last time it had that effect.

With regards to the hospital stay, I was just not going to take them at all. I’d had broken bones and other injuries along with a few minor procedures and just didn’t take anything but Tylenol, if that. I just “sucked it up” and built up a high pain tolerance. Now I tend to have hyper-analgesia which is fucking annoying.

[PainRack]

Methadone is an oral medication.

I take it you're not familiar with it's use in treating addiction.

Honestly nope:).

I don’t take it to get high and I can’t recall the last time it had that effect.

With regards to the hospital stay, I was just not going to take them at all. I’d had broken bones and other injuries along with a few minor procedures and just didn’t take anything but Tylenol, if that. I just “sucked it up” and built up a high pain tolerance. Now I tend to have hyper-analgesia which is fucking annoying.

So...did you actually suffer from withdrawal symptoms such as nausea and etc?

There's been a shift in jargon as medicine adjusts the way it treats addiction, cravings vs actual physical dependence and withdrawal.

Also, I recognise that 4 hourly regime and its.... well, I gotta ask if you mistook them asking if you want meds for them forcing meds on you because that regime sounds like a as neccesary dose, although it's also used for chronic pain such as cancer patients and etc before switching over.

[Flagg]

I’ve gone through withdrawal a few times and it’s god awful.

The situation in the hospital was that I had gallbladder disease misdiagnosed as a fistula (hole) between my duodenum and colon (the doctors were fucking clownshoes stupid. My mom, an LPN, all but begged them to do a test to see if it was my gallbladder because I was the exact same age (23) that my great grandmother was when she had gallbladder disease and they just went with the crazy idea that I had Crohns (even though it tested negative) and a fistula. After they had 2 surgeons perform a laparotomy, basically gutting me, and they found no fistula (but took my appendix out because they were in there and hey, why not?) I was pissed off because at that point I’d been in the hospital for over a month and just had unnecessary surgery, my PCP started screaming at me and said they were right but I was healed by a miracle from God. So that happened... ). I was so bad off when admitted and my mom and doctor knew I was in pain but wouldn’t ask for pain medication so that’s why that happened. I was allowed to have it once every 4 hours, and so after a couple weeks of round the clock narcotics my body needed them.

When I was in recovery after the totally unnecessary surgery that didn’t even fix the problem (they had to have unblocked the bile duct that had been blocked by gallstones when going through my guts because not 2 years later it recurred and was properly diagnosed and removed using scopes and 3 small incisions and I went home the same day, but now have tons of issues with hernias and defective mesh that have crippled me) I went cold-turkey off the pain medication as a “No, fuck you!” to the horrid nurses on the recovery floor who I could hear in the hallway calling me a junky because I was thoroughly addicted/dependent on the narcotics they forced me to take which was totally my fault, right?

But the current situation 12 years from then is that I’ve had so many abdominal surgeries and now a defective hernia mesh that made all of my teeth rot from the inside out so now I have none, I have a hernia, a duck load of scar tissue, and am in agony. So I had been on a dose of pain meds every 4 hours. But now I’m on suboxone, a once a day sublingual dose that is just as effective with the added benefit of not needing to be on a 4-hour schedule.

[PainRack]

that sucks..... yeow:(:(

[Dartzap]

Coincidentally, Louis Theroux has a documentary about this very issue in Virginia airing in the UK on Sunday night. I imagine it'll appear online shortly thereafter.

[Zaune]

I also wonder if the people behind this heinous “three strike and we murder you with neglect” idea support denying liver transplants to alcoholics. Well no I don’t, they would never do such a thing.

I've heard that been seriously proposed in this country, though it seems not to have got past the point of some Disgusted of Tunbridge Wells type writing a letter to the Telegrah before everyone from the British Medical Association to the Church of England wrote letters of their own decrying the idea.

[LadyTevar]

Coincidentally, Louis Theroux has a documentary about this very issue in Virginia airing in the UK on Sunday night. I imagine it'll appear online shortly thereafter.

NOT VIRGINIA.
He's in Huntington WEST VIRGINIA. The same town that's wanting to sue Pharmaceutical Companies for the drug epidemic, that wants the "3 strikes" on ODs, that has over 200+ ODs in a single MONTH.

[Raw Shark]

[ITT Raw Shark occasionally drops some knowledge}

West Virginians and Virginians are not the same at all, and very much do not like to be grouped together. The original split was over slavery: West against, regular for. Fairly different cultures, also.

[LadyTevar]

[ITT Raw Shark occasionally drops some knowledge}

West Virginians and Virginians are not the same at all, and very much do not like to be grouped together. The original split was over slavery: West against, regular for. Fairly different cultures, also.

Actually, there were some disagreements before then over things like timber companies being owned by rich Virginians from their Antebellum plantations, and being worked by poor Mountaineers for starvation wages, as well as tax issues and other things. But the average WVian of the time did not own slaves, and may never have seen an African in their lifetime. Thus, those west of the Shenendoah River were not happy with the idea of Succession from the Union.

Also, we'd been badgering the Virginia Legislature for over a decade by that point to be allowed to break off and form a new state. Much easier to do when the "Government of (Northern) Virginia" is made up of those backing forming a new State.

[houser2112]

Much easier to do when the "Government of (Northern) Virginia" is made up of those backing forming a new State.

I've always thought North Virginia would've made more sense as a name for the new state, since there are parts of Virginia that are further west than the westernmost point of WV, and no part of Virginia is further north than the northernmost point of WV. Any idea why it was named such?

[Ziggy Stardust]

I've always thought North Virginia would've made more sense as a name for the new state, since there are parts of Virginia that are further west than the westernmost point of WV, and no part of Virginia is further north than the northernmost point of WV. Any idea why it was named such?

IIRC, it was originally called "Kanawha" when they seceded from Virginia. There was a subsequent convention to decide on the name during which a number of different options were considered, and "West Virginia" chosen after a vote. I know some of the other potential names included "New Virginia" and "Columbia". I believe North Virginia would not have been considered, because "northern Virginia" was a name traditionally and popularly associated with the part of Virginia proper north of Richmond up to the Potomac River (thus why Robert E. Lee's army was called the "Army of Northern Virginia").

[Raw Shark]

As far as I am aware, the eventual settlement upon simply "Virginia" by that region was pretty much a "fuck you" thing.

[Gandalf]

It's news articles like the one in the OP that make me wonder if WV would have been better off being reabsorbed into VA during reconstruction.