Heroin deaths surpass gun homicides

[Denny347]

"Treatment" is laughable. My guy today was in treatment three times a week and a court run drug testing program. They use while inpatient. They use when they get out. Without rock bottom and finally getting tired of it they will use until they die. They want heroin, not treatment for heroin

Of course some people are unreachable, unchangeable. But so many are savable. I know you see some crappy people. I do as well. It's very easy to see them as things (addicts). I've been there and something changed me, not sure what, if it was even just one thing. But as many addicts as I deal with, they still haven't outnumbered the runs I take where alcohol is the root of the issues and poor decisions...a perfectly legal drug.

 

[hoosierdoc]

The US "war on drugs" has in my opinion never really been about fixing or controlling addiction, but is much more about societal control particularly in regards to the blacks and hippies. It is weird that there wasn't calls for lifesaving measures like Narcan when crack was ripping its way through the inner cities....

Opiate addiction only became a disease when it hit the suburbs via the doctors office.

well opioids are the only things that have an easy reversal agent. Cocaine doesn't usually up and kill you either

bear in mind the docs did it thanks to the Feds demanding we treat pain and slapping our wrists for uncontrolled pain. Pain number is the fifth vital sign they told us. Even today pain control is a measure we're evaluated by with surveys and you can be fired or punished financially for not adequately controlling pain based on a patient survey, not whether it was medically appropriate to give them what they demanded.

opioids are a sad, sad problem that our society has embraced. Hard to close pandora's box. Americans expect everything fixed immediately and as pain-free as possible. Try telling someone with an acutely herniated disk they'll be better in six weeks with prednisone and aleve. Hah. They want immediate MRIs, despite 90% of herniations resolving on their own at six weeks. "But he's in pain, he can't walk". Fine, we'll have social work try to get him into a nursing home, but insurance won't cover it so you'll be payin cash. "We can't afford $400/day!" Ok, well, what do you want then? "We'll just go home". And the guy limps out the door, now able to walk once he has accepted reality.

the expectation was we'd dope him up to minimal pain, admit him if we couldn't get him there, and stay until he "feels better". Nope, home you go. So they complain, file a grievance, say we didn't care. I've had healthy people die in the hospital due to narcotics whose only diagnosis was a knee bruise. But they just want narcs until healed. Not everyone, but a huge percentage. Then they get narcs for six weeks because the doc already had three complaints last month for NOT giving them, then a certain percentage get addicted and blame the doc.

 

[Denny347]

well opioids are the only things that have an easy reversal agent. Cocaine doesn't usually up and kill you either

bear in mind the docs did it thanks to the Feds demanding we treat pain and slapping our wrists for uncontrolled pain. Pain number is the fifth vital sign they told us. Even today pain control is a measure we're evaluated by with surveys and you can be fired or punished financially for not adequately controlling pain based on a patient survey, not whether it was medically appropriate to give them what they demanded.

opioids are a sad, sad problem that our society has embraced. Hard to close pandora's box. Americans expect everything fixed immediately and as pain-free as possible. Try telling someone with an acutely herniated disk they'll be better in six weeks with prednisone and aleve. Hah. They want immediate MRIs, despite 90% of herniations resolving on their own at six weeks. "But he's in pain, he can't walk". Fine, we'll have social work try to get him into a nursing home, but insurance won't cover it so you'll be payin cash. "We can't afford $400/day!" Ok, well, what do you want then? "We'll just go home". And the guy limps out the door, now able to walk once he has accepted reality.

the expectation was we'd dope him up to minimal pain, admit him if we couldn't get him there, and stay until he "feels better". Nope, home you go. So they complain, file a grievance, say we didn't care. I've had healthy people die in the hospital due to narcotics whose only diagnosis was a knee bruise. But they just want narcs until healed. Not everyone, but a huge percentage. Then they get narcs for six weeks because the doc already had three complaints last month for NOT giving them, then a certain percentage get addicted and blame the doc.

Bingo.

 

[Fargo]

well opioids are the only things that have an easy reversal agent. Cocaine doesn't usually up and kill you either

bear in mind the docs did it thanks to the Feds demanding we treat pain and slapping our wrists for uncontrolled pain. Pain number is the fifth vital sign they told us. Even today pain control is a measure we're evaluated by with surveys and you can be fired or punished financially for not adequately controlling pain based on a patient survey, not whether it was medically appropriate to give them what they demanded.

opioids are a sad, sad problem that our society has embraced. Hard to close pandora's box. Americans expect everything fixed immediately and as pain-free as possible. Try telling someone with an acutely herniated disk they'll be better in six weeks with prednisone and aleve. Hah. They want immediate MRIs, despite 90% of herniations resolving on their own at six weeks. "But he's in pain, he can't walk". Fine, we'll have social work try to get him into a nursing home, but insurance won't cover it so you'll be payin cash. "We can't afford $400/day!" Ok, well, what do you want then? "We'll just go home". And the guy limps out the door, now able to walk once he has accepted reality.

the expectation was we'd dope him up to minimal pain, admit him if we couldn't get him there, and stay until he "feels better". Nope, home you go. So they complain, file a grievance, say we didn't care. I've had healthy people die in the hospital due to narcotics whose only diagnosis was a knee bruise. But they just want narcs until healed. Not everyone, but a huge percentage. Then they get narcs for six weeks because the doc already had three complaints last month for NOT giving them, then a certain percentage get addicted and blame the doc.

Oh believe me, I know. The Purdue Pharmaceuticals of big pharma bought and paid for the FDA and .gov actually pushed their their product for them.

The whole thing is reprehensible. I remember personally having pain meds personally pushed at me many times in the late 90s and early 2000 when I had no interest or need.

 

[Route 45]

Well, it's called sarcasm. I thought it would be fairly obviously dripping with it.

 

[churchmouse]

Oh believe me, I know. The Purdue Pharmaceuticals of big pharma bought and paid for the FDA and .gov actually pushed their their product for them.

The whole thing is reprehensible. I remember personally having pain meds personally pushed at me many times in the late 90s and early 2000 when I had no interest or need.

Spouse and I both refuse to take anything that is addictive in nature. There are alternatives.

 

[Bill of Rights]

Had to look up Narcan. Do officers carry it or is it EMT only?

If I recall, it's one of those you can ask your doc and s/he'll write you a script for it. No big deal. Hoosierdoc, please correct me if that's wrong.

Uhhh....NO! We`ve been touched personally, and closely by this plague, and no, legalization wouldn`t help this epidemic to be less of a scourge upon humanity and society. The ONLY way to effectively stop this sad, sad loss of life is to turn people back to both Biblical principles, but more importantly to our Lord and Savior, Jesus Christ. If we followed His commandments, and lived our lives according to the precepts of the Bible, there would be, virtually no crime or needless death.

Not to make this a religious discussion, but Greg, you're forgetting that not everyone is a Christian, nor does everyone need to be, despite what your religion tells you, i.e. John 3:16. Removing belief and opinion from the discussion and just saying that the principles in that book are somehow the key, how do you plan to "turn people back" to them? Even if you were able to force people to believe as you do, wouldn't that be removing their freedom to choose or not choose to believe, and thus, remove the choice that is their salvation, according to Christian belief?

I couldn`t disagree more with the needle exchange programs. Why in the world would government, i.e., society, provide criminals with the tools of the trade?

There's the economic argument and also the condom argument: The kids are GOING to mess around. Knowing that that is not a fact you can change, would you rather they did it more safely or less so? Though to address Phylodog's point, I'd say that if they're going to participate in the needle exchange, they should have to provide some kind of work in exchange for the program being offered... Maybe a few hours a week, they help staff the center, in roles that have no contact with the needles directly (counting people coming in, registering them, if that's done, etc.)

Heroin is on the way out. A kg of it costs about $60k. A kg of Fentanyl costs about $6k. Coming from China and Mexico, we see it taking over...also responsible for the OD's. The "war" is unwinnable as long as the WANT exists. If there is demand, supply will always be there. It is naive to think we can arrest our way out of this. Many, if not most, addicts have underlying reasons that lead to addictions. Why can 2 people take the same drug and one has no lasting addiction but the other does? Much like alcohol, alcoholics. One would be surprised in how many social users of heroin and cocaine there are in the world with no lasting effects. Not saying it's right, not at all. But what I am saying is that we are focusing on the wrong end of this disaster. How is arresting an addict for a BS possession or paraphernalia charge help them? They spend 12hrs in jail at taxpayers expense then a dozen court appearances before trial date...again, we are paying for it. Told to not use anymore, small amount of drug counseling, and off they go. Most doomed to same cycle. What many do not understand is the powerful pull opiates have on the person's brain. It alters it heavily. I've met few addicts that wanted to be addicts. But the addiction is stronger than the will... that is the true myth with opioids, that willpower will get you through (for most). That is why becoming an opioid addict is a death sentence for most. But does it have to be? There was a study in Canada where the city allowed Dr to prescribe a maintenance dose of heroin to the addict, just enough to satisfy the brain but still allowed them to function. They were able to keep their jobs, remain productive, while seeking intensive therapy to find the root cause of their addiction. During this long process, the dose of heroin was slowly decreased. Over time, the brain became accustomed to the lower dose and eventually the addict was able to free themselves of the addiction. It worked very well. Until the program was cancelled. The addicts in the program found themselves back in the destructive addict cycle. However, this is too "outside the box" for most in the US. This approach is seen by many as "too soft" on crime. This archaic mindset is how we ended up where we are now. By the way, we shall also thank the drug companies who developed/sold Oxy and the like for our current level of addicts. They sold their drugs with the caveat that they were non addictive, lied to doctors and the public. Causing an over prescription, leading to many addictions.
Maybe I'm just an old softy. I'm in my 19th year of wearing a badge and anymore I have a hard time seeing addicts as worthless. I arrive to an OD and I see a brother/sister, mother/father, son/daughter, aunt/uncle, wife/husband. All of which have stories to tell. They all had lives before they were addicts. They all had something to say, something to add to this world. All before their lives veered off course. They lie there, ODing, and the world would rather they die, be tossed away like garbage. I talk to the families and see through the addiction. It makes me sad. Addiction has hit VERY close to me, my family, and many of my friends. Many responses here make me feel as bad for the posters as I do for the addicts.

Denny, I'm sorry to read that addiction has hit so closely to you. You're correct that Fentanyl is the next big thing... Look again at those vials posted upthread, folks... things like morphine, even Dilaudid, being measured in milligrams, Fentanyl is measured in micrograms: That is to say, if I'm going to give someone 7mg (milligrams) of Morphine or 1mg of Dilaudid, it's going to be about the same effect. If I'm giving Fentanyl, I might give 175mcg(micrograms) or less than 0.2mg to achieve the same effect. The dosing is incredibly small and the effect and abuse potantial are astronomical. What we need is a way to decrease the want, but I'm of the (solely personal, and unverified) opinion that once the addictively-inclined brain has experienced that high, that feeling... nothing else is going to suffice. They're going to use and use and use until it kills them, absent some very heavy-duty treatment... and even then, the probability of relapse is probably too high to make it worthwhile to try.

I deal with opiate addicts and people with mental disorders on a weekly basis. They are NOT the same. The person with a mental disorder has a difficulty perceiving reality or regulating emotions. The opiate addict is incapable of feeling pleasure, and in fact experiences excruciating pain, unless those receptors are being fed.

When a person with a mental disorder kills themself, it is usually related to distorted perception and despair. OD's generally have decided that escaping withdrawal pains is priority #1 and will actually be angry if you narcan them into withdrawal. Life is a distant #2.

Needle exchanges are a copout which encourages bad behavior IMO and are marginally effective in curbing HIV. You can't fix an epidemic of people who no longer care about living by encouraging their habit.

Needle exchanges make exactly as much sense as providing medically pure heroin to avoid hot batching.

When I first learned about Narcan, the advice was to "titrate to effect", meaning that you give just enough so they keep breathing. Don't wake them up, unless you are looking for a fight you ain't gonna win. FWIW, that advice was spot-on. Them sunzab****es are strong!

well opioids are the only things that have an easy reversal agent. Cocaine doesn't usually up and kill you either

bear in mind the docs did it thanks to the Feds demanding we treat pain and slapping our wrists for uncontrolled pain. Pain number is the fifth vital sign they told us. Even today pain control is a measure we're evaluated by with surveys and you can be fired or punished financially for not adequately controlling pain based on a patient survey, not whether it was medically appropriate to give them what they demanded.

opioids are a sad, sad problem that our society has embraced. Hard to close pandora's box. Americans expect everything fixed immediately and as pain-free as possible. Try telling someone with an acutely herniated disk they'll be better in six weeks with prednisone and aleve. Hah. They want immediate MRIs, despite 90% of herniations resolving on their own at six weeks. "But he's in pain, he can't walk". Fine, we'll have social work try to get him into a nursing home, but insurance won't cover it so you'll be payin cash. "We can't afford $400/day!" Ok, well, what do you want then? "We'll just go home". And the guy limps out the door, now able to walk once he has accepted reality.

the expectation was we'd dope him up to minimal pain, admit him if we couldn't get him there, and stay until he "feels better". Nope, home you go. So they complain, file a grievance, say we didn't care. I've had healthy people die in the hospital due to narcotics whose only diagnosis was a knee bruise. But they just want narcs until healed. Not everyone, but a huge percentage. Then they get narcs for six weeks because the doc already had three complaints last month for NOT giving them, then a certain percentage get addicted and blame the doc.

Opiates and benzos, Doc, but yeah, I get your point. and yes, this is a classic example of too much government: "Oh, you have to believe them when they tell you they have pain! You have to medicate them!" And no one thought that might make the addiction problem worse?

Oh, sorry. I was right, but with too many details: No one thought.

I used to work with a medic who was known for saying, "No one ever died from pain." While he was technically correct, that's going a bit far for me. My standard when I was on the road was "if you can convince me, I will Light. You. Up. Show me you have pain and convince me, and I'll be your best friend."

Of course, the other side of that is, "Convince me that you're seeking and lying to me, and I will not only not medicate you myself, but I'll make sure the ED staff and the EDP all know that I suspect you're just drug-seeking, and why. And yes, conversations like that between people directly involved in the patient's care are FULLY protected by HIPPA." And my report will reflect the facts I saw that indicated it. You ain't gettin' squat if I can help it.

Is it obvious I don't like being lied to or "played"?

One question for you, Doc, and if you'd rather answer privately, that's fine: You discussed specifically a herniated disk, with a general prognosis of 6 weeks. That's all well and good, if you can take the 6 weeks not working, allowing it to heal. Short-term disability, for those who have it, takes a couple weeks to a month to kick in. Even then, it's only a portion of your income, and you still have to live, not to mention you'd like to have a job when you get better. Prednisone and Aleve are wonderful, but they do take time. If the person can achieve enough pain relief for that period to allow them to work (note that I didn't say it was a good idea) in days, to me it seems pretty hard to convince them to take six weeks to heal up. Is there something you tell people that convinces them that the slower course is better for them to the point that they take your advice?

Thanks in advance for the reply, and

to all, as always,

Blessings,
Bill

 

[DoggyDaddy]

Heroin is on the way out. A kg of it costs about $60k. A kg of Fentanyl costs about $6k. Coming from China and Mexico, we see it taking over...also responsible for the OD's. The "war" is unwinnable as long as the WANT exists. If there is demand, supply will always be there. It is naive to think we can arrest our way out of this. Many, if not most, addicts have underlying reasons that lead to addictions. Why can 2 people take the same drug and one has no lasting addiction but the other does? Much like alcohol, alcoholics. One would be surprised in how many social users of heroin and cocaine there are in the world with no lasting effects. Not saying it's right, not at all. But what I am saying is that we are focusing on the wrong end of this disaster. How is arresting an addict for a BS possession or paraphernalia charge help them? They spend 12hrs in jail at taxpayers expense then a dozen court appearances before trial date...again, we are paying for it. Told to not use anymore, small amount of drug counseling, and off they go. Most doomed to same cycle. What many do not understand is the powerful pull opiates have on the person's brain. It alters it heavily. I've met few addicts that wanted to be addicts. But the addiction is stronger than the will... that is the true myth with opioids, that willpower will get you through (for most). That is why becoming an opioid addict is a death sentence for most. But does it have to be? There was a study in Canada where the city allowed Dr to prescribe a maintenance dose of heroin to the addict, just enough to satisfy the brain but still allowed them to function. They were able to keep their jobs, remain productive, while seeking intensive therapy to find the root cause of their addiction. During this long process, the dose of heroin was slowly decreased. Over time, the brain became accustomed to the lower dose and eventually the addict was able to free themselves of the addiction. It worked very well. Until the program was cancelled. The addicts in the program found themselves back in the destructive addict cycle. However, this is too "outside the box" for most in the US. This approach is seen by many as "too soft" on crime. This archaic mindset is how we ended up where we are now. By the way, we shall also thank the drug companies who developed/sold Oxy and the like for our current level of addicts. They sold their drugs with the caveat that they were non addictive, lied to doctors and the public. Causing an over prescription, leading to many addictions.
Maybe I'm just an old softy. I'm in my 19th year of wearing a badge and anymore I have a hard time seeing addicts as worthless. I arrive to an OD and I see a brother/sister, mother/father, son/daughter, aunt/uncle, wife/husband. All of which have stories to tell. They all had lives before they were addicts. They all had something to say, something to add to this world. All before their lives veered off course. They lie there, ODing, and the world would rather they die, be tossed away like garbage. I talk to the families and see through the addiction. It makes me sad. Addiction has hit VERY close to me, my family, and many of my friends. Many responses here make me feel as bad for the posters as I do for the addicts.

There is a saying concerning alcoholics that applies equally to addicts of any stripe. They don't have a "drinking problem", they have a "thinking problem". Which is to say that the addict/alcoholic's brain isn't wired the same as a normal person's brain. It's not a question of willpower for these people. In order to recover from addiction, there must be a change in the way the brain thinks and functions. This can be accomplished for most, but not without significant effort, and it is very much an ongoing process, which must be maintained for the rest of their lives. Way more than just putting the plug in the jug (or the syringe/pill bottle).

 

[hoosierdoc]

We don't give flumazenil for benzos because of the risk of immediate withdrawal seizures. And then you can't give benzos to stop them, and no one carries anti-epileptic drugs on an ambulance other than versed. Even in the hospital we don't give it. In my 12 years I've given it one time, to an 80yo I knew didn't take them, who was DNR on bipap and we gave 0.5mg Ativan for sedation since she was agitated and not keeping mask on. Then she was knocked out and not breathing well so we reversed it a bit to a happy medium.

I wrote the guy yesterday for the Narcan nasal injector thing. But it's not cheap and hard to find. I would wager he will not buy it, despite nearly dying

 

[2A_Tom]

Had to look up Narcan. Do officers carry it or is it EMT only?

If I recall, it's one of those you can ask your doc and s/he'll write you a script for it. No big deal. Hoosierdoc, please correct me if that's wrong.



as always,

Blessings,
Bill

Thanks Bill, Although I am perfectly confident to administer trauma first aid, even having read the symptoms of heroine overdose I would not want to administer Narcon for fear of litigation.

 

[JRPLANE]

I to am tired of paying for everyone else.

 

[hoosierdoc]

Of course some people are unreachable, unchangeable. But so many are savable. I know you see some crappy people. I do as well. It's very easy to see them as things (addicts). I've been there and something changed me, not sure what, if it was even just one thing. But as many addicts as I deal with, they still haven't outnumbered the runs I take where alcohol is the root of the issues and poor decisions...a perfectly legal drug.

that's very true. I offer them all treatment options I just don't expect them to follow through. I'd be thrilled if they would.

we have a patient who loves cocaine. Problem is she's got a sensitivity to levamisole, something they cut the Coke with to increase quantities. She has portions of her skin dying and falling off, but she can't stop.

the funny thing is three years ago the mental health facilities all said inpatient narcotic/alcohol treatment isn't any more successful than a daily outpatient program so they wouldn't admit people who wanted help. Now with Obamacare they admit almost every single one who has insurance and wants to go inpatient. Usually it leads to a period of sobriety and then right back to the drug though, proving their earlier point. But now addiction medicine is VERY lucrative for the mental health world

 

[2A_Tom]

Our Church runs a program, it is totally voluntary, you have to pay for room and board, it is inpatient and has a very high success rate/very low recidivism. I know several men who have come back from Coke and crack addictions, but I am not sure about heroine.

We have a mission which is free and I know men who have turned their lives around. some who have been in and out for years.

We also run the Hammond homeless shelter which provides 3 hots and a cot, but they have to leave during the day. These folk don't seem to have any desire to improve.

 

[Denny347]

Well, it's called sarcasm. I thought it would be fairly obviously dripping with it.

Threads/texts/emails/ect don't communicate that well.

 

[Bill of Rights]

Thanks Bill, Although I am perfectly confident to administer trauma first aid, even having read the symptoms of heroine overdose I would not want to administer Narcon for fear of litigation.

My understanding of the Good Samaritan law is that if you administer first aid (in which this would be included) to your level of skill and ability, do not act negligently, and do not receive any payment for doing so, you have no fear of litigation.

IC 34-30-12-1 Gratuitously rendered emergency care; immunity
Sec. 1. (a) This section does not apply to services rendered by a
health care provider (as defined in IC 34-18-2-14 or IC 27-12-2-14
before its repeal) to a patient in a health care facility (as defined in
IC 27-8-10-1).
(b) Except as provided in subsection (c), a person who comes
upon the scene of an emergency or accident, complies with
IC 9-26-1-1.5, or is summoned to the scene of an emergency or
accident and, in good faith, gratuitously renders emergency care at
the scene of the emergency or accident is immune from civil liability
for any personal injury that results from:
(1) any act or omission by the person in rendering the
emergency care; or
(2) any act or failure to act to provide or arrange for further
medical treatment or care for the injured person;
except for acts or omissions amounting to gross negligence or willful
or wanton misconduct.

There is more to that law, but from what I saw, it applied to defibrillators, not Narcan.

Standard disclaimers apply. IANAL, IDPOOTV, IDSAAHIELN, TINLA

FWIW, I wouldn't want to treat a heroin overdose outside of work because I don't want them waking up and going ballistic on me, by myself. That doesn't mean I *wouldn't* treat them, just that I hope to not be in the position to do so, without the proper "tools" (meds, etc.) to allow me to do it correctly.

Blessings,
Bill

 

[brchixwing]

This had me cracking up for a good 90 seconds

Damn high capacity drug baggies

 

[2A_Tom]

Thanks Bill I will add that IC to my file.

Do you use the nasal or the auto injector version and how do you meter the dose to get them breathing but not conscious.

 

[Jludo]

I have no sympathy for those that do or those that sell drugs. Especially those that sell. I say exterminate dealers with extreme prejudice. That may sound harsh, but I have seen what it does to a family first hand. My cousin OD'd on heroin last year, she died. She was 55 years old. It shocked me, as I knew she smoked weed, but never knew she did anything else. To top that off, her son has OD'd twice, once before she died and once after. He is brain mush now. He would have been better off to die, sad to say, but yeah. This crap seems to be easy to get and cheap. Start terminating the up line, and eventually you will find the head of the hydra.

Part of the problem with being to close to a particular issue, we shouldn't line them all up and kill them.

 

[Jludo]

"Treatment" is laughable. My guy today was in treatment three times a week and a court run drug testing program. They use while inpatient. They use when they get out. Without rock bottom and finally getting tired of it they will use until they die. They want heroin, not treatment for heroin

I must be an optimist but surely somewhere in the world someone has figure out a solution to his problem, I can't make myself believe there are just some people nothing will work on.

 

[PistolBob]

I've seen women give away their kids, steal from their grandparents, prostitute themselves, and even worse....for one more night of heroin filled bliss. The drug is all consuming, getting more is what their life revolves around. Heroin addicts ARE the Zombie invasion.