Why hasnt the opioid epidemic hit other countries?

[Yo_Mama_Been_Loggin]

For the second year in a row, life expectancy in the United States has dropped.

It is not hard to understand why: In 2016, there was a 21 percent rise in the number of deaths caused by drug overdoses, with opioids causing two-thirds of them. Last year, the opioid epidemic killed 42,000 people, more than died of AIDS in any year at the height of the crisis.

“We should take it very seriously,” said Bob Anderson, chief of the Mortality Statistics Branch at the National Center for Health Statistics. “If you look at the other developed countries in the world, they’re not seeing this kind of thing. Life expectancy is going up.”

In other words: In no other developed country are people taking and dying from opioids at the rates they are in the United States. We have about 4 percent of the world’s population but about 27 percent of the world’s drug-overdose deaths.

What explains the discrepancy?

The U.S. medical system.

Americans are prescribed opioids significantly more often than their counterparts in other countries. In the United States, 50,000 opioid doses are taken daily per every million residents. That is nearly 40 percent higher than the rate in Germany and Canada, and double the rate in Austria and Denmark. It is four times higher than in Britain, and six times higher than in France and Portugal. As the BBC put it, “American doctors prescribe — a lot.”

That is in large part a result of our health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments.

http://www.heraldnet.com/nation-world/why-hasnt-the-opioid-epidemic-hit-other-countries/

[shenmue]

1. They have hospitals, where addicts can get help.

[Sophia4]

2. Years ago, if I remember correctly, it was the then East Germany that led

the world in the use of drugs that suppressed pain and consciousness of misery.

What is it in our society that is so painful and that pushes people to want even at the cost of dying to try to avoid that pain?

That is the question we need to ask ourselves.

And by the way, maybe I'm just too old and oblivious, but I am not aware of opioid abuse in Los Angeles. It seems to be more prevalent in the areas that voted for Trump like Southern Ohio where lots of conservatives live.

[Yo_Mama_Been_Loggin]

5. An awful lot of the homeless are opioid addicts

Last edited Fri Dec 29, 2017, 07:09 PM - Edit history (1)

I know that to be true of those in the Seattle area. I imagine it's likewise in LA.

[malaise]

3. Is it only the US medical system?

I'd like to see the data re crime and punishment in said societies as well as the data on fear as well as the data for the place of wealth as a measurement of success.

[Bear Creek]

20. There is this

Pain management Best treatment is physical therapy or surgery but it is alot cheaper to just give out pills.

[malaise]

23. Excellent point

Someone close was hooked on said drugs.

[loyalsister]

4. I don't know about the population distribution elsewhere

But in the US we have a huge population that is aging. It has increased the incidence of pain related long term physical difficulties. Particularly for those who have spent their lives in physically demanding professions. Aging also = cancer. Opioids are prescribed for cancer. Grandma's stash opened doors for some of their kids and grandkids. And, war veterans.

[Aristus]

6. I wonder to what degree doctor-shopping is tolerated in other countries.

Twice this week, a very short work-week for me due to illness, I declined to fill opioid prescriptions for patients who turned up on the state prescription monitoring site.

Add to that patients who come to me for refills of highly addictive medications for which non-addictive alternatives exist in abundance.

In clinic, and right here on DU, I get called callous, heartless, and sadistic for trying to prevent further deaths from opioid overdoses.

Narcos are going to shop around until they find a medical provider who is either unscrupulous and unethical, or just doesn't have time to go eighteen rounds with a narco addict.

[TheFrenchRazor]

12. i hate to break it to you, but you're probably hurting more people than you're helping. you've alrea

already proven that you make decisions about who is/isn't a "drug seeker" base on your own demon-filled imagination. the people who truly are drug seekers will just get even less safe street drugs, and legitimate patients will suffer. thanks a bunch.

[Aristus]

14. Just over an hour. Took longer than I thought it would.

The state prescription monitoring program doesn't exist in my demon-filled imagination. It exists in real life, along with the people who have to evaluate and treat patients who clamor for addictive medications.

If a patient is going around to four or five different medical providers and filling prescriptions every two or three days for highly-addictive drugs, they need to be cut off.

These are the people who yell and scream and call me names. You've basically just admitted to being one of them.

[hunter]

17. Trouble is once they are "cut off" then what?

Street drugs are easy, or if you've got money, scam providers are easy too. Witness Rush Limbaugh living, or Michael Jackson dead...

How do we reduce harm?

It's not working in the U.S.A. because we usually regard addiction as a moral failing not a medical problem.

In the U.S.A. it seems "hitting bottom" has to be a death or near death experience, whereas in more civilized nations it's just a crappy room, supervision and therapy, and whatever it takes to get you through the day, methadone, a few beers, whatever.

We'd be a much more humane society if we accepted the fact that some people are going to be living at very minimal levels of social functionality, years even, before they can move on to better lives, and that a very small minority will never overcome their addictions, but that it's no reason to wish any hell upon them.

By virtue of our humanity, we all deserve a safe place to simply exist.

[stevenleser]

27. You are absolutely right but I am not sure that is within Aristus ability to solve

I have a herniated disc at C6-C7. When it first happened in the summer of 1999 from a sports injury, I was in pain for an entire year and taking 8 percocet a day. Eventually, I got a shot of cortisone and a few days of prescribed bedrest afterwards and I was in no pain. From 2001 to 2014 I would have 1-3 attacks a year lasting from 3-17 days. One of those attacks required another cortisone shot. Some of the time the pain was sufficient where I needed to go back on Percocet for 1-5 days. From 2001-2014 I took an average of around 10 percocet per year.

I havent had an attack since 2014 and a very old bottle of percocet sits in my medicine cabinet 3/4 full since then.

For me, percocet was never addictive, but if I had needed something like that and it wasnt there, it would have been torture. I think now they have better things like the pain patches. Hopefully I will never need those. I also would be willing to try cannabis if it were legal and I had another attack.

All of that is a long winded way of acknowledging that we need an intelligent national effort to figure this out. I don't think it is that complicated. Better guidelines regarding pain medications, addiction care for those who get addicted to pain meds and I think we're 95% there.

[Aristus]

30. You're right about that. For cortisone shots and other comprehensive musculoskeletal

treatments, I always refer to orthopedics.

For most persistent M/S pain, I refer for physical therapy. If my clinical judgement leads me to believe PT would be ineffective, I refer directly to ortho. Sometimes a patient will request an ortho referral right out of the gate. Often, I comply with the request, but I tell the patient that the first thing an orthopedist is likely to do is refer for physical therapy. I'm so grateful for the clinical rotations I took in school. It gave me a good sense for what a specialty-care provider is and is not likely to do.

[NCTraveler]

28. This is a nightmare and what is wrong with society.

"they need to be cut off. "

Bullshit. Even you understand they aren't being cut off while making a comment acting as if they are. You truly contradict yourself. It just makes you feel better to say that. Telling someone no and sending them along is every bit a part of the problem.

"You've basically just admitted to being one of them."

Pure Frist.

[Aristus]

31. I'm not sure how you came to the conclusion that I was contradicting myself.

If a patient shows up on the state prescription monitoring site with frequent scrip fills for opioids, written by multiple providers, I refuse to prescribe what it is they're asking for. That's 'cutting them off'. What they do after they leave the clinic is out of my control.

[cannabis_flower]

21. Oh boy, where do I start?

I'll start with what happened to me.

In 2008 my right knee started hurting really bad. I wasn't sure how I had hurt it. I went to my primary care physician and he told me I probably twisted it and to stay off of it and take Tylenol. So I tried that for a while. I had a cane that I had used when I had an ankle injury and I was using that too. I tried that for about a month.

I talked to someone who recommended I go to Dr. Lee (not sure his last name but it as some Asian name that started with L). He was a orthopedic surgeon and my insurance didn't require referrals so I made an appointment.

He sent me for an MRI and to come back and he would tell me what was wrong. I went back and he said I had a bone bruise and that I should take Tylenol, stay off of it as much as possible and that it would get better. It didn't and after about 2 weeks of pain I called the doctor's office and told the nurse I was in a lot of pain and needed something for the pain. They asked me what I wanted and I told them "I don't know, maybe some Darvocet. So they decided to give me a prescription and I got 30 pills.

I would take half of one in the morning so I could put weight on my leg and walk and in the evening I took the other half so I could sleep because otherwise I would move my leg while I was asleep, and wake up several times a night in pain.

After almost a month, my friends were telling me I should find another doctor because neither of these doctors and done shit for me. So I went to another doctor (we'll call him Dr. Jerk) who I had been to before (he did surgery for me for a torn ligament). I told him about the pain in my knee. I told him the other doctor had given me Darvocet and he barely looked at me and gave me a prescription for 90 Darvocet.

I went to Walgreen's to get the prescription filled and because I was 2 days early they called Dr. Jerk and Dr. Jerk called Dr. Lee and they decided that they weren't going to fill the prescription. I called the doctor, pointed out to him that I had told him about Dr. Lee and that I was in a lot of pain and they decided I had to sign their pain management agreement again (I had already signed it) and they let me get the prescription.

Well, I continued doing what I had been doing for about about a week and one day I forgot to take my pill in the morning. (What kind of drug addict does that?) I was able to make it to my desk and things were not getting any better so I called Dr. Jerk again for another appointment and his receptionist said that he was on vacation and to call Dr. Hume (real name). I called and made an appointment for the next day. But by 10 am break time I got up from my desk and couldn't put any weight on my right knee. I had someone wheel me out in an office chair to an ambulance and took me to the hospital. They gave me a shot of some kind of tranquilizer, a shot of some kind of opiate and gave me a prescription for 7 Vicodin (which they filled at the hospital) and told me to see my doctor the next day.

I had a friend come and pick me up at the hospital, slept on her couch and she took me to see Dr. Hume the next day. He looked at my knee and moved it. He did an X-ray and told me I had significant arthritis in both knees. He gave me a cortisone shot, a prescription for Meloxicam and a prescription for a brace for my right knee. I was walking without pain for the first time in several months less than a day later.

I haven't seen Dr. Hume in several years because I no longer have health insurance but he was the first doctor to take my knee pain seriously and not just assume I was just looking for drugs. I didn't take the opioids again except every once in a while when nothing else worked and I think they lasted 2 or 3 years and I finally threw them away since they were expired.

So why didn't the first 3 doctors do anything that Dr. Hume did? He didn't assume I didn't have pain because I couldn't tell them how I injured the knee and did a thorough exam.

Later another doctor gave me a prescription for 75 mg Diclofenac and that seemed to work really well. After I lost my insurance I found that the Salvadorian grocery stores sold a pill called Dolo-neurobion that has 25mg of diclofenac and B vitamins (you can buy Dolo-neurobion at Walmart but it has Acetaminophen instead of Diclofenac). My husband bought it an I looked at the ingredients. We have also had them sent from his doctor in Honduras. I don't even take them very much because I found a home remedy that seems to work really well. We steep tumeric and ginger and then strain it. Then we add coconut oil, honey and pineapple juice. After about 3 days of this drink the pain goes away. Only in rare cases do I even take the Dolo-neurobion.

So why did I have to suffer for 3 or 4 months because these doctors decided without even doing a real exam that I was a drug seeker? I only asked for something for the pain. I'm not a doctor. The Tylenal wasn't working and I needed something. The only things I knew were Tylenol, aspirin and opioids. Doctors are supposed to know what to give you and perhaps they would have given me the right treatment if they had even bothered to do an adequate exam. By the way, I never went back to Dr. Jerk or Dr. Lee (and never will) and joined Angie's List so I could put a bad review for each of them. I can't say enough nice things about Dr. Hume though.

[Aristus]

24. The first guy was an idiot.

Tylenol works wonderfully for headaches and fever, but does little to nothing for joint pain.

Also, on an initial visit for joint pain, I always do a complete exam. Palpation of the joint to pinpoint the location of the pain, a series of tests to assess any instability of the joint (especially the knee, which is the most unstable joint in the body), pulses at the joint and 'downstream' from the affected joint, and reflexes. Then treat appropriately; a joint brace, if needed, instructions for ice and heat as needed, an injection for the acute pain, and then a prescription for management. Usually a non-steroidal anti-inflammatory. Diclofenac is an NSAID, which I prescribe often.

If the pain is due to an acute traumatic injury, as from a fall, a directed blow, a physical assault, a car accident, etc, I prescribe an appropriate opioid analgesic for use until the severe acute pain abates, then switch to an appropriate non-opioid medication.

[cannabis_flower]

32. I think all of them except for Dr. Hume

were complete idiots.

I think part of the problem is I really couldn't pinpoint anything that precipitated the start of the pain. I just woke up one morning with pain in the knee.

There wasn't anything I could pinpoint as the event that caused the pain.

Dr. Hume said that he could tell from the x-ray and the space between the bones that I had significant osteoarthritis. An x-ray is a pretty inexpensive diagnostic tool. It seems to me that any of the first three doctors could have x-rayed my knee and discovered the problem and I would have not had to endure 3 months of severe pain.

At least my original doctor never assumed I was just trying to get drugs, even if he only prescribed Tylenol for the pain.

The ones I blame the most were Dr. Lee and Dr. Jerk.

[robbob]

25. If tumeric and ginger helped...

You might want to check out an herbal anti-inflammatory called Zyflamend, made by New Chapter. Most health food stores carry it. Started bringing it to my Mom years ago at a point when she was about ready to give up her gardening because of knee and joint pain. It did wonders for her.

[cannabis_flower]

33. I might look into that.

The drink I make isn't terribly bad tasting but it's a pain to make every day. The recipe I got on the internet I changed a little bit
( http://www.healthyandnaturalworld.com/how-to-make-anti-inflammatory-turmeric-ginger-tea/ ). It said honey and lemon to taste - my husband doesn't like lemon (says he's allergic to it but I doubt that since he isn't allergic to any other citrus) - so I use pineapple juice which also helps with inflammation ( http://www.bodyandsoul.com.au/nutrition/nutrition-tips/pineapple-helps-relieve-inflammation/news-story/45f3ddbb5d83f1c9ea3ce322e4aaf916 )

[Sanity Claws]

7. It reached Canada

See http://www.cbc.ca/news/canada/thunder-bay/programs/superiormorning/kyle-lees-opiod-epidimec-1.4271701

[applegrove]

8. More people are going to die from opioids in Canada than car accidents.

[TheDebbieDee]

9. We are suffering from an Opioid epidemic because

Our pharmaceutical industry is un-regulated. JMO, tho!

[TheFrenchRazor]

10. who cares? i'm sick of hearing about this non-crisis. now let me go back to my suffering, because i

can't get any pain relief for my rheumatoid arthritis and herniated disc, etc. thanks.

[oberliner]

11. It has - Russia, in particular

Russian answer to opioid epidemic: 'Cold turkey'

https://www.csmonitor.com/World/Europe/2017/1128/Russian-answer-to-opioid-epidemic-Cold-turkey

[tavernier]

13. Because big pharm made big bucks

off of these drugs, just like big sugar has addicted a generation of us to soda pop and candy and processed foods.

Any means of addiction translates to big bucks for the provider.

[Sen. Walter Sobchak]

15. It sure has in Calgary and Vancouver Canada

It's a slow day if ambulances only show up half a dozen times to revive the junkies outside my office in Calgary.

It's a lost cause because for all the services that are offered the hardcore who need them the most manage to get themselves banned by the agencies that provide them, so all they're left with is an endless supply of free syringes that they leave lying around everywhere.

Vets offices in Calgary now keep Narcan on hand for the dogs that find the junkies needles.

[stevenleser]

16. Russia seems to have a bigger drug problem in general than we do. Canada is going to be hit hard by

the Opioid crisis. I just dont think Canada will have as many deaths per addict because they can get medical help there.

[alarimer]

18. Because they have actual safety nets in the form of rational health care systems.

People are not forced to self-medicate and their ailments are adequately treated. This also accounts for life expectancy differences unrelated to drugs. People can't get adequate health care for any number of conditions and those conditions are made worse by poverty and lack of other resources. So they die instead. Maybe with drugs, maybe by suicide or just by not treating whatever else is wrong with them.

And it is also due to our puritanical treatment of addicts. This is a medical condition, not a criminal one, so harm reduction should be the order of the day. And the treatment for addiction is unavailable for a lot of people who want help.

[PoindexterOglethorpe]

19. In a conversation yesterday with a friend who is a nurse,

I learned that Xanax is very addictive, lots of people have been taking it for 20 years or more, and it seems implicated in Alzheimer's. Which doesn't really address the OP, but I found quite instructive.

The other friend (three of us at lunch yesterday) detailed her issues with her knee replacement and subsequent need to deal with the pain. I will say that of all the many people I've know who've had a knee replacement she seems to be the only one who hasn't bounced back quickly. She also kept on naming drugs that I'd never heard of, which tells me how totally out of touch with the drug industry I must be.

I mean, if it's not Tylenol or aspirin or acetaminophen, I haven't a clue.

[NightWatcher]

26. Xanax and Clonopin were the hardest things I've ever kicked

I've also had oxy/hydro for various broken bones and post surgery. Now I have explicit instructions that I'll only take acetaminophen and cannabis (both non addictive).

[roamer65]

29. I can see why it is.

I was given a significant dose a few years back.

I stay clear of it now.

[Nevernose]

22. Most of those countries have opiates OTC

Or at least a codeine/acetaminophen mixture. I stock up whenever I’m overseas due to a major injury. They don’t alleviate the permanent pain, but they cut through the worst of it, on the bad days. Maybe once a week, if that often?

They won’t get you high, either: by the time a normal person took enough to get buzzed, their liver would shut down. Equivalent of Tylenol 1.