Friedman's 1979 comments re drug prohibition in 1979 all but predicted the catastrophic war on painkillers 40 years later. They did the EXACT SAME THING and got precisely the results Milton outlined.
Dr Josh Bloom has been writing eloquently, and maybe pithily, on this for years. On why cut off pain patients turn to dangerous and expensive fentanyl and, in Bloom's words
"...a 25% drop in opioid prescriptions over the past five years has been accompanied by a 25-fold increase in fentanyl deaths. Yeah, that's gonna work."
In Canada, their version of it has ex-patients buying their old prescription pills on the dark web for at rates as high as $80 per pill! And the physicians and their patients are aware of it all:
As they made the rules tighter, the death toll rises. Precisely per Friedman once again. They do not learn. Then they wonder why people start thinking kindly of the old bomb-throwing anarchists.
Analyzing the Opioid Crisis: 65 Articles by Dr. Josh Bloom:
What Fiedman said seems to make sense, but what is the risk that a patient prescribed an opioid for pain due to surgery or an injury will become addicted by the time the pain has abated?
How are such patients to be withdrawn?
Do some not resist withdrawal even if the pain has diminished. And if so, and if the medication is supplied despite the diminished need, does that not create a permanent dependency?
And if it lead to a permanent dependency, should a doctor continue to prescribe it: i.e., to treat the addiction itself as the basis for prescribing opioids indefinitely?
“Chasing the Scream” by Johann Hari handles this subject pretty well, and his research on surgically-induced addiction squares with my own.
In 1972 I was treated by US Navy doctors at Portsmouth Naval Hospital in Virginia for an emergency appendectomy. Because of the complications I was on high doses of Demerol and other narcotics for just over three weeks. This is beyond the threshold of addiction for high octane. When the near-month was over I was discharged without even being informed I was at risk, and had no sort of craving for anything but getting out and not being a patient anymore.
Hari explains why this was. He gives this subject a thorough treatment, with examples and statistics. He also puts his proofs (too far-ranging for any book) online for anyone willing to check:
https://chasingthescream.com/interviews-2/
But his whole site is worth a look, the book too. There are so many misconceptions about human interaction with drugs that Hari literally starts from scratch. He has a point with that.
Prohibition actually increased alcoholism, BTW, but not as Milton implies. Alcohol use really DID decline during prohibition. The boom in alcohol came in the years after. People who for years had no experience with the drug suddenly discovered it with predictable results. Peak alcoholism seems to have come from the mid-40s through the 50s, and some of us have memories of that. Kids pay attention to those things.
Some good movies came out of the "alcohol epidemic" of the mid twentieth century: The fine Welsh actor Ray Milland won an Academy Award in 1945 for doing an amazing job in the movie "The Lost Weekend." The movie came at high tide: With the war behind them, the liquor flowed too freely for too long. Billy Wilder made the picture, with groundbreaking work on hidden cameras for the naturalistic effect. Researching his subject, Milland actually spend a night in New York's most medieval dry out ward. He split early, amazed at what Demon Rum can do.
Despite a generation of problems, nobody wanted to repeat prohibition. Now that Portugal and Mexico and other countries are throwing in the drug war rag and noticing improvements, it's time for the Anglo-sphere to grow up too.
See that here in British Columbia, doctors are prescribing opioid addicts with something called dihydromorphone, but some are saying doctors need to be able to prescribe heroin and fentanyl. Is that the way to go, or are there some addicts who prefer to buy street drugs than see a doctor about their addiction? And if drugs are to be freely provided via the healthcare system, why not just allow them to be sold from pharmacies (drug stores)?
"...why not just allow them to be sold from pharmacies (drug stores)?"
I think so too.
Back in the old days, say 2006, any US doc would give you a open-ended prescription for painkillers if you had job injury, old war wounds, whatever. As people such as Josh Bloom have been pointing out, even if these were just junkies getting a supply, they either knew how to handle the drug or became a statistic... like liquor. And at least the drugs they were getting were reliably pure.
What changed, at least for us above the Rio Grande, is that de-industrialization creates a large pool of bright, energetic people for whom there is no meaningful work available. The Eternal Drug War creates lots of positions: From "agents" busting down doors to jail guards to therapists. It's lucrative for the US, a nation with an industrial base smaller than one of China's provinces.
Anyway that's one reason, I'm certain.
Josh's latest is a howler, even if depressingly predictable, and reinforces Milton's point about prohibition --
Re: The solution to the problem of de-industrialization in America is the same as I outlined here to the problem of de-industrialization in Europe. Trump had more or less the right idea, but his readiness to act upon it was evidently unacceptable to the ruling plutocracy and their Deep State allies, who therefore fixed the election.
It certainly seems crazy to make the non-prescription sale of ephedrine illegal. Years ago when doing field work in remote parts of Canada, I had a terrible cough, which I fixed with a large bottle of cherry flavored ephedrine. It was great -- it killed the cough and gave me lots of energy.
"It certainly seems crazy to make the non-prescription sale of ephedrine illegal."
My wife works a pharmacy and told me why, the dumbest reason I ever heard.
Certain cough syrups that contain it come in 6 or 8 ounce bottles. Local hard case homeless could afford the generic brand plus a 40-ounce can of malt liquor. She sells tons at closing time and the results are scattered all over the lot before she drives off.
They knock back the cough medicine then use the malt liquor as a chaser. I'd never try it but her customers tell her it's the nearest thing to legal crack cocaine. Except cocaine wouldn't be so hard on the kidneys and liver. It had nothing to do with being an ingredient in speed.
In a sane world we'd have some version of a State Store with aisles for Beer, Wine, Spirits, Tobacco, Heroin, Speed, whatever. Control it all like liquor, tax it, and get it over with.
Friedman's 1979 comments re drug prohibition in 1979 all but predicted the catastrophic war on painkillers 40 years later. They did the EXACT SAME THING and got precisely the results Milton outlined.
ReplyDeleteDr Josh Bloom has been writing eloquently, and maybe pithily, on this for years. On why cut off pain patients turn to dangerous and expensive fentanyl and, in Bloom's words
"...a 25% drop in opioid prescriptions over the past five years has been accompanied by a 25-fold increase in fentanyl deaths. Yeah, that's gonna work."
In Canada, their version of it has ex-patients buying their old prescription pills on the dark web for at rates as high as $80 per pill! And the physicians and their patients are aware of it all:
https://www.acsh.org/news/2021/02/10/canadians-use-dark-web-buy-ridiculously-expensive-pain-meds-15337
As they made the rules tighter, the death toll rises. Precisely per Friedman once again. They do not learn. Then they wonder why people start thinking kindly of the old bomb-throwing anarchists.
Analyzing the Opioid Crisis: 65 Articles by Dr. Josh Bloom:
https://www.acsh.org/news/2019/10/07/analyzing-opioid-crisis-65-articles-dr-josh-bloom-14308
What Fiedman said seems to make sense, but what is the risk that a patient prescribed an opioid for pain due to surgery or an injury will become addicted by the time the pain has abated?
ReplyDeleteHow are such patients to be withdrawn?
Do some not resist withdrawal even if the pain has diminished. And if so, and if the medication is supplied despite the diminished need, does that not create a permanent dependency?
And if it lead to a permanent dependency, should a doctor continue to prescribe it: i.e., to treat the addiction itself as the basis for prescribing opioids indefinitely?
“Chasing the Scream” by Johann Hari handles this subject pretty well, and his research on surgically-induced addiction squares with my own.
DeleteIn 1972 I was treated by US Navy doctors at Portsmouth Naval Hospital in Virginia for an emergency appendectomy. Because of the complications I was on high doses of Demerol and other narcotics for just over three weeks. This is beyond the threshold of addiction for high octane. When the near-month was over I was discharged without even being informed I was at risk, and had no sort of craving for anything but getting out and not being a patient anymore.
Hari explains why this was. He gives this subject a thorough treatment, with examples and statistics. He also puts his proofs (too far-ranging for any book) online for anyone willing to check:
https://chasingthescream.com/interviews-2/
But his whole site is worth a look, the book too. There are so many misconceptions about human interaction with drugs that Hari literally starts from scratch. He has a point with that.
Prohibition actually increased alcoholism, BTW, but not as Milton implies. Alcohol use really DID decline during prohibition. The boom in alcohol came in the years after. People who for years had no experience with the drug suddenly discovered it with predictable results. Peak alcoholism seems to have come from the mid-40s through the 50s, and some of us have memories of that. Kids pay attention to those things.
Some good movies came out of the "alcohol epidemic" of the mid twentieth century: The fine Welsh actor Ray Milland won an Academy Award in 1945 for doing an amazing job in the movie "The Lost Weekend." The movie came at high tide: With the war behind them, the liquor flowed too freely for too long. Billy Wilder made the picture, with groundbreaking work on hidden cameras for the naturalistic effect. Researching his subject, Milland actually spend a night in New York's most medieval dry out ward. He split early, amazed at what Demon Rum can do.
Despite a generation of problems, nobody wanted to repeat prohibition. Now that Portugal and Mexico and other countries are throwing in the drug war rag and noticing improvements, it's time for the Anglo-sphere to grow up too.
See that here in British Columbia, doctors are prescribing opioid addicts with something called dihydromorphone, but some are saying doctors need to be able to prescribe heroin and fentanyl. Is that the way to go, or are there some addicts who prefer to buy street drugs than see a doctor about their addiction? And if drugs are to be freely provided via the healthcare system, why not just allow them to be sold from pharmacies (drug stores)?
Delete"...why not just allow them to be sold from pharmacies (drug stores)?"
DeleteI think so too.
Back in the old days, say 2006, any US doc would give you a open-ended prescription for painkillers if you had job injury, old war wounds, whatever. As people such as Josh Bloom have been pointing out, even if these were just junkies getting a supply, they either knew how to handle the drug or became a statistic... like liquor. And at least the drugs they were getting were reliably pure.
What changed, at least for us above the Rio Grande, is that de-industrialization creates a large pool of bright, energetic people for whom there is no meaningful work available. The Eternal Drug War creates lots of positions: From "agents" busting down doors to jail guards to therapists. It's lucrative for the US, a nation with an industrial base smaller than one of China's provinces.
Anyway that's one reason, I'm certain.
Josh's latest is a howler, even if depressingly predictable, and reinforces Milton's point about prohibition --
https://www.acsh.org/news/2021/03/24/meth-spiked-adderall-threatens-kids-blame-dea-15419
Re: The solution to the problem of de-industrialization in America is the same as I outlined here to the problem of de-industrialization in Europe. Trump had more or less the right idea, but his readiness to act upon it was evidently unacceptable to the ruling plutocracy and their Deep State allies, who therefore fixed the election.
DeleteIt certainly seems crazy to make the non-prescription sale of ephedrine illegal. Years ago when doing field work in remote parts of Canada, I had a terrible cough, which I fixed with a large bottle of cherry flavored ephedrine. It was great -- it killed the cough and gave me lots of energy.
"It certainly seems crazy to make the non-prescription sale of ephedrine illegal."
DeleteMy wife works a pharmacy and told me why, the dumbest reason I ever heard.
Certain cough syrups that contain it come in 6 or 8 ounce bottles. Local hard case homeless could afford the generic brand plus a 40-ounce can of malt liquor. She sells tons at closing time and the results are scattered all over the lot before she drives off.
They knock back the cough medicine then use the malt liquor as a chaser. I'd never try it but her customers tell her it's the nearest thing to legal crack cocaine. Except cocaine wouldn't be so hard on the kidneys and liver. It had nothing to do with being an ingredient in speed.
In a sane world we'd have some version of a State Store with aisles for Beer, Wine, Spirits, Tobacco, Heroin, Speed, whatever. Control it all like liquor, tax it, and get it over with.