Sentences to ponder

Prescription painkillers now kill more Americans than heroin and cocaine combined, according to the CDC.

That is from Andrew Sullivan.

Comments

The solution, obviously, is to make painkillers illegal.

Another probable benefit of making painkillers illegal is that the prices would drop.

War on Drugs for the win!

No, no, no don't be seduced by the raw number of deaths. What is important is what kind of people die. Heroin and cocaine kill people who are not like us.

So, so true.

oxycontin and percocet addicts are as grubby and unemployable as cocaine and heroin addicts. do non-addicts overdose on prescription painkillers at a more than negligible rate? ignorant question alert, but i'm curious.

"do non-addicts overdose on prescription painkillers at a more than negligible rate?"

Here's a bit of data:
"From 1998 to 2003, acetaminophen was the leading cause of acute liver failure in the United States, with 48 % of acetaminophen-related cases (131 of 275) associated with accidental overdose.*
A 2007 CDC population-based report estimates that, nationally, there are 1600 cases of ALF each year (all causes ). Acetaminophen-related ALF was the most common etiology.
Summarizing data from five different surveillance systems, there were an estimated 56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths related to acetaminophen - associated overdoses per year during the 1990 -1998 period."

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/DrugSafetyandRiskManagementAdvisoryCommittee/UCM164897.pdf

The 'why do acetaminophen overdoses occur' section in the link outlines more than a few reasons why it'd be safe to assume addicts aren't the only ones who die from accidental overdoses of this drug. Also, as they point out, "There are many different types of OTC and Rx acetaminophen products and a range of doses for a variety of different indications" - it's always worth having in mind in these discussions that some of the painkillers that may kill you don't require a prescription.

(It seems very likely that the acetaminophen numbers have also increased - Tyler's link doesn't seem to specifically discuss this compound, but given Danish data I've seen before the estimates above would most likely be higher today. I should probably have just quoted from the 'why do acetaminophen overdoses occur' section instead. Anyway I'd be very surprised if those contributing factors have changed much since 2009.)

Not sure what you mean by "like us" but I think I get what you're saying. Just know that heroin overdose rates are higher for non-Hispanic whites than they are for either blacks or Hispanics, even back in 2008. (The data back-up stereotyping for cocaine overdoses, however.)
http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf

100% Correct. All though if 'they' get obamacare and have more access to prescription drugs maybe there will be a shift in legal sentiment.

Painkillers are already illegal to buy without a doctor's prescription.

Clearly not illegal enough!

Rather than taking away medical licenses and jailing users, we should execute these fiends.

The brother of my best friend is adicted to prescription painkillers, and he has no trouble finding doctors to prescribe them. There are some doctors who are in the business of selling prescriptions, not practicing medicine.

There is currently a move to give prescribing privileges to chiropractors. If that happens, you ain't seen nuthin' yet.

This happened back in 2010. The more troubling news is that in over half the states drug overdoses now kill more people than car accidents. This is driven primarily by the huge increase in painkiller abuse. Overdose from other drugs has have been going down.

It is now coming full circle, however, as the number of heroin initiates is increasing, primarily among people who started off dabbling in prescription opioids: http://www.samhsa.gov/newsroom/advisories/1308215815.aspx

Looks like deaths from OD are up 20k while car accidents are down 9k.

If that increase is all or mostly from actual increase and not something like more autopsies finding earlier missed cases, wow.

Care with composition: "heroin and cocaine combined" is the rough formula for "speedball", said to've taken out J. Belushi and C. Farley, among others.

Ain't it curious that the "regulated" and "legitimate" pharmaceutical industry, not the black market, is the source for all these overdoses and abuses. (We could also observe that alcohol consumption kills more people annually than cannabis abuse, since cannabis is virtually non-toxic.)

Prohibition taught us nothing at all.

Don't forget cigarettes - possibly the worst thing you can do for your health.

Well, but the CDC link speaks to "drug overdose". While nicotine is highly addictive, I don't know what its level of toxicity is: I rather doubt very many people die in any given year of "nicotine overdose". (Worth remembering that nicotine is a component in some insecticides: Gregor Samsa, beware!)

Most deaths resulting from tobacco consumption come from exposure to the ingested smoke with ALL of its chemical constituents and the constant irritation this brings to the cardio-pulmonary system, no? If nicotine itself contributes directly to tobacco consumption fatalities, the pharmacology has not been well advertised.

Scattered reports over the past year concerning caffeine dosages present in various "power drinks" at least begin to suggest that caffeine is more an overdose risk than nicotine: but I am no pharmacologist.

Nicotine is quite toxic LD 50 is estimated at around 30-60 mg (most cigarettes have 1mg each). It's very easy to make a home made insecticide by steeping loose tobacco products in boiling water (continued boiling can concentrate the nicotine to a small lethal dose.

I think that's the point of it in tobacco, to keep off the insects.
I wonder if I could make my million selling people pyrethrin sticks to smoke!

"Care with composition: “heroin and cocaine combined” is the rough formula for “speedball”, said to’ve taken out J. Belushi and C. Farley, among others."

Except you're leaving out one very important component: alcohol. Heroin and cocaine "combined" actually isn't even a dangerous combination. Combining uppers+downers is generally safer since the effects on the peripheral nervous system cancel out. By far the most dangerous quadrant is downers+downers (i.e. heroin and alcohol) since it depresses heavily breathing.

On top of that cocaine+alcohol is uniquely dangerous because the presence of ethanol produces different metabolites in than the presence of cocaine alone. Specifically cocaethylene is extremely cardiotoxic compared to anything produced by cocaine alone.

The danger of "speedballs" has barely anything to do with the interaction of cocaine with heroin, but rather the highly dangerous interaction of both of these drugs with alcohol. Which in all the cases you listed was consumed in massive quantities as well. But when somebody dies from a combination of heroin, cocaine and alcohol, the latter critical ingredient is always forgotten about.

True: alcohol's toxicity is vastly underrated.

Is Keith Richards donating his body to science?

This is a good reason for the War on Drugs.

Decriminalize cocaine and heroin, and doctors will find a way to over prescribe those too if there is enough money to be made.

When everything is outlawed, all will be well.

Yes, acetaminophen is a killer. The opiates - not so much.

Can't tell if you're serious, but opioids kill plenty of people via respiratory depression -- it's the same way heroin kills people. Yes, the Tylenol can kill you too, but once people are addicted most start taking high-powered opioids that don't even have acetaminophen in them, like Oxycontin and methadone.

Last time I went to pick up syringes for my kid there was a new pharmacist, I got a little bit of a hint that they had only partially filled the order because they wanted to see who was getting all these needles before passing them out. I'll be pharmacies regularly get cracked down on after reports like this and it makes them all uptight (although I doubt it makes the problem any better).

Iatrogenic disease is very common and very dangerous, and with the hyperinvolvement of the medical in every aspect of our lives it's only likely to get worse. Many of the folks I know have at one point or another been prescribed a narcotic, whether they filled the prescription or not. With my first kid, C-Section, I just doubled up Motrin for the first days at home, but my OB-Gyn insisted I fill the prescription for Percoset because hey, it was unlikely to affect a nursing baby and why should I be in pain when I didn't have to be? Years later, the bottle disappeared one day while we were selling our house, have no idea which lookie loo or house inspector went through the bathroom cabinet (I was saving it for when the zombies came, of course). Our neighborhoods are fairly flooded with approved narcotics, so those who hurt themselves with them both have access and example working against temperance.

Sorry, Percocet.

Doesn't this just reflect the fact that legal items are going to be much more widely used than illegal ones?

I wonder when doctors will start to attribute deaths to statins.

Not until they absolutely have to. Until then, they're the wonder drugs that should be put in the water supply to be enjoyed by all.

Further perspective: obesity is linked to almost TEN TIMES as many annual US deaths as drug overdoses of all kinds.

What public health hazards are posed by broadcast food shows (radio and TV)? or, errr ummm uhhh, restaurant guides?

Well, if we want to use "is linked to" then I can make a ton of connections.

I think when someone dies of a heroin overdose, it's pretty clear that they wouldn't have died of a heroin overdose if they hadn't used heroin.

But when someone dies of a heart attack and is fat, it's not normally considered that if that person hadn't been fat there's still a good chance he'd have died of a heart attack. I know it's not a commonly recognized fact, but all of us actually die at some point or another.

--which leads me to wonder why, as long as capital punishment by lethal injection endures, heroin is not used to dispatch those sentenced to death. The obvious drawback: it might be deemed too pleasant a way to go, as long as it's administered without convulsions resulting. Administration would not require participation by medical personnel, either, any number of competent junkies could serve as executioner. (Grisly prospect, but I'm reading Grand-Guignol plays.)

I would say that letting a heroin addict shoot up himself until he overdoses would certainly be a better path than lethal injection execution. But I read Steinbeck too much. . . . .

Even without subscription: floral supplies:

Confessions of an eBay opium addict
Looking for drugs on the cheap, a writer found poppy pods available on the Web. He also found himself hooked.
http://www.tucsonweekly.com/tucson/confessions-of-an-ebay-opium-addict/Content?oid=1079900

Don't know if this is true, but it is well written.

I like the comments. There are some things some people want so much that the US government is unwilling to spend enough to prevent their use, and even a harsh government cannot do enough to prevent their use. Tax and regulate; regulate and tax.

By the way, I'm drinking and smoking at the moment, and willing to pay one hell of a lot-- to anybody -- for the privilege.

It's interesting to me that Mill, a progressive man in his time, who moreover dabbled in socialism, had a more libertarian view of the issue of self-harm than even most small government types today.

More education/support may be quite helpful but really why should this worry anyone beyond that? Is denying solace to those in serious pain or putting ever more people in cages somehow better than some people dying of their own choices?

Cars kill more Americans than heroin & cocaine combined. So what?

Whatever happened to the benefits side of the equation.

I think it is just a way to illustrate the trends. When people think of drug overdoses, they usually assume cocaine and heroin are primarily responsible. That used to be true, but hasn't been the case for a few years now. And in many places, car accidents are no longer the number one cause of accidental death -- it's overdoses. The trend lines have been moving in opposite directions and have now intersected. The undertreatment of pain was a really big deal in recent decades and it has unquestionably improved, but now the pendulum has probably swung too far the other way with much too liberal prescribing of opioid painkillers.

Fair enough. My point is a comparison between a purely recreational drug and the collateral damage of a primarily useful product is a bit unfair.

There is nothing inherent in the chemical structures of heroin or cocaine that make them purely recreational. Heroin is diacetyl morphine, and morphine is widely used in medicine. Cocaine (ingested orally from unprocessed plant matter) is a mild stimulant. In some ways it is like coffee. Is coffee a "purely recreational" drug?

The useful applications of cocaine and heroin have been made illegal. So when you measure the cost-benefit ratio of each substance, how will you calculate the benefits-that-would-have-been were they not illegal?

Legality is orthogonal to cost benefit calculations. Show me a legitimate scientific study / medical opinion advocating legalization of cocaine / heroin as an improvement in medical care.

cf. Marijuana is illegal too but there's a significant cohort of medical professionals opining it ought to be legalized.

Cocaine is actually a Schedule II drug in the US. It is used occasionally in nasal surgery.

Most people I know who use illegal drugs regularly are essentially self-medicating for their mental, and to a lesser extent physical, problems.

Note- It's often cheaper (maybe ACA will change this) for a low-income person to acquire illegal drugs than receive a prescription for legal ones.

http://www.ksl.com/?sid=25506361

Wrong conversation. look for better solutions for pain!

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