Posted on Sunday 26 June 2016

June 24, 2016

Nonmedical use of prescription opioids more than doubled among adults in the United States from 2001-2002 to 2012-2013, based on a study from the National Institute on Alcohol Abuse and Alcoholism [NIAAA], part of the National Institutes of Health. Nearly 10 million Americans, or 4.1 per cent of the adult population, used opioid medications in 2012-2013 a class of drugs that includes OxyContin and Vicodin, without a prescription or not as prescribed [in greater amounts, more often, or longer than prescribed] in the past year. This is up from 1.8 per cent of the adult population in 2001-2002.

More than 11 per cent of Americans report nonmedical use of prescription opioids at some point in their lives, a considerable increase from 4.7 per cent ten years prior. The number of people who meet the criteria for prescription opioid addiction has substantially increased during this timeframe as well, with 2.1 million adults [0.9 per cent of the US adult population] reporting symptoms of “nonmedical prescription opioid use disorder [NMPOUD],” according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5].

“The increasing misuse of prescription opioid pain relievers poses a myriad of serious public health consequences,” said Nora D. Volkow, M.D., director of the National Institute on Drug Abuse [NIDA], which contributed funding for the study. “These include increases in opioid use disorders and related fatalities from overdoses, as well as the rising incidence of newborns who experience neonatal abstinence syndrome. In some instances, prescription opioid misuse can progress to intravenous heroin use with consequent increases in risk for HIV, hepatitis C and other infections among individuals sharing needles.”

Scientists analyzed data from NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions-III [NESARC-III], ongoing research that examines alcohol and drug use disorders among the US population, as well as associated mental health conditions. The study appears online in the Journal of Clinical Psychiatry…

If you don’t know the story of the Opium trade and the Opium wars in China, or the role of the British, now would be a good time to take a look [see History of Opium in China, How China got rid of opium]. China literally became a nation of addicts and the China we know today was shaped by its history with Opium. Not worried about this problem? Click on the bottle and look at what’s advertised. Ask your kid how hard is it to get pain pills in their school.

If you are a physician who is not in a specialty absolutely requiring the use of narcotics [surgery, etc.], you can do what I did. Surrender the narcotic part of your DEA licensure to guarantee that you don’t contribute one pill to this problem. And expunge the idea that Narcotic abuse is like alcoholism, something that only afflicts certain people. Narcotic addiction is for anyone.

My view? Narcotics are like Uranium. The only solution is to control the supply. The demand is timeless…
    June 27, 2016 | 12:21 AM

    “And expunge the idea that Narcotic abuse is like alcoholism, something that only afflicts certain people. Narcotic addiction is for anyone.”

    Okay, back up for a second. First of all, it seems like you are comparing abuse to addiction.

    I’m going to assume you misspoke. Are you saying narcotics addiction is different from alcohol addiction? Or that narcotics abuse is different from alcohol abuse?

    How? In what way? Are narcotics more toxic physically, or do you believe that only a certain subset of people are prone to alcoholism, but that anyone can become a drug addict?

    My own experience was that alcohol addiction is much more insidious. It’s socially condoned, very hard to titrate (when others pour) and the effect of a given quantity increases dramatically with aging because ETOH causes so much slow, long-term organ damage. As they say in the program, I tried everything– drinking more, drinking less, changing beverages. At the end, I was drinking only a fraction of what I’d been consuming in my 30s, but the impact of my life had gotten far worse. I was completely beaten by it, and my life changed dramatically once I was free of it.

    In contrast, I have taken the same dose of narcotics for pain control for 10 years. I know exactly how much I am taking, and so does my doctor, by checking my prescription history– which I make sure she does.

    Perhaps someday I will be seized by a wild desire to start taking the pills uncontrollably, or I will find that I can’t remember if I’ve taken one or five, or find myself saying or doing crazy thing while I regret later while I am taking pain medication. It that happens, I will be sure to check in back here and let y’all know, and I’m not just saying that.

    There is no greater saint than a reformed whore, but I loathe the insidious influence of alcohol and marijuana on American culture, even it’s nonlethal elements. The beer commercials, the sloppy driving, the vague stoner comments, wine snobs, the smug references in art and literature. It’s like a patina of bullshit sprinkled over everything.

    Sometimes, I even hate the way people talk sometimes if they’ve only had one or two drinks. Not all the time, but… say, about politics– the things they say that they wouldn’t say when they are sober.

    The way they think no one can notice.

    But that’s not their fault. It’s because I’m sometimes a resentful, angry son of a bitch, like most alcoholics.

    June 27, 2016 | 2:44 AM

    I believe Dr. N meant that only a subset of us can become addicted to alcohol, whereas anyone can become addicted to an opioid. I don’t think he meant that everyone who uses an opioid will become an addict. My anecdote is a friend in his late 60s who used to race motorcycles and had one too many smash-ups. He’s been on a stable dose of oral morphine for years. But I know of many Vicodin and Norco addicts, none of whom intended to become addicted.

    I have a hunch that it’s easier stick to a stable dose when there’s a stable supply. When you’re relying on street supply and subject to feast or famine conditions, it seems easier to lose control.

    Personally, I think anyone currently addicted should be allowed the drug by prescription until they can quit taking it. Knowing they can have it if they get into trouble in withdrawal might make it easier to commence withdrawing. (I deplore the presence of acetaminophen in most of the pills, though. It can only increase the odds of addiction, if it makes the pills work better, and we all know about its lethal qualities.)

    There was a binge-eating study to that effect. They filled the bingers’ cupboards with a massive supply of their preferred binge food, and rather than trying to eat it all, they cut way down on binging (or stopped altogether…I don’t recall)

    berit bryn jensen
    June 27, 2016 | 8:19 AM

    In a stagnating economy, opium served as liquid cash and source of taxes, according to professor of Chinese history Jonathan Spence, on which countless people depended, poor farmers, coolies, merchants, military chieftains, emperors, bureaucrats, officials, politicians…British and Chinese. It took concerted moral outrage in China, later also in Britain, to conquer vested interests…Parallels to the present situation in the USA and Britain, in Europe, Ukraine, Greece etc is easy to see, I think, as is the official “pious” spin on new international trade pacts, TTIP, TPP, set to open the globe to the wares of British/American based global Big Pharma, the opium, amphetamine, CNSes of any colour, size, price and potency, for whatever ails man – oppression, poverty, ignorance, war… Sad.

    James OBrien, M.D.
    June 27, 2016 | 9:32 AM

    I simply don’t print triplicates. But this is not an option if you are in a practice using amphetamine variants to treat ADHD.

    Sean R
    June 27, 2016 | 12:22 PM

    And sentence people like me to a life of pain.

    Opioids are the only way I can lead a somewhat normal life.

    Life is a series of trade offs. Should government protect abusers and sentence others to a life of pain? Accept abuse as a cost of doing business? Or put more money into pain research.

    “Opioids absolutely harm some patients. But they absolutely help some patients,” Dr. Daniel P. Alford, told the Globe. He is a Boston University School of Medicine addiction specialist who directs the school’s Safe and Competent Opioid Prescribing Education program.


    June 27, 2016 | 1:25 PM

    Sean R,

    I absolutely agree with you as one who feels very fortunate not to have any issues with pain.

    I find this discussion ironic by the way. One of the criticisms of people who speak out against psych meds is they have and black and white philosophy. But yet, I am seeing the same attitude in the medical community with these meds. Because of issues of abuse that I am not trying to minimize, let’s just ban them and punish everyone which seems so unfair to me.

    June 28, 2016 | 1:09 PM

    Thoughtful and considerate posts, folks, thanks.

    Caroline, good point about a stable supply, binge eating, etc. Does make it easier to take a night off every now and again, which I do. Rebound is definitely there, but not as bad as the symptoms being treated.

    It may seem strange, but my sponsor recommends that I call him on nights when I skip pain meds. He says that if chronic pain patients stop narcotics abruptly even though they still need them– say, trying to be more hard-core with their sobriety– they are sometimes more prone to relapse with alcohol, or whatever their drug of choice is.

    Not always, plenty of people stop taking pain meds, too, after years of using them, but it’s apparently a known risk. No research on that, just his experience being in the program a long time.

    Sorry if my first post was a little shrill. I found out on Saturday that an old friend of mine died from cirrhosis, and it was really a shock– he was a recovering heroin addict, and I had no idea he was drinking. I had no idea he even liked ETOH, never saw him with a beer in his hands. And this was a guy who really helped me early in my sobriety– helped me find a job, talked me through a few rough days.

    Looking back on it, he never actually said he was sober, just that he stopped slamming dope.

    Addiction is very sneaky. Opiates are very dangerous. I always gotta be looking over my shoulder as long as I’m taking this crap, even closely monitored.

    Joseph Arpaia
    June 29, 2016 | 1:36 AM

    Hello Catalyzt. I realize this is a very delicate subject for you, but are you sure your friend was drinking? He might have gotten the liver damage from Hepatitis C which is common in people who have used IV drugs. I am sorry about your friend passing. Peace

    June 29, 2016 | 5:56 PM

    Hi, Dr. Arpaia, good to see you here again.

    Hep C is what I initially suspected; I had noticed some bruising on my friends’ arms even last year, I knew he had health problems, though he absolutely would not provide details and refused multiple offers of assistance– chores, visits when he was out sick, etc.

    What I am hearing from friends is that had been drinking heavily and recently. It is certainly possible that these reports are not reliable; my friend had been a chronic relapser for decades with heroin, and sometimes friends and family do not believe it when someone has stayed clean. (One of my sources of information is very judgmental) So I am keeping an open mind, but I think it is likely that at some point, he substituted alcohol for heroin and continued drinking mostly in secret.

    That is kind of an unusual pattern of substance use– I haven’t heard of that a lot. But it all kind of fits. I’ve lost friends before from this group of people, and usually word travels far and fast. This news reached me slowly and circuitously, and if was hidden behind a veil of shame, that could explain why it took me a week to find out.

    I may not get the full story for a while, but of course, I am very curious about how he relapsed with alcohol if he did relapse. It was really a surprise.

    Joseph Arpaia
    June 29, 2016 | 9:52 PM

    Hello Catalyzt. Thanks for taking the trouble to reply. I know this must be painful for you. My sincere condolences to you and the others who lost a friend.

    July 3, 2016 | 9:30 AM

    Can a salaried doctor (especially one in primary care) really give up this portion of her license?

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