While the US argues whether or not they have an opioid crisis at emergency levels (yes, no, depends what mood the president is in) Vancouver has spent time being the front line of one.
Much has been made about Metro Vancouver’s hyperinflated housing market, but if you want a microcosm of income inequity: not only is Vancouver home to the most expensive postal code in Canada, it’s also home to the poorest. The Downtown Eastside (DTES) is mere blocks away from the high-priced hotels where you might find yourself sharing the lobby with the Hollywood Star d’jour, but it might as well be another world. The triad of extreme poverty, drug use and mental illness defines the DTES, and when most people first became aware of Fentynal as the drug that killed Michael Jackson, in the DTES, people were more than familiar with its effects. With a state of emergency that Federal politicians seemed determined to ignore, people close to the problem recognised that something had to be done, Drug War be damned. And so the “Four Pillars” approach was adopted.
And then came this:
As the story points out, these policies weren’t adopted as any kind of progressive, high-minded ideal, but out of desperation. People were dying at alarming rates and the approaches being used clearly weren’t working. (I won’t dig too deep into the complicating issues like the racism that helped delay TPTB and the general public backing these initiatives, but they were, nonetheless, a factor). There were some dicey moments too, such as the long battle with Harper’s Conservative government who wanted nothing more than to make Insite a footnote of history. And (as the BBC article points out) the solution may not scale or work as well in a city where people dealing with the above triad aren’t as concentrated in a single community, but lives have been saved.
It’s not perfect, it might not even be “good” but as someone who grew up under “Just Say No” and a doctrine that “any is evil” it’s interesting what happens when you change the view from looking at the addicts’ morality and start looking at society’s (who are we, if we’re willing to just let people die?). It is, I think, at least worthy of discussion.
Well, we have bars…and liquor stores…even places set aside for folks to smoke cigars…
And you have folks like William S. Burroughs, and Lionel Barrymore (a morphine addict due to his eventually crippling arthritis)…
I smoke pot. I’ve taken pills. I’m no doubt a caffeine addict. I had to quit drinking (the most chancy legal drug is alcohol, IMNSHO). I never shot myself up, nor let anyone who wasn’t a medical professional inject a substance into my body, and I’m GRATEFUL. That Demerol drip during labor was enough for me, nearly thirty years ago!
Why do folks choose the drugs that are so dangerous? At my first day of work, I found that two of my coworkers (one’s since left) were opioid addicts! Rx pills for one, heroin for the other. Women in their early 30s. White. I’ve also overheard conversations about the different opioid cocktails that are taken by several other coworkers - all for pain.
So, we got physical and emotional pain. Could folks be taught at an early age different ways to cope with such pains so that they won’t even try opiods? I know, Big Pharma has a lot to do with this; but any patient can say “No” to their doctor if they don’t want a particular treatment.
I can see folks at the bars, bitching about the folks in the DC rooms…the irony…
Opioids are extremely cheap; a poor Afghan farmer can produce them without the least trouble. On the other hand small modifications can result in a patented medicine. It’s easy profit for pharma companies. And then you have the CIA covertly supporting the opium trade among the H’mong in Vietnam, and in Afghanistan, to fund the “good guys”.
The ideal medicine for a pharma company is not one that cures a disease but one you have to take for the rest of your life, hence the shortage of new antibiotics.
I remember reading (I’ve forgotten where) that opioids didn’t really relieve pain, they just made you care about it less. Plus they come with substantial drawbacks.
Pot does the same thing- makes you care less about the pain, but doesn’t have nearly the side effects or addiction profile.
And suddenly using pot for pain totally made sense to me.
My supervisor in psychopharmacology said that over 40 years ago, and also that antipsychotic drugs worked the same way.
It gets you into the whole issue of what is pain and why do we need it? At a functional level it warns us not to try to stretch a muscle that has been damaged. But a lot of pain is nonfunctional in that there is nothing you can do to relieve it. It’s an example of how natural selection just doesn’t work to a specification.
Not necessarily a bad thing; working like that maintains the informative function of pain while reducing the negative psychological impact. Total pain-blocking is dangerous; it can lead to further injury.
Linda Watkins is a key researcher to look at if you’re interested in chronic pain analgesia, BTW:
TLDR lay version: opiates mess with your glial cells in a way that causes them to upregulate pain sensitivity in the long term. However, we may be able to tweak future opiates to stop them from doing that.
I had some left over from a car accident (wasn’t too serious and I ended up not needing it). I took some later when I hurt my back setting up furniture. Rather than making me feel better, I had an intense stomachache. After that I threw the rest of it down the Bemis. My friend got really perturbed when he found out I’d done that.
To me it’s a no-brainer. Most of the problems related to opioid use are a direct product of us trying to control them—that’s how you get substances that are cut with dangerous stuff, have unknown dosage, and people desperate enough to resort to sketchy sources. My understanding is that if you have a steady, clean supply, you can live on it indefinitely—or, at least, this was the case for many injured soldiers who got hooked on morphine during WWI. They just kept them on it.
This is setting aside the question of whether there’s really any moral justification for locking someone up for drug possession.
Most of my experience with this is related to people I know who have chronic pain issues, but can’t get their doctors to prescribe enough medication for them.
My brother is really into kratom, which is opioid-like enough that it’s useful for kicking an addiction, but is also addictive itself, and can put you through withdrawal. I tried it a couple times and liked it enough to recognize that it was something to stay away from.
If I was using it to dull the emotional pain from the idiots at work, what next? Use it just because?
Also, it wasn’t that effective at relieving any kind of pain, at least for me. For all I know, I would come home from a particularly shitty day at work and then swallow the whole bottle. I had to flush it before it got to that point.
Two years ago I had the same operation as that doctor’s father, and you know what I got for pain? Tylenol 3s. I took them every four hours for 48 hours, then switched to regular Tylenol when the surgical pain got to me – maybe twice a day for another day or two.
The idea of getting 30-60 opioids for surgery like that seems like incredible overkill.
Easiest way not to get addicted to a substance is not to be exposed to it in the first place. And unlike other substances, these are too new to be part of our cultural history.
Opioids make me need to close my eyes and go to sleep so I stop seeing the damned trails. Once I’m asleep, I can’t feel pain. So, it works for 4-6 hours, but I also don’t seem to have dreams if that’s how I fell asleep, so it’s 4-6 hours of worthless sleep, but at least whatever I hurt isn’t keeping me up.
I basically agree, but by that same token people who are in constant pain aren’t getting relief because there’s so much suspicion/regulation tied up in this. I know people who have rheumatoid arthritis, or who have been through multiple back surgeries, and are constantly in pain, but their doctors are hyper-vigilant about addiction and drug-seeking behavior. In some cases, I’ve heard of doctors being stingy with patients who are well on their way to dying.
While we need to worry about addiction, we also need to make sure that people who legitimately need pain killers are getting them. My concern is that all this press about the opioid crisis ends up making things harder for them.
I’m a ginger.
There’s research that seems to indicate the gene that causes my ginger-ness (MC1R) makes me more sensitive to opioids (among many other weird effects). That seems born out by every experience I’ve ever had with them- I have to take very, very low doses or I end up puking and sick. I avoid them like the plague, and on those (rare) occasions when I’ve required them I get off them as quickly as possible in favor of plain old motrin or tylenol or whatever. And then I ditch the rest of the 'script because I don’t want that shit in my house. I have kids, you know?
If I was again confronted by damage/circumstances sufficient to require pain management, I’d be seriously investigating pot. I’ve never smoked/consumed/whatever marijuana, but I see it as a (potentially) much easier tool to work with.
That was my experience as well. I don’t usually do painkillers, because I don’t need them. When I do, maybe Tylenol will suffice. I have been through surgeries and broken bones, and I have never really needed opioids. They should be more of a last resort, for pain exceeding the norms and that impacts daily life, than something that’s so commonly prescribed.
Handing out opioids like candy, even to someone who 1) didn’t ask for them and 2) has a history of clinical depression, is definitely part and parcel of the opioid crisis.
Yep. Opioids don’t do much for me beyond what Tylenol does… except opioids make me a little sick to my stomach, and make me a little uncomfortable even when I’m sleeping.
I should add when I had the gall stone attack that led to the surgery, I was given a morphine drip, and that was wonderful, because by that point I’d been up for nearly 24 hours and been in intense pain for the previous 5.
Even still, I found out later from my surgeon that my pain had been underestimated, despite telling the intake nurse “mark down 11!” when she asked me to rate my pain from 1 to 10. The attack happened on a Monday night, and I was off work for the rest of the week, which meant I’d had the worse kind of attack. The attending doctor had somehow concluded I’d had the less-bad-but-needs-surgery-anyhow kind of attack, which meant I should have been back to work the next day.
Bottom line is the current pain assessment guidelines are clearly not working, since people who don’t need drugs, or at least not so much, are being given them while people who desperately need them (as you pointed out) are not.