"What interrupts that cycle?"

February 23, 2016 9:06 PM

PBS newsmagazine Frontline devotes two hours to exploring the massive rise in the abuse of street opiates like heroin, how the United States started prescribing more and more legal opiates, and how programs like drug courts and diversion programs are being used to treat the problem in Seattle. Chasing Heroin. (slfl)
posted by fireoyster (40 comments total)

God Bless Frontline.
posted by Going To Maine at 9:26 PM on February 23, 2016 [12 favorites]

We are watching this right now and making muttering noises.
posted by rtha at 9:35 PM on February 23, 2016 [1 favorite]

Interview with the director, by Jason Cherkis, who has done some of the best recent reporting on substance use.
posted by gingerbeer at 9:38 PM on February 23, 2016

I wanted to throw my remote through the television when they got to the part that all of the opiates can be prescribed as much as the doctor wants but a doctor can only have 100 patients per year under treatment for opiate addiction. I really, really hope there's another explanation.

(I live in Seattle and I really wish people across the city who are railing on forums like Nextdoor and the Seattle Times comment section would watch this. There are reasons why people are homeless and under bridges and getting into trouble to score their next hits. Just clucking tongues and demanding that the police chief run the RVs out of the north end isn't going to do anything.)
posted by fireoyster at 9:43 PM on February 23, 2016 [20 favorites]

No, that's correct. It is very difficult for doctors or clinics to provide either suboxone or methadone treatment. There's no other disease that we would tolerate those kinds of restrictions on the treatment for it. Only substance use disorder.
posted by gingerbeer at 9:54 PM on February 23, 2016 [11 favorites]

My earlier post from a different discussion:

Dr. Gabor Maté is chief physician of Vancouver British Columbia's legal supervised safe injection facility and detox, Insite/Onsite. He has stated that all of his female patients addicted to narcotics and involved in street prostitution were sexually abused as children.
posted by little eiffel at 10:21 PM on February 23, 2016 [7 favorites]

More background articles from PBS:

1. How the Heroin Epidemic Differs in Communities of Color

http://www.pbs.org/wgbh/frontline/article/how-the-heroin-epidemic-differs-in-communities-of-color/

2. How Bad is the Opioid Epidemic?
http://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic/

3. The Options and Obstacles to Treating Heroin Addiction
http://www.pbs.org/wgbh/frontline/article/the-options-and-obstacles-to-treating-heroin-addiction/

4. Eric Holder: If Sentencing Reform Dies, “I’d Be Ashamed”
http://www.pbs.org/wgbh/frontline/article/eric-holder-if-sentencing-reform-dies-id-be-ashamed/

5. Drug Czar: Treating Substance Abuse as a Crime is “Inhumane”
http://www.pbs.org/wgbh/frontline/article/drug-czar-treating-substance-abuse-as-a-crime-is-inhumane/

6. Watch a Cop’s Surprising Interaction with a Heroin User
http://www.pbs.org/wgbh/frontline/article/watch-a-cops-surprising-interaction-with-a-heroin-user/
posted by gingerbeer at 10:24 PM on February 23, 2016 [9 favorites]

The sad story of my past few years directly relates to this issue. My younger brother had an addiction to heroin while his girlfriend was pregnant. The substance creates such a tendency towards criminality that I believe it should be classified as schedule 1, controlled and dangerous.

Both of my parents were so affected that they chose to malign me as the opiate addict instead of him. This was hard for anyone to believe, as I was a vegan teetotaler studying graduate level physics, and willing to give a hair sample which always tested negative for opiates. Their denial, slander, and obfuscation still creates a rift in my family life.

Even stranger yet, I still receive online advertisements and telemarketing for opioid addiction counseling and rehabilitation services. I do not know how my email address and phone number were acquired for this purpose; but I suspect that the worst case scenario involves fraud and identity theft. On a social level, there is maleficent cognitive dissonance about this.
posted by MisplaceDisgrace at 10:25 PM on February 23, 2016 [5 favorites]

another take...
Death by Fentanyl - "It's 50 times stronger than heroin. So potent, three grains are lethal to an adult. First synthesized in the 1960s, it's been used to treat severe pain in cancer patients. Today, fentanyl has two main sources: the prescription drug industry, and Mexican drug cartels. And it's the quiet culprit behind the current 'heroin' crisis, one of the deadliest drug epidemics in American history."

interview with documentarians...
The Deadliest Opioid Of Them All – Fentanyl - "Over 5 times more people are dying from fentanyl right now in states like New Hampshire than they are from heroin and yet you see the presidential candidates out there talking about this opioid epidemic and treating it as if it was a surprise in many cases that this is happening. We've been covering this for so many years and we see the effect that it has on these communities and we've spoken to so many families like the Avitabiles, and yet it seems that we're once again behind the curve on this and we're talking about heroin when in fact it's fentanyl that is killing so many more people."
posted by kliuless at 10:40 PM on February 23, 2016 [7 favorites]

Don't know if his work is included in the show, but a key reporter on this subject has been Sam Quinones, who in his recent book Dreamland expertly describes how the two sides of the story – a) overprescribing legal opiates got everyone addicted, then b) black tar heroin from Mexico provided the same high, but was cheaper – are “capitalism run amok whose unintentional collision has been a catastrophic epidemic.”
posted by LeLiLo at 11:28 PM on February 23, 2016 [3 favorites]

Speaking of Gabor Mate, he discusses addiction and childhood abuse here.
posted by Rosie M. Banks at 4:36 AM on February 24, 2016 [3 favorites]

A mainstream medical friend in England specializes in getting people suffering from chronic pain off opiates, and where possible, manage the pain through counselling alone. While it's hard to tell a patient that they're going to be in pain for the rest of their life and they'll get the help they need to be okay with that, it's better than a lifetime of opiate dependence. Opiates may remove the pain, but they also tend to outsource the suffering on those around the user.
posted by scruss at 5:03 AM on February 24, 2016 [1 favorite]

...they chose to malign me as the opiate addict instead of him.
posted by MisplaceDisgrace at 10:25 PM on February 23 [1 favorite +] [!]

Eponypropriate?
posted by paper chromatographologist at 6:26 AM on February 24, 2016 [1 favorite]

Not for nothing, but I'm really tired of chronic pain users who are prescribed weak opiods like hydrocodone being told we need to suffer, oh but you can talk to someone who will make you feel better about those crutches and that wheelchair, because some other people became junkies after taking shit like oxy. I have debilitating tissue connective disorders. There is no cure. There is only temporary relief. I take, on average, 5 10mg pills a week, because I live in fear that the opiate panic is going to either push me into real pain meds, or force me to end up dying in unreal pain.

Not everyone who takes opiates is a junkie. Not all opiates are addictive. Not all people will develop addictions, and I'm am so ducking tired of people acting like a drug sold over the counter in many countries is going to turn me into a trick-turning heroin addict.
posted by SecretAgentSockpuppet at 6:40 AM on February 24, 2016 [43 favorites]

#notalljunkies

God Bless Frontline.

Abso-fucking-lutely.

PBS newsmagazine Frontline devotes two hours to exploring the massive rise in the abuse of street opiates like heroin

And yet, I feel like I've seen this particular "rise" headline every year for the past 30 years. I just read the review of Amy Winehouse's new documentary (where the hell is it? Slate? Salon? Atlantic? Here? Argh.), and it raises the excellent point of REHAB ALMOST NEVER WORKS, WHY DO PEOPLE KEEP CLUCKING THEIR TONGUES AND SAY OH IF ONLY SHE HAD GONE TO REHAB? Why is finding a cure for this epidemic so elusive?
posted by Melismata at 7:24 AM on February 24, 2016 [2 favorites]

They tried to make her go, but she said "no,no,no".
posted by dr_dank at 7:28 AM on February 24, 2016 [2 favorites]

SecretAgentSockpuppet, I wish I could favorite that more than once.

I wear a patch for pain relief. This patch is the difference between either missing work all the time, taking pills that wear off, and just generally being too tired and in pain to do anything, or leading an almost normal life. The thought of opioids for chronic pain being even more difficult to get is exhausting. Those of us who are taking them responsibly are drug-tested every few months, must see our pain doctors -- an appointment with whom is hard to get -- every three or so months, for which I must miss work, and must request our refill each time (in some states, on paper). It is plenty hard enough for responsible opioid users to get our medicine. Targeting this only makes it harder for those of us already exhausted by chronic pain to get relief.

And then think that that's only one medication that I'm on. I've got to deal with different doctors and different refill schedules for everything else, too.
/rant
posted by fiercecupcake at 7:37 AM on February 24, 2016 [11 favorites]

Seconding Dreamland as a great non-fiction book. Not technical or jargony at all. Just the story of how opiate addiction in America came to be, very well told.
posted by paulcole at 7:43 AM on February 24, 2016 [1 favorite]

Ah, here it is: I might have said "no" to rehab, too. Thoughtful piece about what addiction means.
posted by Melismata at 7:48 AM on February 24, 2016 [3 favorites]

A long but very good article about the author trying to help her uncle who is a heroin addict.

"On Heroin And Harm Reduction"

The author visits the Insite program mentioned above.
posted by narancia at 7:52 AM on February 24, 2016 [4 favorites]

Thanks for that article, narancia. That would have been me, had he lived.
posted by Melismata at 8:34 AM on February 24, 2016 [1 favorite]

While it's hard to tell a patient that they're going to be in pain for the rest of their life and they'll get the help they need to be okay with that, it's better than a lifetime of opiate dependence. Opiates may remove the pain, but they also tend to outsource the suffering on those around the user.

This is the kind of blanket thinking that will render efforts towards a reasonable goal--ensuring that only people with a continuing need for pain relief get these medications--into a nightmare campaign against the chronically ill. Prescription opiate dependence, in and of itself, is not the worst outcome imaginable.

The percentage of patients who develop addictions from their own legal prescriptions is lower than most people think. And I believe that many of those addictions could be avoided if (a) patients were screened initially for high risk of addiction (e.g., prior substance abuse) and (b) we provided some actual follow-up and care for that 50-something guy with the back injury who may not be able to go back to his factory job, rather than just handing him a bottle of pills and wishing him good luck.

So often opiate addiction seems to be a symptom of prior unaddressed trauma or of being superfluous in late capitalism. We can and should address diversion and provide substantial help for addicts who want it, but no one should kid themselves that these populations won't just move on to the next thing. And people with chronic pain will be the collateral damage.
posted by praemunire at 9:19 AM on February 24, 2016 [14 favorites]

narancia, I also enjoyed the article at n+1. Thanks.
posted by not that girl at 9:58 AM on February 24, 2016 [1 favorite]

I, too, would really hate to see chronic pain patients thrown under the bus in the name of ending addiction, even if there is now a "kinder, gentler war on drugs" (because White People!).

I'm anti-prohibition. Does making opioids illegal accomplish anything? I think decriminalization would be a good idea, with addiction being treated as a public health issue rather than a criminal one, the same as alcohol and tobacco addictions are now. The original Prohibition in the US did nothing but make huge profits for organized crime. Decriminalizing opioids would defund the cartels, turn addiction into a health issue instead of a criminal one, and chronic pain patients would not be left to suffer.

Counseling for chronic pain patients is a good idea, but not counseling as in "You are going to be in pain FOREVER. Suck it up, Buttercup!" That sounds cruel to me.

I do feel there should be more options in dealing with chronic pain - the guy with the back problem might be offered physical therapy first, and options for a more lengthy course of PT than is offered by many insurance agencies. Medical marijuana could be legalized in all 50 states. There is a middle ground between "No opioids EVER, if you're in pain, you'll just have to suffer!" and "Feel a twinge? Have some pills."
posted by Rosie M. Banks at 10:23 AM on February 24, 2016 [4 favorites]

As stated in the thread from earlier today about dental care, smarter health insurance policy would include better payment support for physical therapy and dental care. We have decent insurance through my husband's company but it only covers so many physical therapy visits and then no help if you continue visits. When my husband developed sciatica, the PT visits really helped him. Luckily, we were then able to afford paying for the rest of the recommended sessions out of pocket so he finished the treatment cycle. He didn't need pain meds after several weeks and by the end was in better shape and able to do most of the exercises at home.

Do people abuse physical therapy or overuse it? Why are insurance companies so stingy with paying for it? It solves problems for patients for the long term if they are allowed to complete the course of therapy so saves money for the insurance companies. I do not understand this at all.
posted by narancia at 11:18 AM on February 24, 2016 [3 favorites]

Speaking of Gabor Mate, he discusses addiction and childhood abuse here.
So glad to see this being addressed. 20 years ago, I remember working alongside substance abuse counselors who stuck mainly to the line that addiction was purely a 'disease', just a medical model of framing the problem. I understand that came from moving away from framing it as a moral failing, a weakness of character, thus destigmatizing users. But it seemed to do a disservice as well to ignore serious emotional causes and triggers*; like any mental health problem, there is a complex relationship between mind and body, mind and brain, and it's now known that trauma can physically alter the brain. There seems to be some hope, however, in the area of neuroplasticity, in which the brain can heal itself, to some degree, with rehabilitative strategies.

*which is definitely going to cause relapse if unaddressed
posted by GospelofWesleyWillis at 11:58 AM on February 24, 2016 [1 favorite]

scruss: "A mainstream medical friend in England specializes in getting people suffering from chronic pain off opiates, and where possible, manage the pain through counselling alone. While it's hard to tell a patient that they're going to be in pain for the rest of their life and they'll get the help they need to be okay with that, it's better than a lifetime of opiate dependence. Opiates may remove the pain, but they also tend to outsource the suffering on those around the user."

I don't think it's right to deny someone who IS capable of using opiates responsibly the right to take them as prescribed. I worry when I hear this as a sort of stigmatizing of all opiate users and doesn't help further the process of respect for them as individuals. I can't speak for all traits of an addict, and I'm sure there are some very dark traits, but certainly the crime associated w/heroin can be decreased to some degree by maintenance management.
posted by symbioid at 12:10 PM on February 24, 2016 [2 favorites]

A mainstream medical friend in England specializes in getting people suffering from chronic pain off opiates, and where possible, manage the pain through counselling alone. While it's hard to tell a patient that they're going to be in pain for the rest of their life and they'll get the help they need to be okay with that, it's better than a lifetime of opiate dependence. Opiates may remove the pain, but they also tend to outsource the suffering on those around the user.
posted by scruss at 7:03 AM on February 24

I'm sorry, but I would much rather have a lifetime of opiate dependence than being told to manage my pain through counseling, and this is not a hypothetical question for me. Also, trust me when I say that my suffering from being in pain is more stressful to my loved ones than my being able to live a decent life.

Not everyone who uses opiates, even for extended periods of time, falls down a slippery slope toward Requiem for a Dream-land. Actual studies have been done that prove this. The number of people who end up off the deep end is quite small compared to the number of people who can take opiates responsibly and for whom they can improve quality of life rather than destroy it.
posted by fiercecupcake at 12:25 PM on February 24, 2016 [11 favorites]

I'm sorry if my comment raised a nerve. My friend's work is not in any way “No Opiates for you, Future Junkie!”, but rather for those who cannot, or no longer wish to, use them for pain management. As usual, I assumed a bunch of detail that you couldn't have known about, for which I apologize.
posted by scruss at 1:18 PM on February 24, 2016 [1 favorite]

NPR: Can Baltimore Provide Addiction Treatment On Demand?
posted by ChurchHatesTucker at 4:07 PM on February 24, 2016 [1 favorite]

-Ithaca Mayor Wants To Allow Heroin Addicts A Safe, Supervised Space To Shoot Up
-U.S. Agriculture Secretary Tasked With Tackling Rural Drug Problem
-Fighting poverty and opiate addiction in rural communities
posted by kliuless at 5:16 PM on February 24, 2016 [1 favorite]

Do people abuse physical therapy or overuse it? Why are insurance companies so stingy with paying for it?

Do the insurance companies have an interest in moving pills?
posted by maniabug at 12:09 AM on February 25, 2016

Maybe someday soon, heroin will be known as a minor potentate in the opiate receptor morality plays. Maybe that day has already arrived. Everything We Know So Far About W-18, the Drug That’s 10,000 Times More Powerful Than Morphine (and 100 times more powerful than fentanyl.)

To understand much more about what's happening with Chinese research chemical companies, check out Mike Power's Drugs 2.0: The Web Revolution That's Changing How the World Gets High. Synopsis: the Chinese are getting ahead of the rest of the world by figuring out that it's not about drugs, it's about brain receptors.
posted by telstar at 12:03 PM on February 25, 2016 [2 favorites]

NPR: Treating Addiction As A Chronic Disease
posted by ChurchHatesTucker at 5:49 PM on February 25, 2016

Six Dangerous Falsehoods Peddled by the “Frontline” Heroin Special
posted by telstar at 4:36 PM on February 26, 2016 [2 favorites]

Why Isn't America Doing the One Thing That Would Reduce Heroin Deaths Right Now?
posted by homunculus at 6:23 PM on February 26, 2016

Harm Reduction Drug Policies Are Gaining Momentum Across the Country
posted by homunculus at 6:24 PM on February 26, 2016 [1 favorite]

I seem to be having a different mental conversation than some of the participants here.
If you have chronic pain, why would there be any hesitation in giving you opioids if they help? Why not up the dose if you develop a tolerance? What is the badness of an "addiction" if the dependency allows you to avoid pain and have a better life. Why is there even a question about this?

I can acknowledge there is seeking behaviour and addicts with purely recreational (self medicational?) ends in mind, but the idea that our society's disapproval of addicts impacts legitimate users of strong pain relief is outrageous.

I say this as a person who has lost friends to heroin and had family members struggle with it - I am very aware of the dangers of street opiates. I still can't understand why we would seek to restrict access to people who could benefit from regulated opiates.
posted by bystander at 5:31 AM on February 27, 2016 [2 favorites]

Oh, and a great film from Frontline. I rarely watch video links, but this was excellent.
posted by bystander at 5:32 AM on February 27, 2016

Excellent questions, bystander. What is so alright about the dozens of hard-liquor stores around where I live servicing thousands of open, legal (and sometimes deadly) addictions, but so forbidden about people who want a less damaging alternative to pain relief, such as opiates? Why, in light of the fact that these same hard-liquor outlets will sell you all the proven-deadly tobacco cigarettes you want, are opiates (and other alternative painkillers) so forbidden? The answer, my friend, is blowin' in the wind.
posted by telstar at 12:40 PM on February 27, 2016