This tack is a good start, for sure, a shift in how people think about the drugs problem. Yet, it's only the beginning. Physicians need to understand the ramifications of what they prescribe. They should be better equipped and trained to determine when use of drugs goes from treating one symptom to becoming a problem in itself.
When someone comes in for painkillers for hip problems, etc and the time passes where it was either effective or not, but the drugs are still prescribed because the patient claims the issue persists way beyond the normal timeline, it's then time to reevaluate the usefulness of the drug's initial prescription.
is this still a problem? from personal experience, the last time I needed pain managed the #1 concern was not getting me addicted, #2 was pain management itself. they were very cautious to start anything "strong" (morphine) and very, very eager to end it. from these and other anecdotal experiences I have a hard time accepting that doctors handing out strong painkillers like candy and getting their patients hooked on them is a genuine problem, do you have any data?
> My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers.
> She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ...
> What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem.
> The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain.
> In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing.
This would suggest that even in 1999 the order was still your #1/#2.
When I had major surgery three years ago, the button to give myself a dose of hydromorphone only worked every 10 minutes. I imagine systems like this are pretty common. When I left the hospital five days later, my prescription wasn't anything nearly so strong—and this was a surgery with a months-long recovery.
Doctors in general are generally cautious. The problem can be traced to a small number of corrupt doctors who decided to abandon their medical scruples so they could make very lucrative livings as semi-legal dealers of high-grade narcotics.
The Feds eventually cracked down on this racket, but not before it had spawned a tremendous number of white, middle-class addicts who found themselves turning to the black market in heroin for their fixes. These people, in turn, are running headlong into the insanely punitive legal structures developed to terrorize, brutalize, and demonize black users when crack became a thing in the 80s.
Given a choice between accepting the punishments they were happy to dole out to others or abandoning this particular vector for racism, bigoted white people are deciding they can find other ways to keep the spirit of Jim Crow alive and well. For them, the Drug War has failed not because it failed to get rid of drugs (that was never the point) but because it's no longer as discriminatory as it used to be.
I think it's more complicated than that simplistic take. Just imagine the numbers of people behind bars if that tactic were followed thru. It was pretty much untenable as it was but we'd be looking at what, locking up 5 per cent of the population?
If you look at who supported the drugs policies, blacks supported them almost as much as whites did. Drugs were ravaging neighborhoods, and back then, this is how societies had treated drugs addicts. Russia, China, Singapore, African countries, etc. It wasn't till the Swiss experimented with alternative back in the nineties that others began looking at alternative policies in treating drugs addicts. Then we had a number of countries in Europe begin to try alternative methods to treat their addicts and people began to see these alternatives were more effective than jailing addicts and now we're seeing similar approaches in the US.
That's a simplification, to be sure. And yes, there was support for the idea of drug enforcement in the places where the drug trade spawned the most violence. But the enterprise went badly sideways from there, quickly degenerating into an excuse for detaining and harassing black people en masse, long after the violence that triggered the crackdown has abated.
That's probably about as helpful as not doing anything, so a step in the right direction, but how often do addicts want to change and how often does wanting to change actually result in the addicts quitting?
When you hit "the bottom" you know, and jail is the last place you want to end up in that situation --to say nothing about having to then maintain a criminal record afterwards. Addicts are addicted, and like anyone who has ever suffered through such a plight the unconscious puts up a fight like none other in order to keep the body wired into the drug. You think you still want to use, but that is merely a projection of the condition, until you know you cannot use, but meanwhile cannot stop. At this point treatment can hopefully become available to the person outside of the criminal justice system.
If executed correctly, then jail is a actually good solution for heroin addicts. In jail, they can't leave to buy more junk, so they'll overcome withdrawals with a 100% success rate. The hard part is staying clean.
Heroin use was popular in the Beatnik generation. In the book Junky, William Burroughs describes how had himself jailed voluntarily. Police stations where he was living at the time had a program similar to Gloucester's where users would bring in their "works" in exchange for a 21-day lockup without charges.
The rest of the civilized world has known that rehab (and social/mental support) is cheaper and more effective than prison for > 30 years.
But the "tough, not supportive" meme in US policy keeps warring people, time, and money. Vote Republican, everyone, because "tough on crime" is tougher than namby-pamby "science" that can never give a clear answer!
Hillary and Bill Clinton were the biggest supporters of "tough on crime" in the 1990s. Your premise falls flat accordingly. The Democrats also put huge numbers of people in prison with their participation in the war on drugs.
Bill Clinton's presidency saw the most people added to the prison population of any president in US history. His tough on crime, tough on drugs policies successfully added roughly 650,000+ people to the prison numbers in just eight years. That's a record that is unlikely to ever be topped.
Clinton was a man of his times. You have to remember that in 1993 all you knew was that violent crime had been surging upwards for decades. You had no way of knowing that it was about to peak and recede.
Violent crime had not been surging upwards for decades. The 90s' highest year, 1993, was about where it was in 1980 when Reagan took office, under whose governance the rate dipped a bit before coming back up (how's that for leaving the place better than you found it?). What we saw was the rate ticking up only slightly in Clinton's first couple of years.
And nothing better than to simultaneously note that a support of unionized cops on the street + demographics-based decline in crime soon to follow would be an almost guaranteed winning policy for re-election for a Dem.
Possibly there is a soft definition of what constitutes "violent crime"? The numbers on Wikipedia show a clear trend that doesn't abate until the mid 90s. Am I reading that wrong?
California is desperately in need of more prison space and Texas is planning on closing prisons and figuring out how to change the laws so fewer people go to jail.
No competition between who handles criminality better between the two states. And one of them is the biggest democrat state and the other the republican. Doesn't prove anything exact this is not a republican versus democrat issue.
Having trouble paying off your mortgage? House an inmate in your basement and earn over $20,000 per year!
Jails overcrowding? Facing budget cuts? Save money by outsourcing inmates to individual jailers!
Reviews:
"We were very hesitant to accept out first inmate, but with our medical bills, it seemed like the only other option was selling the house. Danny turned out to be a sweet young man. Really loves my home-made peach cobbler. I let him have the old PC; he says he uses it to watch educational videos." - Francine Humphrey
"The owner failed to lock the cell and the prisoner waked out the very first night. Edit: CinderBnB customer service was very understanding and offered a full reimbursement for search and recapture" - Sgt. Dale Flannigan
"My lawyer says that according to county law I technically qualify as a tenant, so once my term is up they'll need to evict me but can't keep me locked up" - Shawn Taylor
>30 years - huh? I just looked through wikipedia's Drug Liberalization page and didn't see anything earlier than Portugal's 1999 decriminilization, except that Uruguay never even criminilized them. So what are you referring to?
There isn't much in fact. Most of the so-called civilized world still puts drug offenders in prison, a lot. Just take a look at Japan's extreme drug laws for example (they apparently don't count as civilized).
The parent is claiming a few, mostly tiny European nations represent the majority of all civilized nations.
Depending on what the word "civilized" is supposed to mean it could be true. Nations where the death penalty is still given are not considered civilized in Europe, so there's that. (But everyone chooses not to care in America's case :))
A lot of the developed world does not really enforce the laws on mere users. Certainly nowhere as strictly as it was enforced on inner-city african-americans.
Simple drug possession is one of those offences that is mostly used as a hammer to whack people who are "nuisances".
The Drug War has been a bi-partison effort: https://www.youtube.com/watch?v=3Bk2t0MuvKs. Pretty much everyone lost their fricking mind in the 1980's and 1990's, when the modern drug war was implemented.[1] Clinton doubled-down on the drug war even as he had to lie that he'd "never inhaled" while smoking marijuana. Even many conservatives (40% of republicans today support legalizing marijuana), would not agree with the hardline positions mainstream democrats took on drugs back then.
[1] I just watched "Straight out of Compton" and was reminded of Tipper Gore's war against music in the 1990's: https://www.youtube.com/watch?v=Q_7NSXnlQ64. "Liberal democrats" like her were a pillar of the drug-war movement back then.
While the policies of the party you chose ends up being the only thing that matters during election time, I still think its important to separate them from discussions of certain issues. While I understand that the purpose of the figure pointing is to help dissuade others from voting for the party who enables the issue, in my experience the people who its directed at tend to take it personally; or at least an attack aimed at them specifically. As a result the whole thing ends up being counter-intuitive.
I feel that it would be better to simply speak about the issues specifically and keep their relation to a party out of it until election time. Many people in the US associate with their parties almost like they do a sports team, the better way to persuade them to vote for the other side is to have them make the decision themselves after being properly informed. When they make the decision themselves we are able to circumvent this feeling that they are being attacked and has the dual benefit of allowing us to have another informed voter during the election cycle.
This "team" mentality is not exclusive to one party, I strongly suggest people belonging to both sides to be critical of their respective parties and the actions of representatives they voted for.
I believe you misread the sentence. "> 30 years" refers to the length of time "the rest of the civilized world" has held these beliefs, not the length of a prison sentence.
In the current opiate epidemic, a far greater proportion of addicts are white. Whether consciously or unconsciously, it's seems highly likely that those in power are drawing different conclusions about what the right solution to drug abuse is based on the skin color of the victims.
Don't get stuck oversimplifying with "whiteness" being the full explanation.
Meth has been a disproportionately white drug, but it strikes in areas of poverty where the parents of addicts are already the underclass, and can't drum up sympathy with the 'power structures' of their community. (Think judges, police, town officials.)
Opiates often hit middle class or wealthy families. Thats the real difference: This is a drug epiedemic that is crawling into areas of society with political capital. Parents of addicts or the addicts themselves know or work with the people who can show empathy when creating & enforcing policy.
Meth users are also (in my limited experience) considerably more prone to antisocial/obnoxious/violent behavior than opiate addicts.
It might be harder for people to have sympathy for them VS. a person who quietly struggles with a (sometimes deadly) addiction that begin from a legitimate pharmaceutical prescription.
Here is a psychiatrist presenting the flaws of rehabs and an argument that governments also need to allow widespread use of suboxone to treat addiction:
> The best guesses by outside observers is that for a lot of them about 80% to 90% of their graduates relapse within a couple of years.
The problem with this statement is that you can go back to using drugs, but in a significantly lower risk pattern than previously. E.g. if you were shooting up heroin, but switch to smoking weed. This is actually pretty common, so these top line relapse rates dramatically understate the efficacy of these programs. That's not to say they're super effective, but I think there's at least something to be said for intellectual honesty.
Suboxone is just dope from a dope man in a lab coat. All suboxone does is switch addiction from opiates or opioids, to opioids. I've known more than a few people who were detoxing from suboxone say it's easier to kick heroin.
That's why addicts should only use suboxone to get over the initial, physical withdrawal symptoms and only take it for maybe a week and then taper it down. Suboxone is a far worse thing to detox from because the half life is far longer than opiates -- something like 36-48 hours.
Suboxone is a Godsend if you only use it to get over the initial w/d's
I see no problem with using any drugs as a step-down. But what is happening is Pharma is lobbying state governments to employ suboxone as a long term maintenance solution.
I had a very close ex-girlfriend who went on subs but wanted desperately to get out of the whole game.
After I went to an inpatient treatment center and learned from the professionals there that kicking subs was way harder then heroin, and saw with my own eyes a few people there who were having a bitch of time.
I ended up telling her this, and strongly advised her to get back on heroin for a week and then kick...she followed my advice and thanked me for profusely as she tried the sub detox taper and couldn't make it work.
Suboxone for heroin addicts is like benzodiazepines for alcohol withdrawal. It should only be used in the initial withdrawal period for a short period of time.
The proper protocol is to substitute the short-acting heroin for the longer half-life Suboxone. This stabilizes the blood levels, thereby eliminating inter-dose withdrawal symptoms.
The dose is supposed to be titrated to zero over a few weeks. Otherwise you'll just end up swapping on addiction for another.
It's a shame, because Buprenorphine is a really good medication when used properly.
And if you want to talk about social justice, this is what drug replacement therapy (suboxone)-based rehab looks like in some of our southern states. Addict is remanded by a court to the care of an outpatient treatment facility. Addict must show up at that facility every day with $10-$15 in hand to buy their dose. If they miss a day, the treatment center has the authority to send the addict to prison. Some treatment centers will engage a kind of payday loan scheme to allow the addict to catch up on payments later, for a price.
If the addict has felony priors (most do, using is a felony in many states), they will have a hard time finding a job, and an even harder time paying for food and shelter, on top of the $280-$450 a month for their subs. It's a form of indentured servitude, with pharma being the beneficiary. Some resort to criminal activity to support their state-mandated habit.
47 comments
[ 3.9 ms ] story [ 90.3 ms ] threadWhen someone comes in for painkillers for hip problems, etc and the time passes where it was either effective or not, but the drugs are still prescribed because the patient claims the issue persists way beyond the normal timeline, it's then time to reevaluate the usefulness of the drug's initial prescription.
> My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers.
> She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ...
> What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem.
> The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain.
> In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing.
This would suggest that even in 1999 the order was still your #1/#2.
The Feds eventually cracked down on this racket, but not before it had spawned a tremendous number of white, middle-class addicts who found themselves turning to the black market in heroin for their fixes. These people, in turn, are running headlong into the insanely punitive legal structures developed to terrorize, brutalize, and demonize black users when crack became a thing in the 80s.
Given a choice between accepting the punishments they were happy to dole out to others or abandoning this particular vector for racism, bigoted white people are deciding they can find other ways to keep the spirit of Jim Crow alive and well. For them, the Drug War has failed not because it failed to get rid of drugs (that was never the point) but because it's no longer as discriminatory as it used to be.
If you look at who supported the drugs policies, blacks supported them almost as much as whites did. Drugs were ravaging neighborhoods, and back then, this is how societies had treated drugs addicts. Russia, China, Singapore, African countries, etc. It wasn't till the Swiss experimented with alternative back in the nineties that others began looking at alternative policies in treating drugs addicts. Then we had a number of countries in Europe begin to try alternative methods to treat their addicts and people began to see these alternatives were more effective than jailing addicts and now we're seeing similar approaches in the US.
Once a habit is developed, a desire to quit will rarely be enough. Help is absolutely necessary.
Heroin use was popular in the Beatnik generation. In the book Junky, William Burroughs describes how had himself jailed voluntarily. Police stations where he was living at the time had a program similar to Gloucester's where users would bring in their "works" in exchange for a 21-day lockup without charges.
In that case, it would exclude using a jail for a health care issue. You could apply the same logic to helping people lose weight.
Indeed you could!
Jail's intention is to correct bad habits, not to punish them.
But the "tough, not supportive" meme in US policy keeps warring people, time, and money. Vote Republican, everyone, because "tough on crime" is tougher than namby-pamby "science" that can never give a clear answer!
Bill Clinton's presidency saw the most people added to the prison population of any president in US history. His tough on crime, tough on drugs policies successfully added roughly 650,000+ people to the prison numbers in just eight years. That's a record that is unlikely to ever be topped.
http://content.gallup.com/origin/gallupinc/GallupSpaces/Prod...
(click "show" on the table to see the data) https://en.wikipedia.org/wiki/Crime_in_the_United_States#Cri...
No competition between who handles criminality better between the two states. And one of them is the biggest democrat state and the other the republican. Doesn't prove anything exact this is not a republican versus democrat issue.
Having trouble paying off your mortgage? House an inmate in your basement and earn over $20,000 per year!
Jails overcrowding? Facing budget cuts? Save money by outsourcing inmates to individual jailers!
Reviews:
"We were very hesitant to accept out first inmate, but with our medical bills, it seemed like the only other option was selling the house. Danny turned out to be a sweet young man. Really loves my home-made peach cobbler. I let him have the old PC; he says he uses it to watch educational videos." - Francine Humphrey
"The owner failed to lock the cell and the prisoner waked out the very first night. Edit: CinderBnB customer service was very understanding and offered a full reimbursement for search and recapture" - Sgt. Dale Flannigan
"My lawyer says that according to county law I technically qualify as a tenant, so once my term is up they'll need to evict me but can't keep me locked up" - Shawn Taylor
The parent is claiming a few, mostly tiny European nations represent the majority of all civilized nations.
Simple drug possession is one of those offences that is mostly used as a hammer to whack people who are "nuisances".
[1] I just watched "Straight out of Compton" and was reminded of Tipper Gore's war against music in the 1990's: https://www.youtube.com/watch?v=Q_7NSXnlQ64. "Liberal democrats" like her were a pillar of the drug-war movement back then.
I feel that it would be better to simply speak about the issues specifically and keep their relation to a party out of it until election time. Many people in the US associate with their parties almost like they do a sports team, the better way to persuade them to vote for the other side is to have them make the decision themselves after being properly informed. When they make the decision themselves we are able to circumvent this feeling that they are being attacked and has the dual benefit of allowing us to have another informed voter during the election cycle.
This "team" mentality is not exclusive to one party, I strongly suggest people belonging to both sides to be critical of their respective parties and the actions of representatives they voted for.
Meth has been a disproportionately white drug, but it strikes in areas of poverty where the parents of addicts are already the underclass, and can't drum up sympathy with the 'power structures' of their community. (Think judges, police, town officials.)
Opiates often hit middle class or wealthy families. Thats the real difference: This is a drug epiedemic that is crawling into areas of society with political capital. Parents of addicts or the addicts themselves know or work with the people who can show empathy when creating & enforcing policy.
It might be harder for people to have sympathy for them VS. a person who quietly struggles with a (sometimes deadly) addiction that begin from a legitimate pharmaceutical prescription.
http://slatestarcodex.com/2015/02/02/practically-a-book-revi...
The problem with this statement is that you can go back to using drugs, but in a significantly lower risk pattern than previously. E.g. if you were shooting up heroin, but switch to smoking weed. This is actually pretty common, so these top line relapse rates dramatically understate the efficacy of these programs. That's not to say they're super effective, but I think there's at least something to be said for intellectual honesty.
The same is true of prison. First offenders are much less likely to go back than the 'average' prisoner.
Suboxone is a Godsend if you only use it to get over the initial w/d's
After I went to an inpatient treatment center and learned from the professionals there that kicking subs was way harder then heroin, and saw with my own eyes a few people there who were having a bitch of time.
I ended up telling her this, and strongly advised her to get back on heroin for a week and then kick...she followed my advice and thanked me for profusely as she tried the sub detox taper and couldn't make it work.
The proper protocol is to substitute the short-acting heroin for the longer half-life Suboxone. This stabilizes the blood levels, thereby eliminating inter-dose withdrawal symptoms.
The dose is supposed to be titrated to zero over a few weeks. Otherwise you'll just end up swapping on addiction for another.
It's a shame, because Buprenorphine is a really good medication when used properly.
If the addict has felony priors (most do, using is a felony in many states), they will have a hard time finding a job, and an even harder time paying for food and shelter, on top of the $280-$450 a month for their subs. It's a form of indentured servitude, with pharma being the beneficiary. Some resort to criminal activity to support their state-mandated habit.
First, it helps the addicts develop a better life. Regardless of your stance on the drugs themselves, it's hard to defend real addiction.
Second, it frees up prison space.
Third, it reduces demand for the drug, which is how the drug war should've been fought all along.