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Culture War Roundup for the week of February 14, 2024

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EDIT: Looks like I screwed up the math and chart stuff and it's all kind of weird. CDC says drug overdose is .32% of deaths, but that doesn't jive with their listed number of deaths in 2023, off by an order of magnitude. I'm wondering if deaths have more than one listed cause, or if some set of these numbers are projections or something.

As to why we won't talk about this more: We've talked about the opioid epidemic a lot, which is what this stat is about. 20% of opioid deaths are on prescription meds, and as far as I can tell the large majority of fentanyl users started with prescription opioids and then switched to fentanyl when they could no longer obtain/afford their growing addiction to prescribed meds.

Basically, you can't solve this problem without majorly overhauling the US healthcare system, which is a political quagmire that has been swallowing careers and movements whole for decades (Hillary Clinton started her political life as First Lady pushing for healthcare reform, and it didn't accomplish any more then than it has now).

Sure, you can imagine a world where you lock down the borders enough to stop all imported fentanyl (although the link to immigration is an obvious misdirect, imported drugs tend to come over sea borders and ports not the Mexican land border, and the programs to find caravans of people vs suitcases of drugs are completely different). But we import it because that's cheaper, not because it's the only way... US criminals are well capable of making their own fentanyl to sell if other supply lines close up.

You have to stop demand, which means fixing the prescription opioid epidemic, which means massively overhauling much of how we think about healthcare and the entire healthcare and insurance industries. That's disruptive, expensive, and politically difficult... not to mention opposed to the interests of a lot of rich capitalists. So, good luck on that.

You have misplaced the decimal point. 112000/3500000 = 0.032 which is 3.2%

Hmm yeah. That's weird, I thought it was right because the CDC also says .32%. Don't know where the discrepancy is then, unless it's that deaths can be listed as having more than one cause?

I'm seeing

The age-adjusted rate of overdose deaths increased by 14% from 2020 (28.3 per 100,000) to 2021 (32.4 per 100,000).

but 32.4 per hundred thousand is 0.0324 %.

I think that the issue is that CDC is dividing (overdose deaths this year) by total population, but we are trying to get a feel for the meaning of the number of overdose deaths by doing the calculation

(overdose deaths this year) divided by (total deaths this year)

We are pondering: people are always dying, what proportion of deaths are overdose deaths?

One anticipates that (total population) divided by (total deaths this year) roughly approximates life span, so 70 or 80. But the ratio is more like 100. Err, I'm seeing in other calculations that (total population)/80 over estimates (total deaths this year) by quite a lot. Total population is around 334 million, total deaths for 2021 3.4 million. The ratio is surprisingly (confusingly?) close to 100.

Yeah I think that makes sense.

The US has around 3.5M deaths per year, 112K/3.5M=.32% of all deaths, pretty straightforward.

3.2%

EDIT:

Also, looking at the graph, on first glance it looks like overdose deaths spiked during Covid lockdown, and are already dropping quickly.

Are we looking at the same graph (Figure 1a. 12 Month-ending Provisional Counts of Drug Overdose Deaths: United States)? That apparent downward trend has the note "Underreported due to incomplete data", and the predicted value of deaths is holding steady at 110-112k.

EDIT2: @guesswho (do pings work in edits?)

EDIT: Looks like I screwed up the math and chart stuff and it's all kind of weird. CDC says drug overdose is .32% of deaths, but that doesn't jive with their listed number of deaths in 2023, off by an order of magnitude. I'm wondering if deaths have more than one listed cause, or if some set of these numbers are projections or something.

Still not sure where you're getting .32% from. From their first paragraph, 0.032% (32.4 per 100,000) of people died of overdose deaths (mostly opioid) in 2021. If you round it off to 1/100 people dying each year, it adds up to 3% of deaths.

I'm looking at this graph which runs from 1999 to 2021 and depicts a terrifying rising trend.

I wish someone would explain what’s up with my math and 3% rate. My extrapolation feels right but something not jiving with the lower percent of deaths.

I don’t buy the prescription opioids to fentanyl theory but can’t prove it. Any user I know of (young people) don’t have any reason for pain meds. Even someone I’m thinking of who did prescription meds was also just in the scene and doing both. If anything it would feel like an adderall as a kid to party scene pipeline.

“People who overdose on drugs don’t have long lifespans” - obviously because they died from an overdose. Absent substance abuse a 24 year old drug overdose would have lived to old age. There isn’t an underlying medical condition that would have killed them young absent.

I’m not sure what health care reform has to do with substance abuse. Data I have seen already have Americans doing more prescription drugs so better health insurance/single payer and more money spent on health care wouldn’t seem to shrink the amount of pharmaceuticals American are using. Now if you meant targeted reform like stricter limits on prescribing then it would likely do some good.

PO->fentanyl pipeline I was getting mostly from personal observations plus common sense, but also backed by this paper. Though that paper isn't only about fentanyl so maybe it's not a strict majority for fentanyl itself.

For healthcare I can imagine a variety of policies including stricter prescription control, but really I'm thinking about something bigger than that.

I suspect that a lot of things we prescribe long-term pain meds for could be treated with combinations of things like rehabilitative therapy, biofeedback therapy, various surgeries, personal trainers to maintain overall health, etc. And a lot of things that do need pain meds could be prevented from turning into a long-term addiction with close monitoring by a doctor or nurse to test whether patients still need the meds and help them taper off slowly while using exercise/rehabilitation to recover promptly.

(obviously not all chronic pain conditions are like that, but I wouldn't be surprised if 60% of long-term opioid cases could be resolved with something in these genres)

The problem is all of that takes expensive one-on-one care and treatment by a variety of professionals, as well as some type of personal relationship with medical providers where they remember your name and your issues and are forming and executing long-term plans to work through them with you, and all of that is both more expensive than pills and not the way the system wants to be designed. The system is very much geared towards insurance only supporting the cheapest treatment in the short-term, which is normally pills, and in having an atomized care model where you get 15 minutes with your doctor and they follow a checklist to prescribe you something and then your relationship with them is over and you have to start from scratch if you want another appointment.

I really think the opioid epidemic in large part stems from opioids maximizing metrics that the modern healthcare and insurance industries judge themselves by - it 'solves' a ton of problems at a fairly low cost with very little physician time spent and no expensive in-care facilities needed. I think we could improve this and a lot of other medical problems if we weren't so focused on those metrics, but that would require really fundamentally changing the way the whole industry works.

The problem is all of that takes expensive one-on-one care and treatment by a variety of professionals, as well as some type of personal relationship with medical providers where they remember your name and your issues and are forming and executing long-term plans to work through them with you, and all of that is both more expensive than pills and not the way the system wants to be designed.

Not to mention a tremendous amount of personal discipline, faith, and ability to work through pain for years and years. Trust me, as someone who has done PT and put in over ten thousand hours into stretching/exercise to deal with chronic pain, it is brutally difficult. Easily the most challenging thing I've struggled with in my life.

I wish someone would explain what’s up with my math and 3% rate. My extrapolation feels right but something not jiving with the lower percent of deaths.

3.2% is correct. His .32% was either a typo or a calculation error.

Now if you meant targeted reform like stricter limits on prescribing then it would likely do some good.

I think this experiment has already been tried. Opioid prescriptions are the lowest they've been in decades, down 50% from 2010. Curiously, the downward trend in prescriptions coincides with the upward trend in opiate ODs

https://thegarrisonproject.org/wp-content/uploads/2022/02/opioid-prescribing-1400x788.png

https://drugabusestatistics.org/wp-content/uploads/131/opioid-prescriptions-and-opioid-overdose-deaths.png

Wouldn't be surprised if the short-term and long-term trends are different here - cracking down on prescriptions while tons of people are addicted will force them to look for non-prescription opioids which are more dangerous, but in the long run it may reduce the number of people who get addicted in the first place.

as far as I can tell the large majority of fentanyl users started with prescription opioids and then switched to fentanyl when they could no longer obtain/afford their growing addiction to prescribed meds.

This is another drug warrior talking point. It's probably true, but the main study in support of it I have seen (with heroin, not fentanyl) includes a small detail which the drug warriors generally fail to mention: the prescription did not belong to the eventual street drug user.

Yes, this is correct, the media image (as seen in Dopesick and the Netflix version of it) of legal oxy prescription > illegal oxy purchasing [ > heroin ] > fent is extremely unusual. Most oxy prescriptions are to older people who aren’t taking taxis from retirement homes to buy fentanyl on Sunday afternoons in any great numbers.

Purdue and others were right that opioid abuse and the fentanyl epidemic is overwhelmingly because stupid children and family members stole legitimately prescribed opioids from relatives and then, when grandma didn’t get any anymore because she died or recovered from her fall, they search for an illegal equivalent. Then they sell or give various drugs on the way down to their friends or acquaintances, exacerbating the problem.

Every year millions of competent, middle class and above Americans get prescribed opioids for pain management, do their prescribed course and move on with their lives without incident. The Sacklers were just unlucky that a combination of grifting pill mill doctors (among the greediest professions in America) and feckless underclass communities cost them their reputation.