David Siegel says that he is no expert on the opioid crisis, but I found his article on narcotics to be more informative than most other essays I’ve read. Here’s an excerpt:
When I fell 30 feet off a rock in Central Park, I went to the emergency room, where they refused to give me any pain killers, fearing I was just telling them a story to get narcotics. My knee was badly swollen, yet the hospital rules would not let me get pain relief without a doctor’s exam, which had to be postponed until the next day. That night was agony.
When I fell ice skating in Zurich and couldn’t get up because my hip was broken, the ambulance person came and started a line of Fentanyl immediately, waited for it to kick in, and then moved me onto the gurney and into the ambulance. That was when I learned how amazing Fentanyl is. It’s a wonder drug. It removed the pain, yet it left me clear-headed enough to do research on my phone about the upcoming operation, call family, and manage my medical affairs. The Zurich hospital kept me comfortable until I went into the operating room.
The US and Switzerland have similar per capita GDPs (PPP adjusted). Both are among the highest in the world. I suspect that Switzerland has higher living standards than the US, mostly due to having a more sensible attitude toward pain relief.
Here’s another excerpt:
Carfentanyl is made by many labs and in many different strengths. It’s cheap. It’s easy to get into the country. At its most concentrated, the amount in a normal size suitcase could kill everyone in Boston. This is what makes the opioid epidemic so deadly — people easily kill themselves with uncut or poorly dosed Carfentanyl.
When it’s illegal to get safe doses of pain medication, then people are likely to get unsafe doses.
Scott Alexander’s essay on addiction is also well worth reading.
READER COMMENTS
John
Dec 29 2019 at 11:57am
This seems interesting, do you have a link to the article?
Scott Sumner
Dec 29 2019 at 11:07pm
Sorry, I added it now.
GregS
Dec 29 2019 at 1:05pm
@ John: It’s from a Medium piece titled “My Favorite Narcotics and Why I Love Them.”
https://medium.com/@pullnews/my-favorite-narcotics-and-why-i-love-them-dcc7a73f25b8
kingstu
Dec 29 2019 at 1:43pm
Politicians are doing an excellent job of restricting opiate access to pain patients which will have almost no impact on overdose deaths. Since politicians haven’t been able to “win” the War on Drugs in 100 years or so they can win the War on Pain Patients. Law abiding pain patients are much more likely to obey the law and endure suffering rather than purchasing mystery substances on the street without knowing the potency or ingredients.
Summary:A study from investigators projects that the opioid overdose epidemic in the US is likely to increase in coming years, and that measures based on restricting access to prescription opioids will have a minimal impact in reducing overdose deaths.
https://www.sciencedaily.com/releases/2019/02/190201130613.htm
Lorenzo from Oz
Dec 29 2019 at 6:15pm
Scott Alexander’s essay on X is well worth reading is pretty much a given.
Scott Sumner
Dec 29 2019 at 11:08pm
Yes.
BC
Dec 30 2019 at 2:15am
If a patient became addicted to pain killers in Switzerland, would the doctor, hospital, drug company, or insurance company be at risk of being held legally liable? What about if an ER gave pain killers to an addict that lied about falling off a rock? If people incur legal liability for giving drugs to someone else that abuses those drugs, then people tend to become reluctant to give out those drugs.
BC
Dec 30 2019 at 2:26am
I see from the first few paragraphs of Scott Alexander’s essay that, in the US, some people do indeed want to place legal blame on drug companies if doctors should mis-diagnose a patient’s actual addiction as “pseudo-addiction”.
Most people would agree that we should give patients pain medication when they actually need it. Far fewer people would agree that doctors, hospitals, and for-profit drug companies should not have legal liability for giving drugs to addicts, even though the two statements are actually equivalent.
Alan Goldhammer
Dec 30 2019 at 8:37am
Pain medications are sometimes very necessary in treating underlying medical conditions and those that need it should have access. There are two primary problems related to broader opioid addiction. Some of the modern synthetic opioids are quite easy to manufacture and their very high potency (as evidenced by the picture above) means that an accomplished chemist can manufacture enough to make a lot of money and then get out of the business. This “Breaking Bad” scenario was rumored to have taken place some years ago when an industrial chemist did just that by making one large batch of Fentanyl and cashing out afterwards. This is something that is always going to be very difficult to control.
The second big issue is the abuse of prescribed opioids through over prescribing. Ostensibly this should be controllable as doctors, pharmacists, drug distributors and manufacturers (note that manufacturers are not the same as distributors) all are required to keep records on controlled substances. This level of abuse was a colossal policy failure on multiple levels by DEA, to lessor extent FDA, and state boards that license MDs and pharmacists.
Number two can be addressed but number one will always be a problem and no ‘war on drugs’ will be able to solve it based on history.
Theresa Morales
Dec 31 2019 at 6:15am
I have had a history of passing kidney stones. It seemed every 6 months I would be going to e.r. If anyone that has my history knows exactly how painful it is. In the past I would be given percocet, along with other medication for about 4 days. Until I go see my primary doctor as requested for my e.r. doctor to do.
8 months ago I again went to Jackson Memorial Hospital in Miami. After being given medication for nausea, I was given a dose of Torodal. I was discharged with prescription for 800mg of Motrin! That is abuse in my eyes.
I didn’t fight to be given more than Motrin because I didn’t want to be seen as a drug seeker. I understand that there is a opioid epidemic but not EVERYONE has an addiction. I even went to a pain management team and they said to take unto 4,000mg of ibuprofen in a day. But wait what does those high doses of ibuprofen does the average person know it does to your liver over time???
There has to be some kind of balance. Why not make a high standard pure CBD a priority. Don’t punish the people who need pain medication and are following the rules.
Scott Sumner
Jan 4 2020 at 1:44am
It’s terrible what our government does to people. They are no better that those third world dictatorships that torture people.
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