Why do we continue to demonize those that use prescription pain meds? In doing so, we force them out of mainstream society, hurting our economy and communities in the process.
Substance abuse isn't inherently immoral or ungodlike or whatever. In some cases it can cause harm. Causing harm is a problem at individual and societal levels. Public policy should aim to reduce harm, but our drug policies almost all aim to inflict multiple forms of devastating harm to scare or crush addicts into sobriety. Worse, it doesn't even solve the faux "problem" of substance abuse.
Abuse is any use that is unacceptable to those making the determination. With illegal and prescription drugs, that's usually any recreational use at all.
Substitute "recreational use" for "abuse" if it makes you feel better about the semantics. Then we can dissect the finer points of "recreational". An LEO told me his use of wine wasn't recreational because he only used it socially, not for the effects, whereas recreational drug users are always using it for the effects.
We're not demonising people who use the meds, we're demonising the system that irresponsibly markets and prescribes those meds, which fails to properly treat long term pain, and removes people from the workforce and society, and creates addicts.
Deep within every human resides the thought "If i would run this place then-" which makes for great violations of the libertys of others and loud yelling, if others do the same to the majestic creature that is oneself.
How much is this due to people really needing these prescriptions, and then aren't informed or helped quit, and how much is this due to plain overprescription?
It should be pretty easy to compare with any comparable country to see what the difference in opioid prescription is.
Here we see the comparison with the AMRO zone (the Americas) which shows the US and Canada prescribe a lot more opioids than any other country in the Americas.
> And what it finds about the United States is jaw-dropping: Even when the list is restricted to the top 25 heaviest consuming countries, the United States outpaces them all in opioid use.
> For example, Americans are prescribed about six times as many opioids per capita as are citizens of Portugal and France, even though those countries offer far easier access to health care. The largest disparity noted in the U.N. report concerns hydrocodone: Americans consume more than 99 percent of the world’s supply of this opioid.
You don't really need to script to buy most things in Mexico. Or if you do the kind pharmacist with gladly write one for your ailments, only a small cash fee.
> These data represent the amounts of opioids distributed legally in a country for medical and scientific purposes to those healthcare institutions and programs that are licensed to dispense to patients, such as hospitals, nursing homes, pharmacies, hospices and palliative care programs. Consumption does not refer to the amounts dispensed to, or used by, patients, but rather to amounts distributed to the retail level.
Interesting. What is driving this? Obviously the finger has been pointed towards medical companies bribing doctors to prescribe their meds, but that doesn't explain the use opioids in particular (other than if you are very cynical and believe that pharmaceutical companies want addicted customers - which might be partly true but hopefully not the whole truth).
The question becomes - what are doctors elsewhere doing?
- Prescribing physiotherapy for e.g back pains, rather than meds?
Or
- prescribing other kinds of pain medication?
Or something else?
There is also a question of how many of these people had non-prescription addictions and simply switched to prescription drugs because it's convenient and doctors can be persuaded to prescribe.
Here in Europe I know many people (most?) who have been prescribed pain medication at some point, but no one who has had potent opioids outside of hospital. Typical pain med prescriptions are for higher-than-usual doses of non prescription drugs like paracetamol/ibuprofen and only in rare cases weaker synthetic opioids like tramadol.
Hydrocodone and similar opioids are typically only used for terminal cancer patients and are banned from general prescription. Methadone is used for treatment of heroin addiction though.
Some time ago the VA noticed a lot of people had long term untreated pain. They ran a campaign "pain: the 5th vital sign". That campaign asked doctors to ask patients if they were in pain, and asked doctors to treat pain. It also said opioids are weakly addictive when used to treat pain.
It turns out that opioids, when used to treat long term pain, are more addictive than they thought. And also if you ask people about pain you end up treating a heck of a lot more people.
People in long term pain do need treatment, but that should normally be opioids as a last resort, and carefully controlled in a pain management clinic.
Yes, and "Opioid Use Could Explain 20% of the Drop in American Men from Labor Force" would be a much more accurate title for this item.
> The increase in opioid prescriptions from 1999 to 2015 could account for about 20 percent of the observed decline in men’s labor force participation (LFP) during that same period.
This title is whack. Here's the quote from the article:
"...In earlier research presented at the Boston Fed in 2016, Krueger found that nearly half of prime age men who are not in the labor force take pain medication on a daily basis, and that two-thirds of those men—or about 2 million—take prescription pain medication on a daily basis..."
I take a baby aspirin every morning, so I would qualify as somebody taking pain medication daily.
I believe the opiod problem in the U.S. is an extremely serious thing, therefore we need to be very careful about what kinds of information we stick in our heads regarding it.
There's a ton of correlation here, things like "Over the last 15 years, LFP fell more in counties where more opioids were prescribed"
Well, okay. If more people are being injured and are in pain, they would get medication, right? And therefore there would be less people in the workforce. Because people are on pain meds doesn't mean that's keeping them from work. It might mean that things that keep you from work significantly involve pain.
I have no intention of trashing the article. It's worth reading. I would simply advise caution in jumping to conclusions.
My opinion is that mankind is finally creating the perfect world (relatively speaking compared to all of history): plenty of food and shelter. The internet and gaming means you'll never be bored. Throw in a little pharmacological assistance for any pain, boredom, ennui, depression, or loneliness you're feeling, and what more could you want?
But that's rampant speculation, which I readily admit. I worry about articles that encourage reader speculation without explicitly calling it out.
An important point of clarity: according to the article, 2/3rds of those men taking opiods (and not in the labor force) are taking prescription pain medicine.
That seems consistent, since severe pain generally prevents or limits work.
Just finished a thought provoking book on my flight this afternoon titled Man's Search for Meaning which may shed light on potential underlying causes of this crisis. Interesting that decades ago psychologists observed broad differences in the psychological "health" of men living in the US versus Europe for example that potentially left them more susceptible to physiologically degenerative ailments like depression, suicide and drug addiction. I think that one of the defining challenges of our life time will be to figure out a way to broadly replace in society the sense of purpose and meaning one derives from religion and spirituality in an increasingly secularized world.
Yes and that's probably the explanations! European men went through this 2-3 generations ago, and then, they were too busy with the nasty stuff happening back then in Europe.
Parts are and parts are definitely not (we are after all comparing continents here). I don't believe secularism is the only consideration at play. The question(s) I am noodling on (for myself and broadly) is: do these young men have a sense of purpose and meaning in their lives and if not, is that contributing in a meaningful way to their willingness to engage in degenerative behaviors / drug use?
If we entertain this hypothesis for a moment by assuming there is a causal relationship between lack of meaning / purpose and higher propensity to engage in degenerative behavior and severe drug use, it then begs the questions: what changed? Where did people derive meaning and purpose in society before? Where are they getting it now? Where are they likely to get it in the future?
Again, entertaining the hypothesis, it would follow that setting up more drug clinics is unlikely to solve the problem because people are unlikely to find meaning through the current format of drug rehabilitation. A better solution long term may be increased emphasis on psychological rehabilitation.
I don't have the answer to any of these questions and certainly wouldn't say religion is the only answer. There are alternative ways to accomplish this. For example: as a society we can try to reinstill a greater sense of dignity in labor and non-managerial service roles.
I have wondered if one of the benefits of being a European is having a rich heritage. Coming from a very new country that really has a limited cultural identity it can be hard to grasp onto anything patriotic that feels legitimate. Couple that with less importance on family values and an increasingly isolated and individualist society it's also hard to come across anything feeling much like a community.
Not being able to anchor your contributions to anything meaningful past "a business" it can be easy to feel like it doesn't really matter that much.
To poke at the digital world, most of what we create on our computers is ephemeral, transient and bound for quick obsolescence. With no roots in the real world, with no past to be a part of and no community to belong to, our efforts existing briefly at best, perhaps it is no wonder everything is underscored by a lonely existential dread.
Note to others: "European cultural identity" and "giving men a sense of community" are White Supremacist talking points.
You can't put cultural identity into a box. In other words, it's all in your head, it's whatever you make it out to be. The various European countries don't have it any more than we do, and we in "young countries" are not lacking in it.
A community is only those people in your immediate social sphere. You can't have a "national sense of community" because you don't interact with everyone in the nation. White Supremacists talk about a lack a "sense of community", because they are actively refusing to acknowledge their physical neighbours as a part of their community.
The reason Richard Spencer and his ilk talk so much about "European Cultural Identity" is because of a perverse jealousy of Black Cultural Identity. It's a long-con job that attempts to hand-waive over the vast differences in individual European countries' cultural heritages and ignore that the only reason there is such a thing as "Black Cultural Identity" is because slavery stripped African Americans of their more specific heritage. I can trace my family heritage back more than a thousand years. Few, if any, African Americans can go back any further than 150. They don't even know who in our country might be family, because even once here, their families were ripped apart and scattered to the wind.
Well, thank you for the warning. I was certainly trying to tread carefully, as at least in Australia, patriotism or nationalism is becoming synonymous with racism and bigotry, two things I am absolutely not advocating, and my comment had nothing to do with.
I can definitely see what you are saying in your third paragraph, however I would love nothing more than the opposite to happen. One of the things I love about Australia is it's almost complete lack of a single national cuisine, it's a broad spectrum of dozens of different cuisines, often mixed together. A neighbourhood community equivalent of that would be a beautiful thing in my opinion.
I also wasn't suggesting that Europe has one homogeneous identity, I was thinking in my head more about strong identities tied to the individual countries and their histories rather than Europe as a whole. The buildings alone can date back centuries which, I know when I am in the presence of buildings that old, I feel a strong connection to the past.
In regards to a local community, what I was referring to is division on an individual level, where technology is driving individualism so strongly that people don't feel the need to focus on their communities or social groups. Where there may have been regulars at coffee shops who would strike up conversations with eachother and form a small community, perhaps one of many interconnected communities. What I see happening is individuals sitting at coffee shops alone on their phones, not engaging with anyone.
I've been trying to re-engage with the community which is why this was an interesting talking point for me, but I've noticed that while it's great that I am not face first into my phone, it hasn't helped that much as everyone else still is. Trying to get groups of friends together normally results in half of them bailing because it's easy to do. I noticed when I ditched my phone entirely for a few weeks, I was much better at going places to see people, because I said I would and had no easy out.
Huh, you think patriotism is more legitimate in Europe? Subjectively speaking, I have to say I think it's the opposite, because patriotism and nationalism almost destroyed Europe in the first half of the 20th century, and that still shows in how people think here, IMO.
Revisiting this comment, it's really not to do with patriotism at all and more about individual existentialism. I seem to have connected to a story arc I didn't realise existed by using the word patriotism.
I feel like having more history lends a bit more material to feel a connection to the past, and like you are part of a continuum, which can lend legitimacy to your current existence. You aren't just a fleshy blob meandering through a brief existence, you are part of a long and storied past of fleshy blobs and your existence is a chance to contribute to that story.
This title is not in line with HN guidelines: "Please use the original title, unless it is misleading or linkbait."
I would like to ask the OP to refrain from posting provocative titles which don't comply with the guidelines. I get that the issue is serious but all that title did was alarm me and waste my time.
The Opium Wars brought China to its knees, from which it is only now recovering. I'm surprised that the leaders of the US aren't more worried about this.
Probably he meant that China went from being a top #1 economy in the world by a huge margin when the opioid epidemic began there, and it has just recently became #1 again, so far by a small margin. That sounds about right. They lost ca. 200 years.
Of course explaining that by opioids alone would be balancing between a huge oversimplification and a plain lie, but at least opioids have been the biggest single factor.
Just because they fell in the rankings doesn't mean they actually lost anything.
E.g. Another way for a country to lose the #1 economy spot is for it to simply stay the same while other nations (e.g. Europe in this case) make huge advances.
Being fair, a few other things happened in there too. I don't think that during the communists' Cultural Revolution the country was primarily being held back by opiod abuse.
In a way it was. Majority of population were just off the drugs, and most kids who became 'red guards' - they were born in China's darkest days - had prenatal drug problem so they were kinda mentally impaired which caused most or all that shit.
If such a relatively innocent thing as inhaling lead vapours from suddenly omnipresent cars in 1960s and 1970s could cause a 1980s-1990s crime wave in the U.S., it is easy to see what putting whole nation on opioids could do with the next generation.
China's Century of Humiliation started on the eve of the opium war. The current Chinese government has a goal to never let China ever experience anything like that ever again. I visited their museum of Chinese history in Xian, really eye opening about how this thought drives almost ALL of their foreign and domestic policy.
The Century of Humiliation started them on a road of weakness that took several revolutions to figure out how to stop. Only with Deng Xiaoping in the 80s did China begin to find its stride, and only now are they starting to finally become a world power that the world needs to reckon with instead of ignore. Whatever you think of politics and philosophies, China is now considered a world power in a way it never has been before.
The opium wars were from 1839 to 1860. If you check out this graph of Chinese percentage of global GDP since 1000AD, it started dropping from about 30% to <10% around the time of the wars and started recovering around 1970 but still isn't back to where they used to be. You could argue us brits owe them a few trillion in damages.
In the scheme of a 1000 years of history you could argue 1970 counts as only now perhaps.
He says he wants to spend money on it, but judging by the types of people he's put into positions that have no qualifications to be there, it's hard to see his future intentions as anything more than funneling money to people connected to him.
The one thing that the US has consistently shown recently is for every state that has legalized or decriminalized/medicinal marijuana, opioid abuse and related deaths have plummeted, yet we have trump trying to crack down on this emerging trend.
So it's just more of say one thing but do another.
Saying "we'll spend a lot of time, effort and money" is very different from actually doing something, for example restricting their sales/production to 5% of the current levels. Opioids are prescribed to 1/3 of the population at the moment, and that doesn't even include the illegal usage. Can you imagine the neonatal issues, and the resultant repercussions of bringing up a whole generation of addicts?
They are basically saying porn, social media, the news hype cycle are all tied to dopamine increase in your brain. Its the same mechanisms that drugs, alcohol,cigs can produce.
I think the thing that annoys me about modern medical trends such as the enormous rise in obesity, Alzheimer's, autism and chronic pain and ensuing opiod abuse is the shoulder shrugging by the medical establishment as to the cause. Any meaningful change for the worse in medical statistics over time seems to be uninteresting to most of the medical community and is almost always ascribed to "better reporting" or moral failings of the patient.
> Prime age men who are out of the labor force, however, report less happiness and more sadness during their days than do unemployed men, although they evaluate their lives in general more highly than unemployed men. Prime age and older women who are out of the labor force report emotional well-being and life evaluations in general that are about on par with employed women the same age
Tens of millions of men are suffering in a way that women aren't. It seems when something affects the sexes differently society treats it as gender issue and seeks to help women specifically.
There appear to be specific gender issues here hurting men more. I'd hypothesize unequal expectations. Is this an issue to look at from a gendered perspective?
54 comments
[ 3.8 ms ] story [ 127 ms ] thread- a lot of those people do not need to take those products. Then we have an substance abuse problem.
- a lot of those people DO need to take them. Then we have a public health problem.
In both cases, ouch.
The biggest problem with drugs is that we call them "drugs" and then make very specific claims about "drugs".
It's molecules people, effects vary wildly!
Substitute "recreational use" for "abuse" if it makes you feel better about the semantics. Then we can dissect the finer points of "recreational". An LEO told me his use of wine wasn't recreational because he only used it socially, not for the effects, whereas recreational drug users are always using it for the effects.
It should be pretty easy to compare with any comparable country to see what the difference in opioid prescription is.
http://www.painpolicy.wisc.edu/opioid-consumption-data
Here we see the comparison with the AMRO zone (the Americas) which shows the US and Canada prescribe a lot more opioids than any other country in the Americas.
And here we compare AMRO to EURO: http://imgur.com/a/bb4wD
https://www.washingtonpost.com/news/wonk/wp/2017/03/15/ameri...
> And what it finds about the United States is jaw-dropping: Even when the list is restricted to the top 25 heaviest consuming countries, the United States outpaces them all in opioid use.
> For example, Americans are prescribed about six times as many opioids per capita as are citizens of Portugal and France, even though those countries offer far easier access to health care. The largest disparity noted in the U.N. report concerns hydrocodone: Americans consume more than 99 percent of the world’s supply of this opioid.
> These data represent the amounts of opioids distributed legally in a country for medical and scientific purposes to those healthcare institutions and programs that are licensed to dispense to patients, such as hospitals, nursing homes, pharmacies, hospices and palliative care programs. Consumption does not refer to the amounts dispensed to, or used by, patients, but rather to amounts distributed to the retail level.
The question becomes - what are doctors elsewhere doing?
- Prescribing physiotherapy for e.g back pains, rather than meds?
Or
- prescribing other kinds of pain medication?
Or something else?
There is also a question of how many of these people had non-prescription addictions and simply switched to prescription drugs because it's convenient and doctors can be persuaded to prescribe.
Here in Europe I know many people (most?) who have been prescribed pain medication at some point, but no one who has had potent opioids outside of hospital. Typical pain med prescriptions are for higher-than-usual doses of non prescription drugs like paracetamol/ibuprofen and only in rare cases weaker synthetic opioids like tramadol.
Hydrocodone and similar opioids are typically only used for terminal cancer patients and are banned from general prescription. Methadone is used for treatment of heroin addiction though.
Making everyone healthy... will not be 100% good for their revenue... but I think they went too far on this.
Hope Trump would serve some delicacies called "justice"
It turns out that opioids, when used to treat long term pain, are more addictive than they thought. And also if you ask people about pain you end up treating a heck of a lot more people.
People in long term pain do need treatment, but that should normally be opioids as a last resort, and carefully controlled in a pain management clinic.
Here's the VA document: https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...
Here's a rebuttal which started the reduction in prescriibing opioids for long term pain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/
> The increase in opioid prescriptions from 1999 to 2015 could account for about 20 percent of the observed decline in men’s labor force participation (LFP) during that same period.
"...In earlier research presented at the Boston Fed in 2016, Krueger found that nearly half of prime age men who are not in the labor force take pain medication on a daily basis, and that two-thirds of those men—or about 2 million—take prescription pain medication on a daily basis..."
I take a baby aspirin every morning, so I would qualify as somebody taking pain medication daily.
I believe the opiod problem in the U.S. is an extremely serious thing, therefore we need to be very careful about what kinds of information we stick in our heads regarding it.
There's a ton of correlation here, things like "Over the last 15 years, LFP fell more in counties where more opioids were prescribed"
Well, okay. If more people are being injured and are in pain, they would get medication, right? And therefore there would be less people in the workforce. Because people are on pain meds doesn't mean that's keeping them from work. It might mean that things that keep you from work significantly involve pain.
I have no intention of trashing the article. It's worth reading. I would simply advise caution in jumping to conclusions.
My opinion is that mankind is finally creating the perfect world (relatively speaking compared to all of history): plenty of food and shelter. The internet and gaming means you'll never be bored. Throw in a little pharmacological assistance for any pain, boredom, ennui, depression, or loneliness you're feeling, and what more could you want?
But that's rampant speculation, which I readily admit. I worry about articles that encourage reader speculation without explicitly calling it out.
That seems consistent, since severe pain generally prevents or limits work.
If we entertain this hypothesis for a moment by assuming there is a causal relationship between lack of meaning / purpose and higher propensity to engage in degenerative behavior and severe drug use, it then begs the questions: what changed? Where did people derive meaning and purpose in society before? Where are they getting it now? Where are they likely to get it in the future?
Again, entertaining the hypothesis, it would follow that setting up more drug clinics is unlikely to solve the problem because people are unlikely to find meaning through the current format of drug rehabilitation. A better solution long term may be increased emphasis on psychological rehabilitation.
I don't have the answer to any of these questions and certainly wouldn't say religion is the only answer. There are alternative ways to accomplish this. For example: as a society we can try to reinstill a greater sense of dignity in labor and non-managerial service roles.
Not being able to anchor your contributions to anything meaningful past "a business" it can be easy to feel like it doesn't really matter that much.
To poke at the digital world, most of what we create on our computers is ephemeral, transient and bound for quick obsolescence. With no roots in the real world, with no past to be a part of and no community to belong to, our efforts existing briefly at best, perhaps it is no wonder everything is underscored by a lonely existential dread.
You can't put cultural identity into a box. In other words, it's all in your head, it's whatever you make it out to be. The various European countries don't have it any more than we do, and we in "young countries" are not lacking in it.
A community is only those people in your immediate social sphere. You can't have a "national sense of community" because you don't interact with everyone in the nation. White Supremacists talk about a lack a "sense of community", because they are actively refusing to acknowledge their physical neighbours as a part of their community.
The reason Richard Spencer and his ilk talk so much about "European Cultural Identity" is because of a perverse jealousy of Black Cultural Identity. It's a long-con job that attempts to hand-waive over the vast differences in individual European countries' cultural heritages and ignore that the only reason there is such a thing as "Black Cultural Identity" is because slavery stripped African Americans of their more specific heritage. I can trace my family heritage back more than a thousand years. Few, if any, African Americans can go back any further than 150. They don't even know who in our country might be family, because even once here, their families were ripped apart and scattered to the wind.
I can definitely see what you are saying in your third paragraph, however I would love nothing more than the opposite to happen. One of the things I love about Australia is it's almost complete lack of a single national cuisine, it's a broad spectrum of dozens of different cuisines, often mixed together. A neighbourhood community equivalent of that would be a beautiful thing in my opinion.
I also wasn't suggesting that Europe has one homogeneous identity, I was thinking in my head more about strong identities tied to the individual countries and their histories rather than Europe as a whole. The buildings alone can date back centuries which, I know when I am in the presence of buildings that old, I feel a strong connection to the past.
In regards to a local community, what I was referring to is division on an individual level, where technology is driving individualism so strongly that people don't feel the need to focus on their communities or social groups. Where there may have been regulars at coffee shops who would strike up conversations with eachother and form a small community, perhaps one of many interconnected communities. What I see happening is individuals sitting at coffee shops alone on their phones, not engaging with anyone.
I've been trying to re-engage with the community which is why this was an interesting talking point for me, but I've noticed that while it's great that I am not face first into my phone, it hasn't helped that much as everyone else still is. Trying to get groups of friends together normally results in half of them bailing because it's easy to do. I noticed when I ditched my phone entirely for a few weeks, I was much better at going places to see people, because I said I would and had no easy out.
I feel like having more history lends a bit more material to feel a connection to the past, and like you are part of a continuum, which can lend legitimacy to your current existence. You aren't just a fleshy blob meandering through a brief existence, you are part of a long and storied past of fleshy blobs and your existence is a chance to contribute to that story.
I would like to ask the OP to refrain from posting provocative titles which don't comply with the guidelines. I get that the issue is serious but all that title did was alarm me and waste my time.
Of course explaining that by opioids alone would be balancing between a huge oversimplification and a plain lie, but at least opioids have been the biggest single factor.
E.g. Another way for a country to lose the #1 economy spot is for it to simply stay the same while other nations (e.g. Europe in this case) make huge advances.
Being fair, a few other things happened in there too. I don't think that during the communists' Cultural Revolution the country was primarily being held back by opiod abuse.
If such a relatively innocent thing as inhaling lead vapours from suddenly omnipresent cars in 1960s and 1970s could cause a 1980s-1990s crime wave in the U.S., it is easy to see what putting whole nation on opioids could do with the next generation.
https://en.m.wikipedia.org/wiki/Century_of_humiliation
The Century of Humiliation started them on a road of weakness that took several revolutions to figure out how to stop. Only with Deng Xiaoping in the 80s did China begin to find its stride, and only now are they starting to finally become a world power that the world needs to reckon with instead of ignore. Whatever you think of politics and philosophies, China is now considered a world power in a way it never has been before.
In the scheme of a 1000 years of history you could argue 1970 counts as only now perhaps.
https://www.economist.com/blogs/graphicdetail/2012/06/mis-ch...
http://www.bbc.com/news/world-us-canada-40891691
The one thing that the US has consistently shown recently is for every state that has legalized or decriminalized/medicinal marijuana, opioid abuse and related deaths have plummeted, yet we have trump trying to crack down on this emerging trend.
So it's just more of say one thing but do another.
They are basically saying porn, social media, the news hype cycle are all tied to dopamine increase in your brain. Its the same mechanisms that drugs, alcohol,cigs can produce.
Tens of millions of men are suffering in a way that women aren't. It seems when something affects the sexes differently society treats it as gender issue and seeks to help women specifically.
There appear to be specific gender issues here hurting men more. I'd hypothesize unequal expectations. Is this an issue to look at from a gendered perspective?