I just read Dreamland, which talks about the opioid crisis in US.
The book talks about (chronic) Pain Managment before all the (addictive) "wonder" drugs showed up. Apparently there were Pain Clinics (univ of washington model) that had a multi disciplinary approach(not purely drug based) to pain managment that seemed to be working. No life long addiction and ever increasing issues. But that initial one time cost was more than the cost of pills. So Insurance Companies just stopped covering that as an option. Result was those clinics shutdown and the only option most people were given were pills. They get addicted. Pharma companies profit multiply. Wall St is happy. Those who run out of cash for pills turn too and prop up the drug cartels. What is sad is once everyone starts profiting breaking out of the pattern for all parties involved gets harder and harder.
It’s not helpful to think of most pain clinics as fundamentally interested in treating chronic pain. Rather, these pain clinics were an experiment with de-facto legalization of opioids for recreational use. Just like you used to be able to see certain doctors in California for a “medical” marijuana license under dubious pretenses (“I’m having trouble sleeping”), you could walk into a pain clinic and get legal opiates (“My back hurts no matter what I do”). It turns out that legalization of opiates is a disaster.
>Those who run out of cash for pills turn too and prop up the drug cartels.
You're kind of missing a key step when you frame it that way.
People were mostly fine with their low level addictions until they got cut off by either the knock on effects of the ACA or the feds reigning in the prescribing of opiates causing their doctors to cut them off. Only then did they turn to the streets.
These opiates aren’t health to consume over long periods of time even at low dosage. Fentanyl for instance was meant for end of life care where there was an expectation that the patient wouldn’t be around much longer.
Fentanyl, to me as a paramedic, has a great use case - it's extremely effective for a generally short time, when administered IV.
Broke your leg coming off a horse and I need to transport you to hospital in an ambulance down a bumpy road? Perfect. This will make you vastly more comfortable, and as we are getting to the hospital, we/they can transition you to "better" pain management solutions as they deal with the underlying problem.
>These opiates aren’t health to consume over long periods of time even at low dosage.
Neither are McDoubles. The point is that these people were mostly holding down jobs and being productive and positive contributions to society before they got cut off, not that it was healthy.
The book talks about (chronic) Pain Managment before all the (addictive) "wonder" drugs showed up. Apparently there were Pain Clinics (univ of washington model) that had a multi disciplinary approach(not purely drug based) to pain managment that seemed to be working. No life long addiction and ever increasing issues. But that initial one time cost was more than the cost of pills. So Insurance Companies just stopped covering that as an option. Result was those clinics shutdown and the only option most people were given were pills. They get addicted. Pharma companies profit multiply. Wall St is happy. Those who run out of cash for pills turn too and prop up the drug cartels. What is sad is once everyone starts profiting breaking out of the pattern for all parties involved gets harder and harder.