[notmytarga]

I have read the book Dreamland and heard the author speak. Impressive coverage of a complicated tale. Pharmaceutical marketing of OxyContin as not addicting was bolstered by a letter to the editor which reviewed hopital data and said addiction to opioids is uncommon. This reference was bandied about like it was a multicenter research paper.

OxyContin (long acting oxycodone) was prescribed in greater and greater numbers. Unscrupulous and/or stupid doctors started writing prescriptions for cash and had patients waiting in line. These were/are the Pill Mills that are being rooted out even today. Hotel rooms and Pill Trucks are used these days. Medical Boards are yanking lisences but it takes 2-3 years for this to happen. Opana has been taken off the market because it was the preferred medication to alter and inject in one community where HIV infections spiked. Drug companies are on a race to create pills that are difficult to alter and snort or inject or simply don't have a "liking" effect. These mediations are actually tested in federal lockups on addicts to assess these features.

Heroin enters the picture - brought in from a small enclave in Mexico instead of the Far East as before. Dealers are driving around in cars, using coded cellphone from an organizer for meetups. Black tar heroin is put in balloons so it can be swallowed if law enforcement gets involved. Violence is discouraged, these are not gangs. This system spread from city to city. The book covers all this from interviews and investigation.

The current overdose epidemic, as previously mentioned, is largely from fentanyl made in China and shipped via normal carriers to the US. It is so cheap, potent and concentrated that it is mixed with heroin for more effect and made into counterfeit pills of all sorts. There is not a pharmaceutical purity practice as this happens and dosing has tremendous variability. Consider the user that gets a low dose - unhappy. High dose - happier. Too high - dead. What does the crank supplier shoot for? -
the highest dose that doesn't kill all his customers. Fentanyl can be purchased cheaply and cut to the point where it is 1000 times profitable. The USPS has failed to comply with requirements to track package sources to allow the source of fentanyl shipments to be dealt with.

That being said there are scores of people who appropriately use these medication prescribed by their doctor. Some prescribers do it poorly and give the patient more than is needed - perhaps this feeds the opioid diversion or just reassures the patient that they won't run out. Many family practice doctors are sending their long term opioid patients to pain management practices to avoid the hassles and oversight that threatened their livelihood and freedom.

Being an addict means going through rediculous or dangerous or illegal hoops to get a substance with significant deleterious effects on relationships with crime, unemployment and/or health problems occuring. "Opioid Use Disorder" is a term that describes some of these 'preaddicted' patients.

Many changes have occured of late. Prior to prescribing, state databases are checked to confirm dates, amounts and other prescribers. Urine or saliva tests are done to look for other substances and to see if the patient is taking the prescribed medication. Pill counts are randomly done to confirm appropriate daily use and detect diversion. This is the type of medical practice I am in. We monitor medications if they are appropriate and evaluate patients for painful locations that can be treated with anesthetics, steroids and heat probes in order to improve function and reduce reliance on medications. An majority of these patients have spine pain. We essentially never increase opioid prescribing and see some referrals with ridiculous high dosing occasionally.

If the pill mill, heroin story interests you:Dreamland by Sam Quinones - no affiliation.