Solving the "opioid crisis"

[Timsup2nothin]

The fact that Berzerker liked this post should give you some indication of the waters in which you're treading.

That was a response to "oh so since you say drugs are over prescribed you imply we should do away with antibiotics and go back to leeches." Berzerker likes me when the idiocy I'm mocking isn't his. That hardly deters me.

Yeah, back when we used to lock people up in asylums and lobotomize them. Totally human-centric.

And this part...leaping back to lobotomization when we were talking about whether the better living through chemistry revolution started out human centric...c'mon man.

 

[plarq]

I suggest making them OTC so everyone gets hooked up. If everyone has psychosis, then it is not considered psychosis.

 

[Synobun]

And this part...leaping back to lobotomization when we were talking about whether the better living through chemistry revolution started out human centric...c'mon man.

You've got ghosts in your blood. You should do cocaine about it.

 

[Berzerker]

The fact that Berzerker liked this post should give you some indication of the waters in which you're treading.

Can you give him any indication? What exactly did you find objectionable?

That was a response to "oh so since you say drugs are over prescribed you imply we should do away with antibiotics and go back to leeches." Berzerker likes me when the idiocy I'm mocking isn't his. That hardly deters me.

I liked your comment about the unfortunate trend of drug dependency > getting off the drugs asap... I certainly wasn't endorsing your fondness for mocking people.

 

[Arwon]

I have never heard a doctor prescribe an antibiotic and say "yeah, this is a management program you'll be on for the rest of your life." Ask the next person you meet that is on a blood pressure medication what their doctor says about how they get off it. Ask the next person you meet that takes a "mood enhancer" what their doctor says about getting them off of it. Ask the next person you meet that uses pills to get to sleep when their doctor predicts their unmedicated future will start.

This is a pretty ugly sentiment I've gotta say. And a bit cruel.

 

[Berzerker]

Why?

 

[El_Machinae]

We should enrich the pharmaceutical companies further by having everyone carry around a shot of naloxone just in case they run across someone in a MAGA hat who has overdosed.

Naloxone is a generic. I've previously said that Shkreli is a hero for pointing out how bonkers the generic market is in the States, but that's something specific to be agitated over. Fixing the market for generics will create so much opportunity in the States, I really recommend that people prioritize it in a variety of respects. It needs to be learned about, and then fixed.

Anti-depressants; life sentence. Blood pressure regulators; life sentence. Ritalin; life sentence. I'll pass, thanks.

It's very true that we've insanely trimmed down on the number of diseases that need to be cured. To tremendous net benefit. There are a variety of long-term medications that are designed to be weaned from, most of your list above consists of those. We're just not very good at it. My first response to the above (since I am more cognizant of the weaning process than most) was "healthy diet to control blood pressure, depression, etc? Life sentence, pass". For some, these meds are insignificantly different from my desire to reduce my salt consumption. But for many, this is obviously not true. The mechanism for weaning is not well-elucidated.

But as to the fact that Big Pharma focused more on creating the solution than the weaning ... It's a function of incentives, and I very (very!) much blame the middle-income average joe. Big Pharma obviously has no incentive to create the mechanisms for weaning ... but this is obvious. Stunningly so. Literally no one is surprised. The average person utterly refuses to fund the research wings that would actually tackle this question. They don't vote in governments that will fund this research, they don't donate to charities that look at this. Once every few years they vote for a party that gives the idea lip-service, but it's low on the priorities.

Find a mental health charity. Donate an hour's wages per month. Just do it. Get your friends to do it. Then when the politicians come knocking, tell them what you're doing. It's not just the government that doesn't "give a crap until it's whitebread suburbs", it's literally the people who post about it online.

A few paragraphs on a forum every few months literally doesn't compare to actually putting money in the hands of people trying to do something about it. In the developed world, mental health is the low-hanging fruit of well-being in the 21st century.

 

[Timsup2nothin]

This is a pretty ugly sentiment I've gotta say. And a bit cruel.

How is it ugly or cruel? It illustrates the difference between antibiotics, which got dragged into the conversation as a pure sidetrack effort, and the kind of "hey hey here we go, now you're on them forever" drugs that doctors hand out in the US without a moment's hesitation or a single question from their patients.

 

[Timsup2nothin]

Naloxone is a generic. I've previously said that Shkreli is a hero for pointing out how bonkers the generic market is in the States, but that's something specific to be agitated over. Fixing the market for generics will create so much opportunity in the States, I really recommend that people prioritize it in a variety of respects. It needs to be learned about, and then fixed.



It's very true that we've insanely trimmed down on the number of diseases that need to be cured. To tremendous net benefit. There are a variety of long-term medications that are designed to be weaned from, most of your list above consists of those. We're just not very good at it. My first response to the above (since I am more cognizant of the weaning process than most) was "healthy diet to control blood pressure, depression, etc? Life sentence, pass". For some, these meds are insignificantly different from my desire to reduce my salt consumption. But for many, this is obviously not true. The mechanism for weaning is not well-elucidated.

But as to the fact that Big Pharma focused more on creating the solution than the weaning ... It's a function of incentives, and I very (very!) much blame the middle-income average joe. Big Pharma obviously has no incentive to create the mechanisms for weaning ... but this is obvious. Stunningly so. Literally no one is surprised. The average person utterly refuses to fund the research wings that would actually tackle this question. They don't vote in governments that will fund this research, they don't donate to charities that look at this. Once every few years they vote for a party that gives the idea lip-service, but it's low on the priorities.

Find a mental health charity. Donate an hour's wages per month. Just do it. Get your friends to do it. Then when the politicians come knocking, tell them what you're doing. It's not just the government that doesn't "give a crap until it's whitebread suburbs", it's literally the people who post about it online.

A few paragraphs on a forum every few months literally doesn't compare to actually putting money in the hands of people trying to do something about it. In the developed world, mental health is the low-hanging fruit of well-being in the 21st century.

Oh, I have no doubt that the average Joe is a major component of the problem, because of exactly the quote I posted earlier. Good health is hard work, and in the US hard work, as a solution, is completely off the table for most people. But, no, I'm not contributing to any research into bottled solutions either, because I do recognize that the problem has already been solved. The fact that USians desperately want good health to be something they can just find a doctor and buy doesn't mean I have any interest in making it so.

 

[Arwon]

How is it ugly or cruel? It illustrates the difference between antibiotics, which got dragged into the conversation as a pure sidetrack effort, and the kind of "hey hey here we go, now you're on them forever" drugs that doctors hand out in the US without a moment's hesitation or a single question from their patients.

The derogatory description of the anti-depressants, anti-psychotics and anti-anxiety medications that allow some people I love to feel human and live normal lives (and in some cases have literally saved their lives) as "mood enhancers" is foul. That's just not how it works. And I also took the implication that people with chronic and potentially lifelong needs for mental health treatment are in some way failures.

 

[Timsup2nothin]

The derogatory description of the anti-depressants, anti-psychotics and anti-anxiety medications that allow some people I love to feel human and live normal lives (and in some cases have literally saved their lives) as "mood enhancers" is foul. That's just not how it works. And I also took the implication that people with chronic and potentially lifelong needs for mental health treatment are in some way failures.

What I meant by "mood enhancers" was in fact "mood enhancers." In the US there are plenty of people who are prescribed these things without any serious mental illness diagnosis. Frequently the "mood enhancer" is prescribed because people don't feel quite right when their blood pressure meds or other permanent prescription starts affecting their sense of well being. As for people with "lifelong needs for treatment," it isn't them that are failures, it's the treatment.

 

[Ajidica]

Tim, is this really the hill you want to die on? It is one thing to say that there has been a concerning trend in overprescription of psychoactive or behavior affecting drugs to children. It is a completely different thing to that properly prescribed psychoactive drugs aren't necessary or some sort of medical racket.

 

[Timsup2nothin]

Tim, is this really the hill you want to die on? It is one thing to say that there has been a concerning trend in overprescription of psychoactive or behavior affecting drugs to children. It is a completely different thing to that properly prescribed psychoactive drugs aren't necessary or some sort of medical racket.

Do you want to die on the "since some people do really need them the fact that millions of people who don't are prescribed them anyway is just something we have to accept" hill?

 

[stinkubus]

Tim's not out in left field. Doctors have been prescribing antidepressants for decades and medical science hasn't even conclusively established that they are more effective than placebos.

 

[Arwon]

Yeah I'm not convinced there's really an issue with over-prescription when in any given year, surveys suggest circa 20% of the population is going to face a mental health issue and lifetime prevalence is like 45%. (Noting that the methodology excludes a lot of rarer affective disorders as well as relatively common eating disorders, and doesn't seem to cover psychotic disorders at all)

I reckon the last thing we need is takes that belittle and undermine efforts to really come to grips with mental health.

 

[Timsup2nothin]

Yeah I'm not convinced there's really an issue with over-prescription when in any given year, surveys suggest circa 20% of the population is going to face a mental health issue and lifetime prevalence is like 45%. (Noting that the methodology excludes a lot of rarer affective disorders as well as relatively common eating disorders, and doesn't seem to cover psychotic disorders at all)

"Mental health disorders" as defined by people who make their living treating mental health disorders. Amazing that so many people have them. What's REALLY amazing is that the same humanity that now has one specimen in five "requiring" treatment managed not to fall into extinction before such treatments became available.

 

[Lemon Merchant]

Those doubting the necessity and efficacy of anti-psychotic medications are invited to remove a schizophrenic from his/her medication and then contrast the before and after behaviour of said schizophrenic.

As for anti-depressants, Big Pharma has no idea how or why they work, in most cases; and the jury is still out on the efficacy of some medications, but 25 years in the mental health field tells me that they do work. Whether that is simply due to placebo effects, or not, I can't tell you, but I can tell you that there is a marked change in behaviour in most patients who have been prescribed anti-depressants after a certain length of time. Of course, that might be due to adjunct psychotherapy as well.

Oh, and Ritalin is over prescribed.

 

[stinkubus]

Big pharma doesn't really know how any of the antipyschotics work, either. I worked in a state institution for almost a decade. I saw plenty of schizophrenics taken off their medication. It's not always a bad thing. Often the patient will not respond to the medication so eventually you have to try something else. Sometimes they experience serious life altering or life threatening side effects. There were at least a few dozen people I encountered in time there whose lives were literally saved by stopping their meds.

 

[metatron]

Whatever, point being that characterizing ADD as a fake condition invented to sell medication is false, insulting, and potentially very harmful to people who have it.

The status quo is rather harmful to those who don't have it.

Nobody is contesting that doctors are shady about mental health. To claim that ADD was invented to sell pills is so shockingly abstracted from that I don’t know how you can possibly even see the two as connected.

It is horribly ableist to perpetuate the idea that people lie about their mental health to get high. It is just as ableist to claim that people’s mental health problems don’t exist at all, or that they don’t need the medication that helps them to overcome them.

There is a rather stark contrast between minors and adults.
Why is that?
Some sort of insurance matter i suppose?
Or do the adults have some form of internalised ableism thus depriving themselves from their much needed Ritalin/whatever?

It really all started with penicillin tbh. Ever since they started “prescribing” “antibiotics” to people with “diseases” like “cholera” our society became hooked on “medicine” from “doctors”.

How can it be that otherwise civilised highly developed countries with excellent public healthcare systems are so outrageously "ableist" that they are "underprescribing" drugs like Ritalin to the tune of multiple orders of magnitude?
How did that happen?

Yeah, back when we used to lock people up in asylums and lobotomize them. Totally human-centric.

Similar question to the above: How did it occur that lobotomy (a practise disproportionatly inflicted upon "patients" who were female and/or young and/or socially marginal and/or deemed sexually "deviant" (typically all of the above)) was so heavily concentrated in Scandinavia and the Anglosphere and most prominently the United States to the tune of (even more) orders of magnitude?
How did that happen?

I am curious as to what your answers will be. I'm pondering how laborious it may be to get my hands on some international statistics on barbiturate usage by "good old-fashioned housewives".

Another question:
Why are these psycho-medical marvels the US exceptionally discovers always equiped with some gendered angle? No offense, but that's a bit of a curious trend, isn't it?

 

[Arwon]

"Mental health disorders" as defined by people who make their living treating mental health disorders. Amazing that so many people have them. What's REALLY amazing is that the same humanity that now has one specimen in five "requiring" treatment managed not to fall into extinction before such treatments became available.

This is a pretty weak conspiracy theory and an even weaker naturalistic fallacy.

FWIW as far as this discussion goes, the survey was conducted by the Australian Bureau of Statistics using a World Health Organisation recommended diagnostic interview methodology. It's got precious little to do with the alleged evils of the United States pharmaceuticals industry or for-profit healthcare provision. The rest of us don't just let profiteering Americans determine our own health policy and clinical practice.

Believe me, with the extent to which Australian mental health services are overburdened and underfunded, medical professionals would rather the prevalence be lower. For my entire city of about 350,000 people there's about 40 specialised beds in our main hospital for acute mental health treatment, they're usually at 105% capacity, and people get turned away regularly (ie "your dozen slashing cuts on your arms and legs are all superficial, here's some bandages"). There is also basically nothing in the way of pre-acute prevention (ie there's nowhere to go if you're at high risk of self harm before actually undertaking self harm) and post-acute transition facilities.

It takes booking weeks in advance to get a psychiatrist appointment, and psychiatrists and psychologists are usually very expensive. We've had to travel interstate for certain things too, and had to resort to things only covered by private insurance not the public system. Nobody wants mental health to be such a huge problem.