Opioid Epidemic

Nearly 100 people die each day from an opioid overdose. Whether via prescription drugs or synthetic, black market opioids, families are being torn apart roughly every 15 minutes, and Trump is doing nothing about it.

This is a serious subject, and I’m sorry if it scares you, but if you don’t already know, well, it’s not just about drug addicts OD’ing because they wanted to get high. It’s barely about that. Nearly 100 people die PER DAY in America from opioid overdoses, and until recently, more than half were from doctor-prescribed painkillers that had addictive properties and from doctors who kept prescribing higher and higher doses. In short, the patient presents with pain, they get the medication, over time pain sensitivity grows because that’s a side effect of most opioids, and then the pain returns and the doctor prescribes more. Additionally, the government financially supports some healthcare professionals who turn in surveys showing highly satisfied patients, meaning that the patient says they like the effect of the opioids and love the doctor for prescribing so much and the doctor gets more money than when the patients check “dissatisfied” on the survey because the doctor acts responsibly by cutting them off because they seem to be getting hooked.

We’ll get to that, but first, take a look at this chart that shows the number of deaths from opioids per year in the United States.

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Until recently, more the half were from doctor-prescribed opioids. However, despite the incredible importance of this epidemic–and it is an epidemic–there’s a greater issue: synthetic opioids. There are people out there that are manufacturing synthetic opioids on scales measures in MEGATONS. So people aren’t just getting hooked on medications from their doctors. There are also many variants available on the black market, and they WILL kill you. I’m not a fearmonger or a doomsday predictor. Chemically, these opioids are designed to either kill you quickly or over time.

Let’s think for a second. Is this epidemic really a problem? I mean, do people really need painkillers? Maybe addicts should just deal with the problem themselves and stop wasting our tax dollars. Can’t we just tell doctors to stop prescribing opioids? Can’t we just ban them?

Well, no, we can’t! See, we can stop incentivizing doctors who turn in surveys of satisfied patients, but that’s not going to stop the whole issue. We can’t just stop prescribing painkillers either because then people can’t go to work and, more importantly, the pain will cause further physical problems. Some people, most people, are legitimately in a ton of pain. A few people just want to get high, but many addicted to opioids start out in pain and then get hooked, which leads to increased pain sensitivity, which legitimately causes them to feel pain, and the cycle of actual pain continues even if alongside the addiction telling them they need a higher dose. So, it’s not as if we can just stop prescribing painkillers because most people asking for them really need them. Furthermore, banning them will just push them underground. The underground market for opioids is already gigantic, and as I said, synthetic opioids, which are inherently black-market drugs, already cause more than half of the overdoses.

So, since we know the people who say this isn’t really a problem are absolutely stupid, let’s get to work and talk about what opioids really are.

There are actually TWO opioid epidemics in the United States. You know the one where people are taking too many prescription painkillers, but there’s also a lot synthetic opioids that are being produced outside the country and ending up in the United States.

Let’s first look at the prescription painkiller front, which is primarily a domestic issue.

You go to your doctor because you’re in pain, and they prescribe opioids. Plain and simple. You might be working in a field that involves a lot of physical strength and end up with aches and pains or even severe back pain, and then you go to the doctor. Many painkillers have addictive properties, but opioids are actually quite strong, which is why they are so favorable. Moreover, doctors are incentivized to provide patients with what they need to be comfortable and pain-free. When the patient comes back again wanting an even stronger dose, the doctor then has to question whether or not the patient is getting hooked but usually doesn’t do much thinking on that subject and simply increases the dose. Since opioids themselves actually increase pain sensitivity, you end up less able to cope with even lighter aches and pains than before ou started taking the opioids. Alongside your brain telling you that you crave higher doses, you actually need higher doses, as well.

Additional risk factors that contribute to this addiction include those are who are already hooked on other drugs, teenagers and young adults, and people who are suffering from severe forms of long-term depression.

This now accounts for a little less than 50% of all opioid deaths in the United States.

Synthetic opioids account for more than half as of 2016. They’re not made by pharmaceutical companies, and they are intended to exploit their addictive properties, ruining people’s lives.

You may have heard the names fentanyl, carfentanil, and others. You may not have heard of U47700, AH-7921, MT-45, W-18. Fentanyl has become quite popular in political conversations. China has technically banned fentanyl, but right after that, carfentanil became a huge export from China so they’re not really doing much except changing the formula. In fact, U47700, also from China, is transdermal. That means the chemical seeps in through your skin. You don’t even need an open sore or a cut because it’ll go through your pores. So, if you touch U47700, you’re gonna get the same effect as if you snort it, inject it, etc. In some cases, it’s going to kill you. In fact, Mexican drug cartels accepting shipment of U47700 from China and smuggling it into the United States have to wear gloves when they handle it so that they don’t get killed.

So, if you touch U47700, you’ll get the same effects as if you snort it, inject it, etc. In some cases, it’s going to kill you. In fact, Mexican drug cartels accepting shipment of U47700 from China and smuggling it into the United States have to wear gloves when they handle it so that they don’t get killed.

You can read more about synthetics as well as many precursor chemicals that are being used to create fentanyl and others by reading this State Department report. The document is 297 pages so it’ll take some time, but I recommend it if you’re obsessed with details like I am. Fun fact: the country of Benin in Sub-Saharan Africa is being comparatively impactful in this fight relative to its small size.

So how exactly are these opioids killing people?

Now, if you’ve never been exposed to this epidemic in any form or fashion, A) you’re lucky, B) you’re probably unfamiliar with how it kills, and C) you’re a great person to spread the word about what’s going on because you’re one of the few not too busy being afflicted by this all day.

Basically, your veins can collapse, cutting off blood flow. The lining of your heart can get infected, particularly if you’re taking one of the street forms of the drug. You can experience extreme forms of sedation, which sounds nice, except that your heartbeat drops to a dangerously slow speed and our breathing becomes extremely shallow. Among all this, your immune system weakens. You won’t die from a common cold, but if you happen to cut yourself, you won’t heal as quickly. If you’re young and otherwise healthy but end up with pneumonia or mono, as is so commonly passed around in schools, then you could die from one of those if your immune isn’t strong enough to fight.

In the case of U47700, however, you don’t have to do anything. You don’t have to ingest the product in any form. All you have to do is think about having one, and if you make it to that stage where you’re holding it in your hand while you’re wondering whether you should take U47700, then it can kill you. It’s transdermal, which means it’ll go through your skin. So where gloves. Or just don’t touch it. If you see it, report it. Tell anyone, seriously.

So you get that it’s dangerous, but if it’s so dangerous, why is it here? Why does the government “allow” it? How come we haven’t gotten rid of it yet?

For prescription drugs, the answer is easy to explain. A reputable pharmaceutical supplier sends them here, and it’s all above board. You get a pill bottle from your doctor, and that’s it. Nothing illegal except the obvious overmedication of America that Trump is likely going to worsen.

However, synthetics have a more complex story.

Take a look at this report from the Bureau of International Narcotics and Law Enforcement Affairs, which explains the supply chain of opioids from China to the United States and its many stops along the way. I want to be clear that this report doesn’t just talk about China. Dozens and dozens of countries are involved in spreading this epidemic, but the descriptions of such activities in almost all of these countries include one of the following phrases: “coming from China,” “originate from China,” or “imported from China.”

In other words, China produces synthetic opioids. They’re pretending independent producers are popping up left and right and that they’re having a hard time shutting them down despite having more control over their people than any other government worldwide. An operation of this scale that is this organized is centrally operated and controlled. Additionally, the Chinese government felt the need to deny their country was the biggest source of these drugs. Why say anything?

I put together the below chart to show the supply chain of synthetic opioids. As mentioned before, it starts in China. These drugs have even been seized aboard container ships heading our way. They make a quick stop in Mexico where they’re offloaded by the drug cartels there and loaded onto delivery trucks moving north. Once large dealers in the U.S. get the delivery, which measured in MEGATONS, by the way–definitely a centralized operation–they distribute to known dealers in their area. Those dealers, of course, are in touch with gangs who then distribute more locally on the street level. Finally, it’s quite common for someone addicted to a drug to seek company or, let’s say, strongly encourage, someone to join them in their habit.

Screen Shot 2017-07-13 at 3.57.14 PM.png

So, how do we stop these epidemics?

Frankly, you can easily talk about each one separately by breaking the issue down into domestic policy and international policy.

==Domestic Policy==

To stop the prescription drug abuse and overdoses, there has been a lot of talk about defunding the Center for Medicare and Medicaid Services. Remember those surveys I talked about, where the patient says they’re satisfied? Well, the doctors get money if the patient is satisfied, and if you know anyone who is hooked on painkillers, the only way to be satisfied is to get a higher and higher dose. So, if the doctor actually cares but needs the money, then they’ll see that they won’t make money by ignoring symptoms of and/or susceptibility to addiction. They’ll cut off the patient’s supply like they’re supposed to.

We can also continue getting Narcan into every ambulance, every hospital, and apparently every library in America. Other antidotes that we’ll need are naloxone, suboxone, and subutex.

We can also establish drug courts where the only thing they do is focus on drug addiction and getting people into rehab. Despite the fact that Donald Trump doesn’t care, it’s clear that at least the city of Buffalo care because their judges sometimes see addicts every single day until they’re clean. They say their goal is “keeping them alive.”

==Foreign Policy==

Stopping synthetics is a much more complicated issue, and frankly, again, Trump may want to stop it, which is nice because he doesn’t seem to care about anything else, but he’s the least capable.

The antidotes mentioned above won’t work because, as soon as Hillary Clinton started talking about Narcan, China switched up their formula to make a Narcan-resistant form of opioids. So now Narcan isn’t a reliable method anymore for fentanyl or any other black market opioids because we’re not going to know in advance whether it’s going to work or not.

The only way we’re going to be able to stop the synthetic opioid epidemic is through foreign policy negotiations with the big players on either end of the supply chain: China, the producers, and Mexico, the last country before the synthetics hit our streets.

Sooooo……well, China hates us, and Mexico doesn’t necessarily hate the United States but certainly thinks Donald Trump is a steaming pile. They’re not wrong. Just saying they don’t him, and none of this makes me very confident that we’ll be able to curb this epidemic.

Frankly, the best ways are going to be through international cooperation. We’re going to have to work with Mexico to stop the drugs at the border by getting them to shift their more general focus on the drug cartels to a more specific focus on synthetic opioids as it relates to the cartels. We can also work with Canada on their partnership with China. We can be a third-party observer to this cooperation, allowing us to look at the data on what China is really doing. By staying out of the decision-making, we appear to be taking a backseat, which is what China wants, but we’ll actually be collecting evidence via open information sharing environment that we have with Canada, who will be receiving the information from China in order to participate in the partnership.

We should also look at every country along the supply chain. For example, in Africa, the small country of Benin destroys all fentanyl that crosses their borders. So they’re clearly our ally on this issue. They also already have a contract with China for infrastructure development that actually spans 300 YEARS. Since they’re already aligning with China economically but supporting the fight against opioids, there’s no danger in pushing them to do more or to speak out more publically against opioids because they’ve already decided not to work with us on anything else, opting for one of China’s get-rich-quick infrastructure projects instead.We should ask for international support from any other country that isn’t susceptible to such pressures from China. If they’re already intensely loyal to China, no problem, and if they’re intent on sticking with the foreign model of the United States, that’s even better, as long as they’re not positioned in a way that makes it easy for China to bully them when they continue to align with us.

We should ask for international support from any other country that isn’t susceptible to such pressures from China. We should seek partnerships with countries that are already intensely loyal to China such that we can’t lose more or intent on sticking with the United States but that aren’t easily targeted by China for doing so, then countries  positioned in a way that makes it easy for China to bully them when they continue to align with us.

However, the most important thing we can do is fight China directly. We can sanction China. We can fine China. We can block products from China that come on the same containerships as the smuggled opioids. We can even pressure the countries whose companies sell the products that were on those containerships into sanctioning China because they’ll obviously be hurt when we block them from entering the U.S. consumer markets. All of these methods seem right in line with Trump’s style regarding international trade policy, but he hasn’t done it.

What is Trump doing about this? He’s basically just cutting Medicaid, which is the exact opposite of doing something about this issue, unless you consider making it worse to be doing something about it.

Medicaid is the biggest payer in the fight against opioids. In his campaign, he said, “We will give people struggling with addiction access to the help they need.” So, he’s clearly not going to do that because he’s cutting Medicaid. Moreover, it’s clear bringing jobs back and putting America first is the “help” that he’s referring to. Additionally, he’s enlisted Chris Christie and Jeff Sessions in taking a crime-and-punishment approach. Since addicts don’t stop when they’re told to stop or even when they’re punished severely, ya know, cuz it’s a fucking addiction and, at that point, no longer a choice, this approach is not going to work either! Being treated at the emergency already costs thousands of dollars, and being admitted overnight costs more than $20,000 in some cases. That would seem to be punishment enough, and that’s not curbing the addiction. Obviously.

So it’s pretty obvious what this means, but he’s only not going to stop the issue, he also can’t anyway because the more pressing issue is the synthetic opioid epidemic and he hasn’t tied this issue to anything else that he’d like to work on with China, like international trade.

For what it’s worth, here’s what I think he should do: He loves to talk about how trade is going to fix everything, getting better deals and so on. Given his focus on “deals,” he could tie bilateral trade deals to a reduction of Chinese synthetic opioids entering the United States. He could keep it vague and let China figure out how to stop it and, therefore, wouldn’t have to call them out on their mass production of opioids, but he’s not doing anything.

However, he’s not even mentioned one trade policy that includes China getting a more preferable trade deal if they clean up the opioid problem.

I think we’ll make some progress on curbing addiction to prescription opioids, but I don’t think we’re going to really make any progress on the synthetic front because China keeps coming up with new ways and staying one step ahead of us.

So what can WE do? The most important thing you can do about the opioid epidemic is to comfort the people who are affected. Sorry, that’s really the most important thing right now. A lot of people are mourning. If you don’t know anyone that’s going through this, then the best thing for you to do is to tell everyone you can about opioids. Tell them where it’s coming from. Tell them that their doctors might be encouraged to prescribe opioids even if they don’t need that much. Tell them to ask their doctor if maybe they could start with something not so strong. When you go to the doctor, always remember to be your own advocate. While most doctors wouldn’t ignore symptoms of drug abuse, they may choose to overlook a higher susceptibility to abuse. Remember, they have student loans, too, and if you thought your student loans are high, ask your doctor about theirs!

You also need to do something that is probably less comfortable. Most of us don’t want to call the police or report something to the FBI, despite always hearing “see something, say something,” but if you see a website online that is selling fentanyl, U47700, report it. Even if you’re ignored, at least that call will have been recorded. Call again. Keep calling. If you don’t want to call the police, call Congress. Let them know that you found a website that is openly stating that there are synthetic opioids available from overseas and that all you need to do is type in your credit card and your address and you can start taking pills. There are dozens out there.

Finally, and I know this is going to be hard and probably impossible, but you need you to resist the temptation to start taking these pills yourself. Find every excuse not to. Tell yourself that it’s going to cost too much and you won’t have money for beer because, frankly, beer is safer anyway. Tell yourself that even one pill will kill you. Even though this won’t always happen–sometimes it does–if you tell yourself it’s deadly, you won’t risk it. I know that sounds silly, but if you have an urge to take more than prescribed, go for a walk or watch a movie or call a friend. Most importantly, talk about it. Tell someone what you’re thinking about doing. It’s not like you’re calling the suicide prevention hotline. You’re just telling someone you might double your dose or take a few more pills to see what happens. At this point, someone out there is going to know that that’s a bad idea and will tell you to stop.

If you want to stop this epidemic, you can call Congress and get them to vote on special funding to ensure that all hospitals and schools are prepared with antidotes. You can get them to vote on stockpiling antidotes at FEMA warehouses. You can insist that they treat this not just as an epidemic but an ongoing national crisis that is killing the citizens of the United States of America. Tell them that you know the synthetic opioids are coming from China and that China is fully intent on destroying this country. You have the power to get the United States to be tougher on China. Get U.S. companies to start doing business with other countries. Most importantly, though, we just need someone new in the White House. This has been the longest administration of my life, and it hasn’t even been six months. Get out there, support a campaign, get as many Democrats in office in 2018, and encourage them to support a head-on approach both domestically and internationally so that we can stop this crisis once and for all.

 

Next Post: Repealing Dodd-Frank

11 thoughts on “Opioid Epidemic

    1. Jessica, you’re right. They’re just like us. While one person is more susceptible to addiction, someone else is more likely to contract something that an addict would not.

      If we see the potential for ourselves to become victims, then we won’t want to marginalize, discredit, or look down upon someone who is suffering already.

      I’m glad to have you here. If you have any additional information about the opioid crisis, I’d be happy to hear from you.

      Like

    2. Exactly, and this is definitely a social issue, a national crisis. The White House wants to treat it like a crime and go after the addicts.

      They need to treat the wounded AND go after the criminals, but the victims aren’t the criminals.

      They should go after the opioid production companies in China that operate online pharmacies and load these drugs onto megaton container ships.

      Like

    3. Imprison more. Teach less. Increase Federal Civil Forfeiture. Beat down the poor, old, most at risk, helpless. Take away our social safety nets. Leave people uninsured. Loyalty. Restrict the First Amendment. Attack the free . Turn the people into a subclass below the super wealthy who run the country. Blind nationalism. It’s almost as if someone was trying to make the US more like an autocracy, like Russia or something.

      Liked by 1 person

    4. They believe they have all the answers, some incontrovertible plan that will fix everything, just so long as we fall in line or get out of the way.

      They can try to force us, but regardless of their methodology, their solutions are wrong, out of date, and out of touch, and I hope they learn that before more people get hurt.

      Liked by 1 person

  1. Working on the front lines of this exact problem, I think this was well written, informative, and kept the politics out of it for the most part. Very well researched and constructed.

    I don’t agree with you politically in some areas, but I think one of the best ways to combat this particular epidemic is people like you educating others in just this way. Very good job!

    Liked by 1 person

    1. Thank you so much for the work that you do. Since you have personal experience, please share what an individual can do on their own to stop this epidemic. Anything little they can do.

      I’m glad you’re here. At times, we’ll disagree, but it makes me just as excited to hear a dissenting opinion than my own opinion repeated back to me. That’s how we can actually get somewhere!

      If you have any additional information on the opioid epidemic, I’d love to hear from you.

      Liked by 1 person

    2. Individuals who ARE addicted can absolutely ask for help. I know it may seem (from the outside) that it is shameful. But healthcare workers deal with it all the time. I’d much rather hear a patient say “I think I’m addicted, can you help me out?” Than have to dodge around their vomit in the trauma room while they aspirate and die. Besides nurses are absolutely cool with questions like this, and have tons of resources to give you for free. Same with pharmacists. Will we talk about you after you’re gone? Yeah. But we’ll say things like “Hats off for that kid. He’s doing the right thing.”

      Individuals who KNOW someone who is addicted, use these resources:

      Crisis Call Center
      800-273-8255 or text ANSWER to 839863
      Twenty-four hours a day, seven days a week
      http://crisiscallcenter.org/crisis-services

      The National Alcohol and Substance Abuse Information Center
      800-784-6776
      Twenty-four hours a day, seven days a week
      http://www.addictioncareoptions.com

      National Institute on Alcohol Abuse & Alcoholism
      800-662-HELP (4357)
      Twenty-four hours a day, seven days a week
      http://www.niaaa.nih.gov

      Let them know they’re in good hands and you want to be someone they can go to. Give them the numbers.

      Healthcare providers can help by asking the hard questions about drug therapies and how the patient takes them. Addiction is such a taboo, which is laughable, because everyone has them.

      I’ve personally seen 60 lbs of necrotic tissue carved off an ugly person’s naked backside and crotch. Complete with maggots.

      Someone asking for help for an addiction is a breath of fresh air. Literally in some cases.

      Walk into anyplace with a nurse…and just give it to them straight. It might be an awkward three minutes, but after that they’ll help you! Besides, it isn’t nearly as awkward as “fidget spinner stuck on penis” written on the ER admission board.

      Liked by 1 person

    3. Thank you for providing this valuable information.

      Anyone reading this should know that we all have addictions, and that’s okay. Might even be a part of being human. What’s not okay is the stigma that having an addiction makes you somehow inferior. That’s not true. We used to say a physical impairment meant you were also somehow dumber than others, and that’s now widely considered ridiculous.

      However, mental illness and addiction both seem to imply that you’re not as valuable. As a society, we need to be more mature than that.

      You’re definitely just as valuable and definitely worth saving. No matter what.

      So text or call one of the numbers above if you need help or know someone who does. It doesn’t have to be a perfect message either. “Help” will do just fine.

      Liked by 1 person

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