> There is a reason that blacks appear to have been spared the worst of the narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies have found that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.
If I read this correctly the doctors' pervasive racism is keeping young black men alive.
It would be good to read the study's paper. Studies often don't reach any explicit conclusions, which is one of the important features of the scientific process. Other people make inferences that aren't supported by the actual findings.
Some studies are intentionally deceptive, e.g. https://news.ycombinator.com/item?id=97299. I've pointed that one out a few times over the years, since it's such an excellent showcase of incentives gone wrong. The researcher ended up getting a lot of funding, partly thanks to the pretense of "rat brain flies plane." No one bothered to try to pull apart their paper.
It takes a lot of effort to do this. The only reason I spent hours reverse engineering that paper was because of how excited I was about the implications. Discovering that it was nothing more than a rube goldberg nearly shattered my faith in academia. Especially the realization that sometimes researchers have to do that sort of thing to get funding, or lose.
It's entirely possible that what you said is true. All I'm saying is, it's best to seek out the original paper. (If it's locked behind a paywall, post a request to /r/scholar and you'll usually get it in under an hour.) Sometimes the truth is quite different from appearances.
Studies have also shown inter-group empathy gaps. Or, basically, white people don't believe black people's pain [to the same extent], similarly with men and women.
> Or, basically, white people don't believe black people's pain
If a guy is rushed into the ER, you, as a doctor or nurse, don't have to believe anything. Just run the patient through the proper protocols, regardless of race, age or gender.
The same is true for hiring, etc. Sitting here behind computer monitors we see the solution so clearly: to stop racism, just ignore race.
But out in the real world after we step away from these screens, the futility of that demand becomes clear. You and I commit implicitly biased acts on a routine basis that we don't even notice.
Doctors don't under-treat black patients' pain because they explicitly dislike black people. They do so due to implicit bias. You cannot admonish people into shedding their implicit biases. The solution is to build a system that is resilient to implicit bias.
Bias is a built-in human feature. In fact, all living things are hard-wired to discriminate.
So your "implicit bias" is right. Most of the time we engage in it unconsciously.
Sometimes that "implicit bias shows up as racism, nepotism or some other form of favoritism.
> Doctors don't under-treat black patients' pain because they explicitly dislike black people. They do so due to implicit bias.
No necessarily true. A racist doctor will under-treat black patients simply because he's racist. And note that I'm referring to a racist doctor, because not all white doctors are racist.
Ok but the opioid pain medication would be prescribed after the dust has settled from that ER scramble. Doctors don't have a way to measure pain, other then the patient's own reporting (often they are asked to describe it on the scale of 1-10). So belief is a central part of the process.
It's not like there is a machine or a blood test you can use to find out the person is experiencing "37.3 pain". The 'protocols' you refer to will necessarily require a subjective evaluation of the pain the patient is experiencing (as well as assessing other social factors that may point to a higher risk of abuse).
There are people who will call the ambulance or show up at the ER, claiming pain, when in fact they are 'simply' looking for drugs to meet their addiction.
The only person who knows how much pain the patient is actually experiencing is the patient themself. However, blindly relying on them to accurately report that level pain is simply not an option, given the potential for abuse.
That's awfully glib. There is medical marijuana in Michigan (a relatively restrictive regime, but still) and we still have pretty big problems with prescription drug abuse and heroin. Never mind that marijuana is at least as available as other illegal drugs. It's probably even easier and cheaper to get than a prescription for opiates.
A lot of these people got hooked on opiates through a prescription from their doctor. These doctors prescribing opiates before trying medical marijuana for pain management are endangering the wellbeing and lives of their patients.
Bupenorpine. Made it free. It will help a lot of addicts.
(Doctors shouldn't have to take a special course in order to prescribe it.)
I'm getting tired of this opoid problem. I'm tired of addicts overdosing. As to rehab--if you don't relapse--fine.
We have a drug for opioid dependenancy, and maybe even the
a tool to combat depression, and anxiety that's very safe. Unless you are hell bent on overdosing, you don't need Suboxone, you could get by with Subutex--that is if you can find a doctor to prescribe it? Once you have just bupenorpine in your system; the physical cravings for opioids go away. Plus--you might give up a few other bad habits too--like drinking?
Subutex and suboxone are not the answer just like methadone is not the answer. I know people who I went to high school with take those for years and years. Instead if doing pain killers they are now addicted to the pill that was supposed to get rid of addiction.
Physical cravings aside its a mental game to get rid of an addiction. Every time one of those friends stopped taking subutex/suboxone they would relapse. Some people took them for 4-5 years and were on such a high dose they had withdraws.
The goal of suboxone therapy is not to free someone from physical dependence. It is to save lives and restore livelihoods by replacing a dangerous and debilitating drug whose use is associated with a whole set of unhealthy behaviors with another drug that permits nearly normal functioning in society.
If we take addicted to mean "need to function normally" I have family members who are addicted to anti allergy drugs, the problem isn't having to take a particular drug for the rest of your live, the problem is needing heroin to function.
I live in Rhode Island, and the heroin use is out of control. In the small town I grew up we lose someone to OD every month or so, and I have many acquaintances that are using. 5-10 years ago heroin use in the town was unheard of. All of the people I know that use started with Oxycontin, and then moved on to heroin when they became more desperate.
It's bad in AK too, at least in Juneau. A city of ~30,000 people during the tourist season had at least 6 overdose deaths last year[0], and one particularly bad weekend saw 4 people treated for overdosing on heroin[1], and just the other day a seemingly healthy acquaintance of mine was found dead[2]. While they haven't ruled that one an overdose yet I think it's pretty likely.
Disable JavaScript to get around the Empire pay wall.
That's how it is all across Indiana as well. It is awful. I was back there this summer to see a friend, had to find a new place to crash at the last minute because he had to go pull his brother out of a shed and let him detox at his house.
People are broke and broken. Very few decent paying jobs even with a college degree, if you are broke you don't have access to decent medical/psych care either.
Same. Went home to Indiana for thanksgiving, and found out my 4th grade best friend had ODed a few months before. Sad thing was, is that I wasn't surpised.
> of both illegal drugs like heroin and prescription painkillers
I was a teenager in the early 90's and i'm horrified with that heroin come-back. I don't understand how it can be, especially in western countries. What the f. is happening ? I thought we dealt with that sh. long ago ?
In what way do you think it was dealt with? As far as I know for actions like 'The War on Drugs' it's at least debatble whether they actually did reduce the amount of use of illigeal substances (let alone amount of related crime etc)?
I was thinking about pop culture + education more than "war on drugs", since I live in Europe. I mean since when taking heroin is cool again ? it destroyed or killed so many people i knew 20 years ago ...
The article is mostly talking about people who are wrongly prescribed opioid meds for long term pain.
They don't start taking those meds because it's cool. They start taking those meds because they don't have access to pain clinics; they don't understand that exercise is effective for many forms of pain (especially musculo-skeletal); that opioids should not be used for long term pain, etc. The meds become less effective if they're used for a long time, so people increase their dose. They become addicted to the meds, and need higher doses. A couple of things happen here.
1) Doctors restrict the meds. People then either buy illicit meds, which are stronger than they're expecting; or they buy heroin because it's easy enough to get.
2) People die from liver damage caused by the paracetamol that these pain meds are often mixed with. Partly we used to think that combining paracetamol and opioids meant we could use less of each (but that turns out to be untrue), and partly some people thought that mixing a poisonous substance in with the opioid would reduce abuse. (It sort of does, by killing the user.)
My grandmother started drinking after my grandfather died. And died herself ten years later of liver failure. I remember emptying out the medicine cabinet and tossing a half empty 500 pill bottle of Tylenol in the trash. And then finding two more unopened in the cabinet under the sink. My thought then was, 'this and the booze is what killed her.' That was 35 years ago.
Drugs come into and go out of fashion, and there are changes in availability as various precursor chemicals are made harder to get.
With things like MDMA this control over precursor chemicals does harm, because people use "research chemicals" or bath-salts instead, and there's not much evidence of safety for those. And there's some environmental impact as illegal loggers cut down trees in rain forest to get safrole oil.
Increase everyone's rent, reduce everyone's job security, increase everyone's working hours, reduce everyone's access to cheap healthcare and generally let the Trump's of the world run things and you get an underclass of very unhappy people to whom heroin seems like a pretty good idea (at the time).
I'm sorry, but this is nonsensical. 'Poor' people, on the whole, work less, and have a better standard of living now than for most of recorded history.
It's much more likely that over-prescription of oxycontin is the root cause of any increase in heroin use.
I'm not sure if heroin ever left Santa Cruz after the 90s. It took a concerted effort to get a trail into part of a local park that had been dubbed "heroin highway". There was anyone from guys in suits and BMWs to homeless getting their fix in the area.
The trail helped mitigate issues for the park quite a bit, but the heroin problem is still huge. In Santa Cruz, I think a lot of it stems from decades of tolerance and looking the other way.
Now when people are fed up,a lack of treatment options, ease with which those living on the street can get a meal and access to cheap drugs, as well as a judiciary that is at best revolving door perpetuates the problem.
As european, may i ask from americans - what pains do you have so that doctors so easily prescribe hard painkillers? When taking into account that one can sue doctors easily in US, why they even dare?
tl;dr - "Chronic pain conditions affect at least 116 million U.S. adults at a cost of $560-635 billion annually in direct medical treatment costs and lost productivity. [...] [It] is much more than a biological phenomenon and has profound emotional and cognitive effects. [It] contributes greatly to national rates of morbidity, mortality, and disability; and is rising in prevalence."
Well there is a lot of research showing that opioids aren't effective when used longterm. But the caveats are that most chronic pain isn't continuous, it's intermittent, so maybe only a couple days per month. And also there are ways to reset your opiate receptors to undo the damage from opiate use, which this research doesn't take into account.
For most people weed is probably a better choice for chronic pain, but I also think opioids have a more negative reputation than is deserved.
The bulk of disability (after mental illness) is musculo-skeletal. Very many of those people would benefit from exercise. Here's a programme from BBC Radio 4.
> If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.
U.K. here, but im allergic to NSAIDS (as are many asthmatics) so they're immediately off the table for me. It severely limits your options when you're in pain.
This makes me wonder how making drugs legal would affect the overall mortality rate. The changes in Portugal are interesting but it's not the same culture as the US. Would it make it worse (easier to get drugs) or better (less stigma about treatment).
You could argue it both ways, but I'd argue that the externalities of legalizing it (drug dealers don't have to shoot each other to compete, police officers are no longer risking their lives breaking into meth labs, etc.) make legalizing worth it.
I have to point out that we didn't legalize drugs, merely decriminalized their consumption. Just this week there have been multiple busts, ones for growing cannabis and others for selling amphetamines and hashish.
> Would it make it worse (easier to get drugs) or better (less stigma about treatment).
That may not be as binary as it seems on idle reflection.
There certainly are drugs that used in extremes, and (occasionally) in moderation, put people in a position where day to day functioning is impossible, but equally there are drugs that cause very little harm for reasonable consumption patterns. All else being equal, who would you rather have living next door? A drunk or someone who smokes a fair bit of weed on the weekend?
There's this thing that people do - certainly that governments seem to do with respect to the issues surrounding decriminalisation and/or legalisation - where the ideal, the thing they measure success by, is getting people to stop doing something that they wouldn't choose for themselves. That metric doesn't necessarily make a lot of sense.
For what it's worth, almost everyone I know my age has a relationship with drugs that falls somewhere between open-to-the-idea, dabbling, or frequent-but-functional. Designer drugs are viewed as cool and a status badge in some ways. Concentration/ productivity drugs are popular, nootropics are trendy, almost normalized. The other day a perfectly normal, if rather nerdy social media manager I know brought up to me how he's looking to get into cocaine because he thinks it'll be fun (but maybe that's just a social media manager thing). Granted, the article said the rates were more associated with lower socio economic groups, but I think all this still points to there being something in the air.
The thing about the gateway oxycontin to heroin is that when people get "clean" and then relapse, the idiots try to take their old dose and end up killing themselves because they do not have the tolerance anymore:
Living in a low income area, I am grateful every day that I do not seem to have the attraction to drugs that so many people around here seem to have. I'm not even tempted. Not patting myself on the back for that because I suspect it is just fortunate genetics in that one regard. Now put a pizza or chocolate in front of me and I have an impossible time stopping but that won't kill me of course.
I expect it's due to your upbringing rather than genetics. You'd enjoy drugs as much as anyone else does. They're additive for a reason: they're really quite amazingly fun.
I've come to the sad conclusion that ODing on heroin is a rite of passage with that drug and simply...you either survive it or you don't.
I was fortunate enough to survive 4 hospital-trip-inducing ODs in my life.
I know it may sound flippant or glib or obvious, but when you start down that path its always "oh, that will never happen to me" or "i'm too smart to make that mistake"
Sad truth is...it pretty much happens to everyone.
I've read that most heroin ODs occur when a person gets clean and goes back to their old dose after growing a tolerance. Has that been your experience?
It makes me wonder if simply making this fact more common knowledge would cut down on life-threatening overdoses
> Sad truth is...it pretty much happens to everyone.
Which is why it's so critical to get Narcan into more addicts hands.
They are going to overdose either way... It's just a matter of surviving them long enough to come to the point that some other external factors drive you to get clean (which seems to be the subtext of your post).
Were you ever administered Narcan, and were you pissed when at whoever gave you the Narcan? The times when I've administered it I've gotten yelled at for ruining people's highs when they came back. One guy even threw a punch at me in the back of the ambulance.
If you want them to be happier, preoxygenate before administering the Narcan. They aren't pissed because you "ruined their high". They're pissed because they're hypoxic (and therefore confused, disoriented, etc), and surrounded by people in uniforms, and don't know how they got there.
Bag them up before you push the Narcan and you will have much happier patients.
According to the CDC 40% of Medicaid patients prescribed an opiate are misusing or abusing the drug.
Almost half of prescription drug overdoses are by those on Medicaid.
Medicaid patients with an opiate drug prescription had about six prescriptions on average in 2010.
Compared to people with private insurance options, Medicaid patients were much more likely to be prescribed stronger painkillers and have more prescriptions.
This is a complicated issue that is going to take time to solve. In the meantime, we need to 'stop the bleeding' by getting Narcan[1] into the hands of those most at risk of a Heroin overdose (or more importantly, into the hands of those who are likely to be around them when they do OD).
Thats certainly one thing we could do, if we value the druggies lives enough. Honestly I don't see why we, as a society, should help those who won't help themselves.
Ignoring your implication that someone must be "productive" to be worth saving from death... You don't have to go any further than this comment page to find likely examples of that (there are personal accounts of opiate abuse, and it's probably a safe bet that someone who bothers to read Hacker News meets some definition of "productive member of society").
I'm sure the research is far less biased,
But I couldn't escape the connotations of "there should be more black and hispanic deaths than white" from the author of this piece. It seemed to decry of the actual issue of drug OD less than this particular disparity.
75 comments
[ 3.4 ms ] story [ 160 ms ] thread> There is a reason that blacks appear to have been spared the worst of the narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies have found that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.
If I read this correctly the doctors' pervasive racism is keeping young black men alive.
Some studies are intentionally deceptive, e.g. https://news.ycombinator.com/item?id=97299. I've pointed that one out a few times over the years, since it's such an excellent showcase of incentives gone wrong. The researcher ended up getting a lot of funding, partly thanks to the pretense of "rat brain flies plane." No one bothered to try to pull apart their paper.
It takes a lot of effort to do this. The only reason I spent hours reverse engineering that paper was because of how excited I was about the implications. Discovering that it was nothing more than a rube goldberg nearly shattered my faith in academia. Especially the realization that sometimes researchers have to do that sort of thing to get funding, or lose.
It's entirely possible that what you said is true. All I'm saying is, it's best to seek out the original paper. (If it's locked behind a paywall, post a request to /r/scholar and you'll usually get it in under an hour.) Sometimes the truth is quite different from appearances.
That's probably also a factor.
If a guy is rushed into the ER, you, as a doctor or nurse, don't have to believe anything. Just run the patient through the proper protocols, regardless of race, age or gender.
Otherwise what's the Hippocratic Oath all about?
But out in the real world after we step away from these screens, the futility of that demand becomes clear. You and I commit implicitly biased acts on a routine basis that we don't even notice.
Doctors don't under-treat black patients' pain because they explicitly dislike black people. They do so due to implicit bias. You cannot admonish people into shedding their implicit biases. The solution is to build a system that is resilient to implicit bias.
So your "implicit bias" is right. Most of the time we engage in it unconsciously.
Sometimes that "implicit bias shows up as racism, nepotism or some other form of favoritism.
> Doctors don't under-treat black patients' pain because they explicitly dislike black people. They do so due to implicit bias.
No necessarily true. A racist doctor will under-treat black patients simply because he's racist. And note that I'm referring to a racist doctor, because not all white doctors are racist.
There are people who will call the ambulance or show up at the ER, claiming pain, when in fact they are 'simply' looking for drugs to meet their addiction.
The only person who knows how much pain the patient is actually experiencing is the patient themself. However, blindly relying on them to accurately report that level pain is simply not an option, given the potential for abuse.
Your perception is at least partly emotional.
In other situations, confirmed by many studies, racism in emergency rooms (and hospitals in general) have been very bad for blacks.
I'm getting tired of this opoid problem. I'm tired of addicts overdosing. As to rehab--if you don't relapse--fine.
We have a drug for opioid dependenancy, and maybe even the a tool to combat depression, and anxiety that's very safe. Unless you are hell bent on overdosing, you don't need Suboxone, you could get by with Subutex--that is if you can find a doctor to prescribe it? Once you have just bupenorpine in your system; the physical cravings for opioids go away. Plus--you might give up a few other bad habits too--like drinking?
Physical cravings aside its a mental game to get rid of an addiction. Every time one of those friends stopped taking subutex/suboxone they would relapse. Some people took them for 4-5 years and were on such a high dose they had withdraws.
Disable JavaScript to get around the Empire pay wall.
0: http://www.adn.com/article/20151107/juneaus-heroin-heartbrea...
1: http://m.juneauempire.com/local/2015-11-17/one-weekend-5-dru...
2: http://m.juneauempire.com/local/2016-01-15/juneau-man-found-...
People are broke and broken. Very few decent paying jobs even with a college degree, if you are broke you don't have access to decent medical/psych care either.
I was a teenager in the early 90's and i'm horrified with that heroin come-back. I don't understand how it can be, especially in western countries. What the f. is happening ? I thought we dealt with that sh. long ago ?
There are some macro economic aspects as well making heroin cheap & powerful & readily available.
In what way do you think it was dealt with? As far as I know for actions like 'The War on Drugs' it's at least debatble whether they actually did reduce the amount of use of illigeal substances (let alone amount of related crime etc)?
They don't start taking those meds because it's cool. They start taking those meds because they don't have access to pain clinics; they don't understand that exercise is effective for many forms of pain (especially musculo-skeletal); that opioids should not be used for long term pain, etc. The meds become less effective if they're used for a long time, so people increase their dose. They become addicted to the meds, and need higher doses. A couple of things happen here.
1) Doctors restrict the meds. People then either buy illicit meds, which are stronger than they're expecting; or they buy heroin because it's easy enough to get.
2) People die from liver damage caused by the paracetamol that these pain meds are often mixed with. Partly we used to think that combining paracetamol and opioids meant we could use less of each (but that turns out to be untrue), and partly some people thought that mixing a poisonous substance in with the opioid would reduce abuse. (It sort of does, by killing the user.)
With things like MDMA this control over precursor chemicals does harm, because people use "research chemicals" or bath-salts instead, and there's not much evidence of safety for those. And there's some environmental impact as illegal loggers cut down trees in rain forest to get safrole oil.
It's much more likely that over-prescription of oxycontin is the root cause of any increase in heroin use.
The trail helped mitigate issues for the park quite a bit, but the heroin problem is still huge. In Santa Cruz, I think a lot of it stems from decades of tolerance and looking the other way.
Now when people are fed up,a lack of treatment options, ease with which those living on the street can get a meal and access to cheap drugs, as well as a judiciary that is at best revolving door perpetuates the problem.
http://www.nap.edu/catalog/13172/relieving-pain-in-america-a...
tl;dr - "Chronic pain conditions affect at least 116 million U.S. adults at a cost of $560-635 billion annually in direct medical treatment costs and lost productivity. [...] [It] is much more than a biological phenomenon and has profound emotional and cognitive effects. [It] contributes greatly to national rates of morbidity, mortality, and disability; and is rising in prevalence."
For most people weed is probably a better choice for chronic pain, but I also think opioids have a more negative reputation than is deserved.
http://www.bbc.co.uk/programmes/b06vkg24
> If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.
That may not be as binary as it seems on idle reflection.
There certainly are drugs that used in extremes, and (occasionally) in moderation, put people in a position where day to day functioning is impossible, but equally there are drugs that cause very little harm for reasonable consumption patterns. All else being equal, who would you rather have living next door? A drunk or someone who smokes a fair bit of weed on the weekend?
There's this thing that people do - certainly that governments seem to do with respect to the issues surrounding decriminalisation and/or legalisation - where the ideal, the thing they measure success by, is getting people to stop doing something that they wouldn't choose for themselves. That metric doesn't necessarily make a lot of sense.
http://www.sciencemag.org/news/1998/06/heroin-relapse-ups-ov...
Living in a low income area, I am grateful every day that I do not seem to have the attraction to drugs that so many people around here seem to have. I'm not even tempted. Not patting myself on the back for that because I suspect it is just fortunate genetics in that one regard. Now put a pizza or chocolate in front of me and I have an impossible time stopping but that won't kill me of course.
Obesity kills.
Plus I know better than to keep food like that around.
I assume it is exponentially harder for drug addiction though.
I was fortunate enough to survive 4 hospital-trip-inducing ODs in my life.
I know it may sound flippant or glib or obvious, but when you start down that path its always "oh, that will never happen to me" or "i'm too smart to make that mistake"
Sad truth is...it pretty much happens to everyone.
It makes me wonder if simply making this fact more common knowledge would cut down on life-threatening overdoses
http://www.businessinsider.com.au/philip-seymour-hoffman-ove...
Which is why it's so critical to get Narcan into more addicts hands.
They are going to overdose either way... It's just a matter of surviving them long enough to come to the point that some other external factors drive you to get clean (which seems to be the subtext of your post).
Glad you're still around.
Bag them up before you push the Narcan and you will have much happier patients.
Almost half of prescription drug overdoses are by those on Medicaid.
Medicaid patients with an opiate drug prescription had about six prescriptions on average in 2010.
Compared to people with private insurance options, Medicaid patients were much more likely to be prescribed stronger painkillers and have more prescriptions.
https://www.thefix.com/content/study-shows-40-medicaid-patie...
[1]: https://en.wikipedia.org/wiki/Naloxone
2) Our society already has mechanisms that help in case of OD: People usually try to call 911 if they see someone in a bad shape.
The question is whether we need to spend more resources on helping fixing OD cases or may be spend these resources on other good causes.
Deaths seem to be a mix of direct use or not knowing it was mixed into another drug.
Fentanyl is frighteningly powerful so little of it can kill.