I've been summoned for a roundtable discussion for my municipality.

[Elite Engineer]

The topic of the discussion is addressing a terrible opiate epidemic that has struck my city...as with many cities in the US in the last couple of years.

 

I'm open for suggestions any of you have that I can provide at this discussion.

 

~EE

[Sensei]

I don't recall you ever talking about opiates on forum...

 

So, if you don't know anything, pretending that you know (from forum answers), would be lie..

Or even worser, you could become city expert in the subject.. *)

 

ps. Have you been in Afghanistan, Pakistan, f.e. as soldier on mission, bodyguard, pilot, "tourist", etc.. ? Do you know such people.. ?

 

ps2. You could always read f.e.

https://en.wikipedia.org/wiki/Opium_production_in_Afghanistan

how to produce, how to process, how to transport, what is compound formula and structure, etc. etc.

https://en.wikipedia.org/wiki/Heroin

Print them, present and talk for hours..

 

*) get ball-n-stick enough to build heroin compound model to show.... If you're interested in such job..

Edited February 14, 2017 by Sensei

[Endy0816]

Maybe something along the lines of treatment and prevention options?

 

Do good to talk with addicts and recovering adicts, if time permits.

[imatfaal]

I think the most important issue is how a community decides to tackle addiction; there is the tolerant, cheap, effective method of treating addiction through medical and social care methods or the intolerant, expensive, and counter-effective method of punishing addiction via the courts, prison, and the justice system. Brain-numbingly, many societies choose the latter - they are the ones who tend to have drug-problems.

 

Read up on some of the literature on imprisonment v treatment for addiction - bring an evidence-based perspective to the meeting

[waitforufo]

I have known a few people who became addicted to oxycodone / oxycontin. All of them started taking these drugs on a prescribed basis, generally after a significant surgery. All of these people told me that there doctors told them that they couldn't become addicted if they were truly in pain. What nonsense. Once adequately healed, and they attempt to go off the oxy, they have normal withdrawal, which they associate with their recent surgery pain, so they stayed on the oxy addicted. Then slowly there lives fall apart, particularly after their doctors pull the meds and they sought illegal sources.

 

The only other issue I can think of is the volume of pills prescribed to one individual. When my mother was dying from cancer, I would pick up her meds from the pharmacy. One of the pill bottles contained a huge volume of oxy meds. I would guess greater than 100 pills, maybe 200. So many I was worried that someone would break into her home to steal them. When my mother was connected to a morphine pump, they did not take these pills back. After my mother passed, hospice gathered up my mother's meds and destroyed them in my presence. The hospice nurse mentioned during this destruction process that I could have made a tidy sum on the street selling those meds. I bet.

[CharonY]

I have known a few people who became addicted to oxycodone / oxycontin. All of them started taking these drugs on a prescribed basis, generally after a significant surgery. All of these people told me that there doctors told them that they couldn't become addicted if they were truly in pain. What nonsense. Once adequately healed, and they attempt to go off the oxy, they have normal withdrawal, which they associate with their recent surgery pain, so they stayed on the oxy addicted. Then slowly there lives fall apart, particularly after their doctors pull the meds and they sought illegal sources.

 

The only other issue I can think of is the volume of pills prescribed to one individual. When my mother was dying from cancer, I would pick up her meds from the pharmacy. One of the pill bottles contained a huge volume of oxy meds. I would guess greater than 100 pills, maybe 200. So many I was worried that someone would break into her home to steal them. When my mother was connected to a morphine pump, they did not take these pills back. After my mother passed, hospice gathered up my mother's meds and destroyed them in my presence. The hospice nurse mentioned during this destruction process that I could have made a tidy sum on the street selling those meds. I bet.

 

I agree, discussing the sources of addictions is important. Unfortunately it is easy to become addicted and there should be more awareness regarding the potential dangers. Somewhat related to that, it is interesting that certain minorities (African Americans and Hispanics, I believe) were less affected by the recent opiate wave and it has been speculated that it is because they get less pain med prescriptions. It is a bit ironic that the assumption of higher addiction rates prevented addiction in this demographic, whereas white folks suffered more. But it also means that a more controlled prescription and use of alternate ways of pain control could, at least in part, reduce the incidence.

Another aspect of recent high fatality rate has been attributed to fentanyl, which is highly potent with higher toxicity leading to increased overdoses.

[StringJunky]

 

Another aspect of recent high fatality rate has been attributed to fentanyl, which is highly potent with higher toxicity leading to increased overdoses.

I can't understand how it's so prevalent since it was designed for a very specific niche; as a breakthrough pain-reliever for patients, usually terminal cancer-patients, on long-term morphine and other potent analgesics where addiction was not considered an issue given that their life expectancy was likely to be relatively short. Basically you had to have an already high tolerance to have them. I understand it' s used just after an operation as well.

[CharonY]

I read about it a while ago and according to a Canadian report (Canada has seen one of the biggest increase in abuse) it could be linked to the decline of oxycodone, due to a change in formulation, which made oxycodone less usable for drug users. Together with the fact that fentanyl is relatively cheap to produce, there was surge in the illegitimate production and sales.

 

It is probably relevant to note is that heroin has not gone away either, and currently oxycodone and heroin are still leading causes of overdoses. Fentanyl is mostly a worry as the deaths increased rapidly, again, most likely as it starts replacing oxycodone and many people get the dosages wrong.

 

It is probably also relevant to add stimulants such as cocaine and methamphetamine to the mix. While stimulants account to maybe only ~20% of deaths their use is currently on an uptick. While we are in politic I would like to add that law enforcement and politicians have often viewed drug abuse as a gang problem or a minority problem (including the current president). As such it was often treated as a moral problem with all the issues and abuse that imatfaal brought up.

 

However, it is clear that it is, and to some degree always has been a population-wide problem and has to be treated more like a health issue than a merely a criminal one. Ultimately, addicts are victims of their addiction and punishing them does nothing to change that.

 

Potential because of the focus on specific groups, the constant increase of drug abuse among white people (check the SAMHSA survey, for example) has not sufficiently been recognized and targeted. And that is despite the fact that there are at least five times the amount of white drug users than blacks. Potentially, as it came with a moral burden health care responses were anything but adequate to address this situation while at the same time certain avenues of drug trade, such as prescription drugs, were not effectively shut down or reduced.

 

So overall mistargeted law enforcement (no doubt supported by rhetoric of tough on crime politicians) together with inadequate health care at least contributed to the overall problem.

[MigL]

One of the biggest factor is that people with legitimate prescriptions can put up with some pain and make a good buck selling their pain medication ( as waitforufo didn't do because he's a good guy ). Everything is available on the street. Heck, I know people who are selling prescription Viagra to make a few dollars ( until some old guy has a heart attack ).

 

But there have to be buyers for the market to exist.

What drives people to take substances they know are harmful, so as to feel a little better ( or less aware of their circumstances, I should say ).

And its not just a New York state or Canadian issue.

Other areas have their own problems. Like the Crystal Meth problem in the former coal mining areas of the Appalachias/west Virginia.

 

You don't need to be an expert on the drugs themselves to recognize how it impacts your community, and how to help mediate the problem.

[iNow]

Like others above, I'd emphasize the importance of rehabilitation services instead of wasting money on prison. You might also explore injecting abusers with a blocker drug like Vivitrol.

[Elite Engineer]

One of the biggest factor is that people with legitimate prescriptions can put up with some pain and make a good buck selling their pain medication ( as waitforufo didn't do because he's a good guy ). Everything is available on the street. Heck, I know people who are selling prescription Viagra to make a few dollars ( until some old guy has a heart attack ).

 

But there have to be buyers for the market to exist.

What drives people to take substances they know are harmful, so as to feel a little better ( or less aware of their circumstances, I should say ).

And its not just a New York state or Canadian issue.

Other areas have their own problems. Like the Crystal Meth problem in the former coal mining areas of the Appalachias/west Virginia.

 

You don't need to be an expert on the drugs themselves to recognize how it impacts your community, and how to help mediate the problem.

I never took the time to notice that you lived in St. Catherines, ON. until you mentioned Canada. I live 10 minutes outside Buffalo, NY., and I regularly go to lewiston, NY and Old Fort Niagara..howdie neighbor!

 

I bet you've heard about the terrible opiate issue here in Buffalo though. I've lost 5 people from my high school graduating high school class of 2011..all in about 3 years after graduation. and that's just one town..much worse in the city. I had no idea Ontario was having issues too.

 

I liked some of the suggestions of getting info from abusers, and their take on the situation..how they got started, where the got, etc. All excellent responses folks!

[StringJunky]

I read about it a while ago and according to a Canadian report (Canada has seen one of the biggest increase in abuse) it could be linked to the decline of oxycodone, due to a change in formulation, which made oxycodone less usable for drug users. Together with the fact that fentanyl is relatively cheap to produce, there was surge in the illegitimate production and sales.

 

It is probably relevant to note is that heroin has not gone away either, and currently oxycodone and heroin are still leading causes of overdoses. Fentanyl is mostly a worry as the deaths increased rapidly, again, most likely as it starts replacing oxycodone and many people get the dosages wrong.

 

It is probably also relevant to add stimulants such as cocaine and methamphetamine to the mix. While stimulants account to maybe only ~20% of deaths their use is currently on an uptick. While we are in politic I would like to add that law enforcement and politicians have often viewed drug abuse as a gang problem or a minority problem (including the current president). As such it was often treated as a moral problem with all the issues and abuse that imatfaal brought up.

 

However, it is clear that it is, and to some degree always has been a population-wide problem and has to be treated more like a health issue than a merely a criminal one. Ultimately, addicts are victims of their addiction and punishing them does nothing to change that.

 

Potential because of the focus on specific groups, the constant increase of drug abuse among white people (check the SAMHSA survey, for example) has not sufficiently been recognized and targeted. And that is despite the fact that there are at least five times the amount of white drug users than blacks. Potentially, as it came with a moral burden health care responses were anything but adequate to address this situation while at the same time certain avenues of drug trade, such as prescription drugs, were not effectively shut down or reduced.

 

So overall mistargeted law enforcement (no doubt supported by rhetoric of tough on crime politicians) together with inadequate health care at least contributed to the overall problem.

I don't think we have that kind of problem here with Schedule 2 drugs (Schedule 1 have no known medicinal use except in research) as they are controlled by primary care trusts - private entities have to go through them as well - and the traceability and authorisation process is very rigid. You can only get a month's worth at a time save exceptional circumstances. i think this is one advantage of a nationally-controlled health service; better control and traceability

[imatfaal]

. Point of order, please.

 

When you guys are referring to "opiates" what exactly do you mean? I assumed you meant heroin and other morphine derivatives which in USA are illegal - it seems from the conversation that "opiates" is used as a generic term to mean prescription pain-killers

[StringJunky]

. Point of order, please.

 

When you guys are referring to "opiates" what exactly do you mean? I assumed you meant heroin and other morphine derivatives which in USA are illegal - it seems from the conversation that "opiates" is used as a generic term to mean prescription pain-killers

I suppose it is meant with respect to those drugs that affect the same receptors as natural opiates.

 

 

A drug, hormone, or other chemical substance having sedative or narcotic effects similar to those containing opium or its derivatives: a natural brain opiate. Also called opioid.

[iNow]

Oxy is a prescription pain killer that is hugely abused in the US, and which leads to use of often cheaper options like heroin. This may be one of those areas where it's a distinction without a difference.

 

https://www.cdc.gov/drugoverdose/epidemic/

[Lord Antares]

. Point of order, please.

 

When you guys are referring to "opiates" what exactly do you mean? I assumed you meant heroin and other morphine derivatives which in USA are illegal - it seems from the conversation that "opiates" is used as a generic term to mean prescription pain-killers

 

There is a difference between opiates and opioids. Opiates are, generally speaking, drugs like heroine, opium, morphine etc. They are simply drugs exctracted from the papaver somniferum plant, otherwise known as the opium poppy. It is actually trivially easy to extract some of these, which is another reason opiates are so abundant.

Opioids are generally pills or other forms of drugs synthethized from opiates. Pain killers would be opioids.

 

So you would, generally speaking, use opiods to cure someone of their opiate addiction. Of course, opioid addiction is another problem.

 

Anyway, OP, you didn't specify what was the purpose of this meeting? Is it to reduce the opiate epidemic or to better help the addicts? Because if it's the former, not much can be done. Possibly nothing. If it's the latter, it could be discussed.

[Elite Engineer]

 

There is a difference between opiates and opioids. Opiates are, generally speaking, drugs like heroine, opium, morphine etc. They are simply drugs exctracted from the papaver somniferum plant, otherwise known as the opium poppy. It is actually trivially easy to extract some of these, which is another reason opiates are so abundant.

Opioids are generally pills or other forms of drugs synthethized from opiates. Pain killers would be opioids.

 

So you would, generally speaking, use opiods to cure someone of their opiate addiction. Of course, opioid addiction is another problem.

 

Anyway, OP, you didn't specify what was the purpose of this meeting? Is it to reduce the opiate epidemic or to better help the addicts? Because if it's the former, not much can be done. Possibly nothing. If it's the latter, it could be discussed.

The former. My thought is to hear what former addicts have to say, how they got it, where they got it, etc. More than anything else, the spree of overdoses we've seen in Buffalo has been caused by heroin being laced with fentanyl (it is primarily an opiate problem as you explained).

Because if it's the former, not much can be done. Possibly nothing. If it's the latter, it could be discussed.

I know it sounds terribly cruel, but what if narcan were restricted from being used? From what I've heard is that the narcan is somewhat enabling abusers. If the customer base dries up, there won't be any drugs. That's at least my sentiment, and I know removing narcan won't be an attractive idea.

[Lord Antares]

It depends on what you mean by ''how they got it'' and ''where they got it''.

Do you mean that you should ask them for the exact source of their drugs or how they got around to being in a position to acquire drugs in the first place?

 

I'm not sure if you intend to deal with actual drug dealers or the source of a user's drug problem.

[CharonY]

In that context a recent study is interesting: Barnett et al. 2017 New England Journal of Medicine.

 

In that paper the authors found a link between addiction and high-intensity pain opioid prescribers (i.e. MDs that prescribe painkillers more frequently).

[iNow]

You could follow New Jersey's lead. Just tonight, they passed one of the nations most comprehensive laws to address the crisis: http://www.ajmc.com/newsroom/NJ-Opioid-Treatment-Mandate-Prescription-Limit-Heads-to-Governor-Christie

[Lord Antares]

This article tackles opiod addiction. OP has specifically stated that he need to address opiate addiction. There is a marked difference.

 

Opioid problem is addressable by law (i.e. via pharmacies, medicine etc.) while an opiate problem isn't.

[Elite Engineer]

It depends on what you mean by ''how they got it'' and ''where they got it''.

Do you mean that you should ask them for the exact source of their drugs or how they got around to being in a position to acquire drugs in the first place?

 

I'm not sure if you intend to deal with actual drug dealers or the source of a user's drug problem.

No I'm talking about former addicts, who've been off the stuff for years. Get as much internal info as possible.

[CharonY]

This article tackles opiod addiction. OP has specifically stated that he need to address opiate addiction. There is a marked difference.

 

Opioid problem is addressable by law (i.e. via pharmacies, medicine etc.) while an opiate problem isn't.

 

It does not seem trivial to dissociate the issue based on OPs description (heroin laced with fentanyl). Also, considering that addicts pick and choose between different opioids depending on availability it may be insufficient to only one or the other aspect. I.e. addicts that got hook up on opioids may seek morphine or heroin to satisfy their addiction, if they cannot get oxycodone, for example. And this is what data suggests: ~2010 oxycodone use started declining, while heroin abuse started to increase. And more recent data suggest now a strong increase in fentanyl.

 

As an additional issue, prescription drugs can and have been distributed outside of legal distribution routes, as especially for fentanyl the synthesis is not prohibitively complex. That is not to say that there are no means to reduce abuse using such means, as some pharmacies have started using an exchange system for fentanyl patches. However, focusing on only one part of the equation is unlikely to be sufficient to put a dent into the problem.

 

 

It also makes sense to talk to social workers, addiction centres and researchers in that area, assuming that they are not already part of the discussion.

Edited February 16, 2017 by CharonY

[StringJunky]

 

It does not seem trivial to dissociate the issue based on OPs description (heroin laced with fentanyl). Also, considering that addicts pick and choose between different opioids depending on availability it may be insufficient to only one or the other aspect. I.e. addicts that got hook up on opioids may seek morphine or heroin to satisfy their addiction, if they cannot get oxycodone, for example. And this is what data suggests: ~2010 oxycodone use started declining, while heroin abuse started to increase. And more recent data suggest now a strong increase in fentanyl.

 

As an additional issue, prescription drugs can and have been distributed outside of legal distribution routes, as especially for fentanyl the synthesis is not prohibitively complex. That is not to say that there are no means to reduce abuse using such means, as some pharmacies have started using an exchange system for fentanyl patches. However, focusing on only one part of the equation is unlikely to be sufficient to put a dent into the problem.

 

 

It also makes sense to talk to social workers, addiction centres and researchers in that area, assuming that they are not already part of the discussion.

Opiate/opioid addicts are in a constant on-off state of withdrawal depending on supply frequency and will use whatever is available to deal with the withdrawal at any given time just to avoid the symptoms. This is basically an addict's life and MO. In my experience they are generally polydrug users with emphasis on the analgesics. The great bulk of addiction is psychological. Just because I say that doesn't mean that it's trivial to deal with. It took me two years of professional help and I wasn't addicted to opiates; My thing was amphetamine primarily. The physical addiction side of opiate addiction takes two weeks of abstinence for the body to readjust but the behaviourally habitual element is far more deeply ingrained. The first step has to come from within the addict themselves otherwise it's a waste of time.

Edited February 16, 2017 by StringJunky