Tag: opioids

Is the Opioid Crisis Mainly a Story of ‘Late Capitalism’ or Something More Complicated?

 

For capitalism’s critics, the opioid crisis is a powerful witness for the prosecution. They charge that inequality, stagnant wages, immobility, job loss — the four horsemen of the neoliberalism endgame — have generated a massive surge in “deaths of despair,” especially from overdoses of opioid drugs. Case closed.

But a new NBER working paper “Origins of the Opioid Crisis and Its Enduring Impacts” suggests a different theory of the case, one that focuses on a supply rather than demand explanation.

From the paper (bold by me):

The Opioid Use Hiding Behind the Alleged Superiority of “Nonopioid” Chronic Pain Treatment

 

The SPACE randomized clinical trial, which 234 veterans with chronic back or knee pain completed, has been touted as demonstrating that opioids are superfluous to chronic pain management. According to JAMA’s summary of the trial,

In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.

In this AEI Events Podcast, AEI’s Sally Satel and Nicholas Eberstadt join a distinguished panel to begin a series of conversations addressing the opioid crisis ravaging the nation. The panel discussion touches the cultural factors underpinning today’s crisis, the social, cultural, economic factors driving overdose deaths, and the role of the federal government to provide treatment and prevent overdose.

Panelists include Christopher Caldwell (The Weekly Standard), Nicholas Eberstadt (AEI), Harold Pollack (University of Chicago), and Danny Seiden (Office of the Governor, Arizona). The discussion is moderated by Sally Satel (AEI).

Sympathizing: Must Loving Fishtown Equal Hating Belmont?

 

We have plenty of folks on Ricochet who inhabit Belmont, more or less, but identify with Fishtown. It seems the easiest way to signal this sympathy is to be a self-hating Belmontonian. But what if you don’t hate everything about Belmont? Is it possible to sympathize with Fishtown even then? I would say yes. Though I would not, at this point, expect to be believed.

I recently reviewed Dreamland, a reporter’s magnum opus on the opiate addiction epidemic. My interest in its devastation isn’t academic. After all, I, too, have known chronic pain, death-wish despair, and repeated exposure to opioids through injury and surgery. Nor am I the only one in my family to have had these problems. Yet we’ve been spared from narcotics addiction, and the buffer of Belmont customs is at least partly to thank for this. Growing up, I hadn’t thought of myself as “Belmont.” My parents’ one sacrifice to dwarf all others was buying us a precarious perch in a Belmont neighborhood so we could attend its famed Belmont schools. It meant money was always tight. We dressed in the kind of secondhand clothes that made other kids point and laugh. In Belmont, we were at the bottom of the food chain, and that, plus my family’s right-leaning distaste for Belmont smugness, left us thinking of ourselves as outsiders, crypto-Fishtowners. It took leaving Belmont to find out how Belmont we’d become.

Being Belmont isn’t such a bad thing. There’s much more to Belmont than smugly looking down on the rubes. We rely on Belmont to support much of the finest flower of Western civilization – the arts, the sciences. As Charles Murray noted, Belmont neglects to preach the morals it still practices, while Fishtown struggles to practice what it preaches. But practice is not nothing, especially for youngsters who get to grow up surrounded by the practice. In my teens, I began attending about the Belmontiest church you could imagine – folks way richer than us, socialites on the “in” when I was “out,” with everybody reluctant to preach what they practiced. But among the things they practiced was traditional worship music (it’s why I went) and, as Lutherans like to say, music is its own sermon. You can get a pretty good Christian formation in one of those churches by ignoring what’s spoken and taking to heart what’s sung. And oh, the music!

Dreamland – A Review

 

Billed as “the true tale of America’s Opiate epidemic,” Sam Quinones’s Dreamland is a pretty quick read considering it’s about 350 pages. The blurbs on the back promise “expert storytelling,” and I suppose it is. The storytelling is good enough to make me wonder how heavily Quinones selected for stuff that would make a good story, while other stuff, equally true and relevant, but less dramatic, got discarded along the way. Quinones focuses on the marketing of OxyContin as a safe prescription drug, its subsequent abuse, the spread of a new means of dealing black tar heroin, and the connection between these, telling the tale of several colorful characters along the way.

To Quinones, the spread of opiate use to white America – not just to impoverished “rust belt” regions, but also to the offspring of the wealthy, managerial class – is fraught with moral meaning, though perhaps contradictory moral meaning. Heroin tempts us when we’re too wealthy, when we’re too poor, because we feel entitled to pain relief, because we don’t feel entitled to stop when it hurts but instead succumb to pressure to tough it out by any means necessary; it tempts us when we’re underwhelmed by life, it tempts us when we’re overwhelmed… Opiates are both the new party drug and the new drug of social isolation… Addiction is simultaneously a moral indictment of American consumerist excess during the pre-crash boom, a testament to post-crash misery, and an illness which deserves less moral stigma than it gets. Forgive me for suspecting at times that, to Quinones, opiates serve mostly as a random moral generator.

Which isn’t to say Dreamland is a bad book. There seems to be plenty of impressive journalism in here, crime journalism especially, although the science journalism falls rather short: there are multiple errors in describing how drugs are metabolized; in describing the drugs derived from the opium poppy (in particular, using “the morphine molecule” as shorthand for all of them); and sometimes there’s just illiterate wording, like calling what’s not statistical mechanics “statistical mechanics” or calling a lumbar sprain “a sprained lumbar” (a sprained lumbar… what?). Still, for someone like me – someone who uses opioids conservatively as part of a pain-management regimen, considering them a not-very-fun occasional treatment reserved for pain that inhibits productivity even more than being doped up would – Dreamland is a tour of a world Quinones, if his story is to be believed, claims I could easily have become a part of, yet haven’t.

Member Post

 

I read Jim Geraghty’s “Morning Jolt” daily.  I enjoy it and get a lot of insight I would not have encountered otherwise.  But sometimes Jim just doesn’t get it.  This morning for example: Are Republican Voters Interested in What Republican Lawmakers Are Doing? Preview Open

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Pain and Suffering in New England

 

imageHere in New England, it’s hard to get through a news cycle without at least one mention of the region’s opioid epidemic. Every media outlet covers it; governors are creating task forces faster than you can count; and the presidential candidates expect daily questions on the matter, often from parents who lost a child to an overdose. (Notably, Jeb Bush’s daughter has struggled with addiction for years, and Carly Fiorina’s stepdaughter died of an overdose.)

Is the problem worthy of the hype? More so than I had thought. In Massachusetts last year, there were nearly 1,100 confirmed deaths from opioid poisoning, and that number is likely to crawl higher as some investigations are completed. That’s up from 711 deaths in 2012, which constituted very nearly 30 percent of all accidental deaths in the state. Most depressingly, confirmed overdose deaths have increased every year since 2010, when the number was just 555. New Hampshire has only a fifth as many people as Massachusetts, but almost a third as many fatal cases. These rates are significantly higher than national averages.

Now, statistics like this are only a reflection of reality and often a distorted one: It’s wholly possible that the increase in the number of recorded incidents reflects, at least in part, a growing awareness of such causes of death (when you start looking for things, you tend to find them). Still, that’s a staggering number of deaths, both in absolute numbers and as a proportion of preventable deaths. I’m hesitant to use the word “epidemic” to describe things short of the Spanish Flu, but there’s a undoubtedly a very serious problem here.