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Opioids – you have no idea.

Two people very close to me are on the front lines of the opioid disaster.  Working in ERs and ambulances in the northeast, they see – multiple times every day – how bad it is.

You have no idea.

The toll this is taking is wide, deep, and devastating.  Some public safety workers are burning out, beyond frustration and anger to a place of fatalism.

Yesterday an unconscious woman was admitted after her kids told their dad she was taking a nap on the kitchen floor.  The nap was induced by a very heavy dose of benzos on top of heroin; when dad came home from work – he’s a public safety worker too – she was unresponsive.

Revived with a hefty dose of Narcan, the woman “justified” her dosage as needed due to some unspecified mental trauma.

This one example is playing out multiple times every day for every ambulance crew, in every ER, in every neighborhood.  NPR’s morning news greeted me with a piece about elephant-tranquilizer Carfentanil, a made-in-China chemical that is exponentially more powerful than fentanyl, which is exponentially more powerful than heroin.  Now spreading rapidly thru Ohio, Florida, and the midwest, carfentanil will soon find its way into your town.

If you think I’m being alarmist, you’re wrong.

Here’s how this is impacting us today.

  • parents are dying in front of their kids.  who’s going to take care of those kids, and prevent them from following in their parents’ tragic footsteps?
  • To some public safety workers, Narcan is NOT saving lives, it is a Get-Out-Of Jail-Free card, allowing users to “safely” push the limits of dosing in their quest to get ever higher ever longer.
  • opioids may soon be replaced by drugs such as carfentanil.  Why grow poppies when you can just order this pill from a chemical factory in China?
  • Public safety workers are at the end of their ropes.  How can they not be white-hot with anger at users when confronted several times a day with parents “justifying” their using after being revived with Narcan.

This started with legitimate “prescription” drugs pushed by pharma companies making billions.  Make no mistake, these bastards are the ones who started the ball rolling, a ball that has gotten ever-larger and is crushing more and more of us as it picks up momentum.

The great late David DePaolo penned a piece on Purdue just days before he died.  It’s well worth reading, and remembering.

But the disaster unleashed by Purdue and their ilk is way beyond what any of us thought it would become.  As powerful and necessary as the Surgeon General’s letter to physicians is, it is so, so late.

Will this epidemic be solved by public health measures far greater than anything we’ve thought of or funded to date, or, like smallpox among Native Americans or the Plague in Europe, is it fated to burn out only after it kills most users, leaving no one else to infect?

Have a great weekend.

12 thoughts on “Opioids – you have no idea.”

  1. I’ll say it again. Unless and until we punish the executives at big pharma for incentivizing doctors to push more and more opiates on their patients the way we do other drug kingpins, this epidemic will never end. Innocent people who have no idea they’ll become an addict may in fact become addicted after a legitimate injury for which they are over prescribed opiates. I think there is potentially a never ending supply of victims. So we must prosecute big pharma or risk everything.

  2. Let’s not forget that these doctors have a choice to educate themselves and they have the option to tell Big Pharma they don’t want their incentives. Prescribing medical professionals were and are on the ground floor of this epidemic and we need to redouble our efforts to make sure they are held to their share of accountability.

    1. I agree with you Fred – the prescribing medical professional has taken the oath to “first do no harm”. They are responsible for making the medically appropriate choice to prescribe a short term narcotic. Further, the treating professional is not a puppet of big pharma; they are the advocate of patient health and safety. Let’s help our doctors stay educated and informed.

  3. Having lost a family member last year to a heroin overdose (he escalated from opioids) I can attest first hand to the devastation. He left two young daughters behind.

    Doctors are killing people by needlessly prescribing drugs and addicting their patients. When they can’t get the drugs anymore they hit the streets in search of heroin.

    When the workers’ compensation tradeshows have drug rehab centers buying booths… you know things are out of control.

  4. Joe,
    It is still shocking to me that the feds do not try to control oxy while keeping marijuana as a schedule 1 drug. With that status goes all of the medical research on using marijuana derived drugs in lieu of oxy. GW Pharma of the UK markets such a drug called Sativex. It is approved for use in much of Europe. The presentation that I saw indicated that it has better pain relieving properties than oxy, is not addictive, and costs about 75% less than oxy. This situation OK is the result of bad government decisions.

  5. One thing that is left unsaid is why there are people, mostly white, rural folks who are taking heroin, as is happening in many states, including the one governed by that Archie Bunker of Lobsterland.

    The despair these people are dealing with is not coming from big pharma alone, but big business, corporate America, who has shipped their jobs overseas for greed and greater profit.

    The fault, as Shakespeare said, is not in our stars, but in ourselves, our economic system, our political system, our outmoded 19th century values about wealth and power, and all that it brings to those it crushes under its heel.

    Back then, the “drug” of choice was alcohol, and then opium, which was sold openly and prescribed for all sorts of ailments and afflictions, so that many white, middle class men and women were usually high, and the blue collar workers were drunk.

    The company coffee break ended the drinking problem and a sober workforce was born that launched the US to the top of the economic ladder. Laws against opium and other drugs did the same, and the Pure Food and Drug Act played a part.

    But today, with globalization and automation disrupting and eliminating jobs, and one political party’s mantra of taking the country back (to the 19th century, economically speaking so that their rich friends get richer), will only make things worse.

    Big pharma is one aspect, doctors another, but the free market, profit-making machine called Capitalism has struck again in this century liked it did in the 19th, and this nation is the worse for it.

    We must stop these greedy bastards and put people back to work, blue collar and white collar, and damn Wall Street and their greed. That’s is how you end this vicious drug cycle.

    1. Yet noting about personal choice and responsibility. I would agree that those who prescribe have a significant role, but those who ask for these drugs, where is their responsibility to use as prescribed? Do they really have 10/10 pain 20 years later? This is not us against them debate. at each level there must be a fundamental change. Not every sprained ankle needs opioids. Not every low back strain needs a benzo. But every one leaves with multiple scripts and they wants the max and not what is indicated. When do we blame plaintiff attorneys when they send their clients to those providers who over treat? You simply cannot point a finger at a legitimate business, or an entire profession and place the blame, that is way to simplistic.

  6. Decades in the making and as always; now we need an instant solution. Blame will not solve the problem; we need a focused nationwide movement to bring this to an end, stop the prescriptions and detox and rehab the addicts. Our society has for some reason created an environment where people need to numb themselves to their perceived reality. The reason for this is difficult to ascertain and the solutions very difficult as they require focus and persistence, something which our society has lacked as we prefer ‘bandaids’ that look good over a ruptured artery and then move on to the next problem, or we focus on problems that aren’t really problems and ignore the reality. This is going to get very ugly before anyone even starts to lift a finger to solve the problem.

    1. Tony – thanks for the note.
      I’d agree that blame will not solve THIS problem, but placing blame will
      a) ensure those bastards are prosecuted for mass murder
      b) enlighten others as to the consequences of less-than-diligent drug approval processes
      c) encourage us to remember that the explosion cannot be put back in the bomb, so we damn well better be sure before we drop that bomb in the future.

  7. Joe,

    Thank you for being clear and blunt! Not all of us should be locked up for our actions or callous lack of action but that doesn’t mean we can’t start locking up a few! Everyone of us has a responsibility here–there is no room for “not my problem.”

  8. Well said. We as a country worry about the dealers on our street corners or dealers coming over the border – but the ones at home doing it legally and under license are actually killing and addicting more people. People choosing to use the drugs also need to have some self-accountability and coping skills, which have obviously diminished in our society for various reasons.

    An old post I did on this subject that still blows my mind.
    Eighty percent of the world’s opioid prescriptions are taken in the US, yet we make-up just 4.6 percent of the world’s population (2011). That means we’re consuming 83 painkillers for every one pill the average person takes around the world. I guarantee we are not the spot in the world with the most pain. That means less than 1 out of 83 prescribed pills is likely really needed. Scary.

    It is a real problem and it isn’t going to go away on its own.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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