76 Billion Pills

This is a stunning piece of reporting in the Washington Post:

America’s largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control, according to previously undisclosed company data released as part of the largest civil action in U.S. history.

The information comes from a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city. The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.

Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; ­Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

I’m assuming most people are like me, who have used pain pills like these, but mostly after a major incident or surgery. I have not been prescribed a pain pill since my shoulder accident and surgery, and that was in 2009-2010. Prior to that, I don’t remember anything for at least a decade. So over the course of a 20 year period, I was probably prescribed 100 pills, if that. And again, I am assuming that most people are like me or have had even fewer scripts. Then you have chronic pain sufferers, who obviously need the meds. But again, I would suspect that while there are probably more people you know who have consistent chronic pain, it is nowhere near accounting for this number of pills.

You also have to take into account how people deal with pain. My shoulder hurts every single day. At least 2-3 times every night I wake up with it locked in place, causing sharp stabbing feelings until I can slowly move it and loosen it up and fall back asleep. I’m eventually going to have another surgery to deal with it. But there are a number of reasons why I don’t ask for or take anything for it, not even otc stuff. I have an addictive personality, I am already an alcoholic, so I just don’t think it is wise for me to introduce a powerful narcotic into my daily life. Second, I don’t like how they make me feel. I feel groggy and cloudy (I remember brushing my teeth with soft soap a couple of times confusing it with toothpaste), I get a horrible histamine effect after a couple days and am itchy and sweaty, they make me constipated, and I found after surgery years ago they don’t actually make the pain go away so much as just get me stoned so that I am not focusing on it. Third, I don’t NEED to be pain free. I’m not digging ditches or lifting boxes for a living- were I exposing myself to that sort of labor every day, like, say, a coal miner with a bad back or an auto worker with bad knees, I might think differently. Fourth, I have found that other things help more- a hot shower, stretching, etc. Finally, and I guess this is just me, but life isn’t pain free. I’m almost 50. I’ve fallen off roofs, been through windshields twice, fallen off of tanks, slipped on ice, beaten up in street brawls, hit over the head with a bottle, played contact sports for two decades, etc. Some things are just going to fucking hurt no matter what I do.

Having said all that, I still find the number of pills to be MIND BOGGLING. The geographic distribution is interesting, too:

Again, that is pain pills PER YEAR. That can not all be explained away by manual labor and populations that have higher numbers of dangerous vocations. It appears (and I am just making shit up here- I have nothing to back this up) that pain pills were dumped in places in lieu of social policies. Again, just amazing.






111 replies
  1. 1
    Jerzy Russian says:

    Interesting map. Since the colors are pills per person per year, there is less bias towards densely populated areas. I wonder what is going on near California’s eastern border, especially near northern Arizona. Who knew the Grand Canyon had this problem?

  2. 2
    Aleta says:

    “That can not all be explained away by manual labor and populations that have higher numbers of dangerous vocations. It appears (and I am just making shit up here- I have nothing to back this up) that pain pills were dumped in places in lieu of social policies.”

    Yeah, I imagine they are also used for psychological pain and are a very bad remedy for that horrible pain that is often ignored, laughed at, dismissed or overlooked.

  3. 3
    J.A.F. Rusty Shackleford says:

    It looks like a regional pastime for the folks in Tennessee, Kentucky and West Virginia.

  4. 4
    laura says:

    Spouse had rotator surgery for his bike accident and was prescribed oxy for pain. Didn’t fill the scrip and relied on the ice water circulator instead and the nerve block that lasted a couple of days post surgery.
    I went to the doctor complaining of: sleep disrupted by hot flashes – hydrocodone 100 count, stress related jaw clenching – hydrocodone 100 count, a unexplained itching for a few weeks, hydrocodone 100 count.
    Spouse had hip pain from being an old runner, hydrocodone – 100 count.
    We got 5 bottles of hydrocodone on the cupboard. Neither one of us is willing to take one single opiod pill and were and continue to be stunned by the casual dispensing of a drug we’d never consider messing with. 100 pills at a time. I swear it seems like dispensing loaded gun for things that would warrant a much more limited medical response. How could you possibly avoid dependency when given such huge quantities of these dangerous drugs?

  5. 5
    Nicole says:

    And the pharmaceutical companies were lying about the pills from the very beginning, as I recall. They claimed the pills were slower-releasing, or lasted longer, or something that made them sound like a better option and doctors believed it.

    I was prescribed Percocet in my late 30s, after a fall from a horse (okay, technically a throw from a horse) that left me pretty banged up. The doctor stressed the pills were only to help me sleep (I was in so much pain I couldn’t roll over). The first night, it was like I touched the face of God. I woke up feeling great, and couldn’t wait for it to be bedtime and realized that was a bad mental place to be at 6:30AM. But the second night was okay, not a religious experience like the first, so after 3 days, when I’d healed enough to gingerly roll over on my own I was done.

    Had the same experience the first time I took Valium, in my mid-40s after cancer surgery. Face of God on the first night. Did not have the same experience the second night and didn’t finish the prescription. But I can see how it can be very tempting to try to keep chasing the dragon, because I have very, very fond memories of those respective first nights. And when Pharmaceutical is so eager to make a lot of money very quickly, and doctors are pressured to get patients in and out as soon as possible, human lives lose their value.

  6. 6
    Mart says:

    I am thankful that along with my addictive personality I am allergic to natural and synthetic opiods. Every surgery I tell the Docs, and they still prescribe as its all they have. I now ask the pharmacist if the drug has oplods, and if so skip picking up. I have less pain when I do not take the pills.

  7. 7
    hells littlest angel says:

    The Velvet Underground’s “Waiting For The Man” was originally written as a country and western song. Given the apparent popularity of opioids around the Nashville metro area and beyond, they really blew their chances of having a number one single and gigs at the Grand Ole Opry.

  8. 8
    Nicole says:

    @laura: That’s mind boggling; that the doctors prescribed 100 pills at a time! Acute pain after an injury or surgery is a textbook example of when those pain pills are appropriate for prescription, but they’re supposed to be short-term us; definitely not 100 pills’ worth.

    I mean, cancer patients and those who are terminal, I can see wanting to make sure they always have them on hand, especially if they live a ways away from a health clinic or pharmacy, but after surgery with recovery expected?

  9. 9
    Mandalay says:

    @Jerzy Russian:

    Interesting map.

    Indeed. The purity of South Florida is a thing to behold.

    We don’t need no stinking pills down here to mess us up. We’re there already.

  10. 10
    Alan says:

    76 billion pills over six years sounds bad. However, some back-of-the-envelope math: 8% of the Americans have high-impact chronic pain. 8% of America x 4 pills/day x 365 days x 6 years = 230 billion pills. And that’s less broken bones and root canals and shit. It sounds like a lot, but for people whose quality of life is dependent on pain meds, “one pill every 4-6 hours” really adds up.

  11. 11
    Ohio Mom says:

    @Nicole: Your story reminds me of my late uncle’s experience when he was given morphine once in the emergency room, what the occasion was, I don’t remember.

    His face positively glowed when recounting this blissful experience. I think he considered it a high point of his life. But he never went searching to recreate it.

  12. 12
    Gin & Tonic says:

    @Nicole: I’m trying to recall how many I was prescribed after I broke my arm, but I’m damn sure it wasn’t 100.

  13. 13
    Fair Economist says:

    The spottiness of the map shows there are a few highly problematic doctors/local cultures. There need to be some investigations there. I suspect the larger counties in the West are hiding some similar situations.

  14. 14
    FlipYrWhig says:

    If only the people of Kentucky had a high-profile politician to whom they could turn for solutions to their devastating crisis.

  15. 15
    acallidryas says:

    Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post.

    This might be a question for David Anderson, but given the monopolistic nature of, well, everything in the United States right now, I’m curious how this compares to most medications? What I mean is, is it that these six companies were particularly complicit in pushing opioids? Or is it that this is where 75% of scrips are filled?

  16. 16
    Michael Cain says:

    @Jerzy Russian: While not perfect, there’s a general correlation when you compare this map to ones showing change in median household income. For example, the dark county in central-ish Utah is Carbon County where shutting down coal-fired plants and associated coal mines has had a cascade effect through the local economy.

  17. 17
    The Moar You Know says:

    Wife’s cousin is a firefighter/EMT in Ohio. He is rather opinionated about opioids.

    Now I see why. He’s been working Ground Zero the whole time.

    Of course, after losing my best friend to them in 2008, so am I.

    I’d like the people responsible for this to be bankrupted, flogged and dragged through the streets, but on another level it doesn’t matter. They can’t give the world back the lives that were lost, and the souls that are gone even though the people live on (for those of you who’ve known someone who has survived serious opiate addiction, you will know what I am talking about. Their bodies live, but they’re fundamentally gone.)

  18. 18
    Ruckus says:

    Three different opiods have been prescribed for my condition. Not pain pills but opiods that control certain things. They don’t work for me at all, on the issues. But they do have serious side effects that make the original problem seem, well better. It isn’t but I’d rather suffer than take the only meds that exist, don’t work and fuck me up.
    I don’t have an addictive personality and so can not feel those issues on a personal level but I can certainly see the effects of them, they are real and around us every day. And the pains that they are there to treat are real. But being stoned is not the answer. Some docs think that it is OK as long as we don’t complain about issues. I’m getting the impression that a lot of the addictive pain meds scrips are written because the doc has no real answers. People have issues that can’t be fixed, just treatment for the symptoms. People have issues that they have no insurance to cover, so they never get fixed and people need some sort of relief for them.
    Best healthcare my ass.

  19. 19
    Ohio Mom says:

    @Jerzy Russian: Retirees with chronic, painful conditions?

    @J.A.F. Rusty Shackleford: I seem to recall seeing that crescent stretching over West Virginia, Kentucky and Tennessee in any number of other maps showing social ills.

  20. 20
    gvg says:

    Hmm, I am pretty sure I have had those prescribed for major dental surgeries and crowns. Not 100 though, maybe 10 at a time and for me they worked as intended. I needed something to take the edge off the first day and I felt…not especially great, just pretty normal and pain free. The 2nd day they made me feel like I had no sense of balance and groggy, a bit nauseous so I learned to cut the pills in 1/2 for 2 or 3 days, then done. In other words when my body didn’t need that much pain relief, I didn’t like it. I don’t recall if they counseled me to do that or if it was my sister the doctor, but I do that routinely with any strong pain relief meds prescribed. It works for me. I have had a few surgeries and chemo, but they gave different meds to me.
    I have a suspected allergy to morphine and the docs since have all listened closely about avoiding that and relatives.
    Our area has excess prescription meds drop off days and I have turned in some. I have kept just a few….in case of dental agony on a weekend or holiday in my mind. Since its always my Dentist or oral surgeon who has prescribed it, I sort of associate it with that kind of problem.
    I wonder if being related to a doc who would tell us to avoid problematic doctors or diagnosis has helped us avoid this situation? Maybe also being in a state University town with med school has raised the quality of doctors?

  21. 21
    The Moar You Know says:

    I wonder what is going on near California’s eastern border, especially near northern Arizona.

    @Jerzy Russian: Used to be methland. Still is, but they’ve piled opiates on top. You go up, you go down.

    Central-Eastern California is truly a living example of a “no-go zone” all the racist politicians like to talk about. Everyone: cops, politicians, people…regardless all awful. I stay the hell out of that part of the state. Some of the area south of Yosemite is the most dangerous in the United States.

  22. 22
    I'll be Frank says:

    Looks like an alt-right heat map of “whiteness”

  23. 23
    Enhanced Voting Techniques says:

    My god, the pill use matches Trump’s base. This is really about mass drug abuse?

  24. 24
    gvg says:

    @acallidryas: I don’t see how the companies filling the prescriptions relate. Several of those have filled other prescriptions for me, CVS Walgreens Walmart are around here just where you get prescriptions filled. They don’t generate the prescriptions and those big corps are going to have simular numbers for everything prescribed.
    The makers of the drugs make more profit if more are prescribed. Insurance companies could influence things if they say pay for oxy and not an safer alternative. But I don’t know that they did. Its the manufacturers that have been fingered before. They hid data about addiction and lied to doctors, and I think there were also kickbacks or incentives to doctors but I am not sure about that.

  25. 25
    trollhattan says:

    I’m seeing a sciatica pain ad atop comments.

  26. 26
    trollhattan says:

    @Enhanced Voting Techniques:
    Betcha it correlates nicely with gun ownership. Great combo.

  27. 27
    Gelfling 545 says:

    I have fibromyalgia. I hurt some most days, occasionally a lot. My pcp sent me to a rheumatologist a While ago because she felt I should get a specialist opinion which I hadn’t had since I was diagnosed. He told me that opioids – not that I wanted any- are useless for fibromyalgia but doctors continue to prescribe them anyway. I continue to manage pretty well with Tai Chi, vitamin D and aspirin.

  28. 28
    plato says:

    Speaking of drugs, el chapo gets life.

    https://www.bbc.com/news/world-us-canada-49022208

    Is the site borked yet again?

  29. 29
    Steeplejack says:

    @J.A.F. Rusty Shackleford:

    Appalachia, in other words. Perhaps less a “regional pastime” than dulling the pain and hopelessness of poverty.

    Wikipedia:

    Since at least the 1960s, Appalachia has a higher poverty rate and a higher percentage of working poor than the rest of the nation. Wages, employment rates, and education also lag. The Appalachian Regional Commission (ARC) was created in 1965 to address some of the region’s problems, and though there have been improvements, serious issues still exist. Communities that are not considered “growth centers” are bypassed for investment and fall further behind. In 1999, roughly a quarter of the counties in the region qualified as “distressed,” the ARC’s worst status ranking. Fifty-seven percent of adults in central Appalachia did not graduate high school (as opposed to less than 20 percent in the general U.S.), roughly 20 percent of homes have no telephone, and the population is declining.

    The Russians are killing themselves with vodka; we’re doing it with oxy.

  30. 30

    A lot of it seems to be
    1) Location does matter. More rural/mining communities where physical ailments can occur but fewer physical therapy services may lead to over-reliance on medications for pain
    2) Professional blindness by certain doctors who over-proscribed. Comments here are showing certain doctors just wrote out scripts for meds without a second thought.
    3) Pill mills that were fronts for drug dealing on oxy and other opioids, which were rampant in the 2000s in certain states (especially the southeast cough Florida cough).

  31. 31
    Brachiator says:

    So, how many people were addicted over this period? How many of other types of pain medications were produced?

    And even anecdotes here suggest that pills produced or prescribed does not equal the number of pills taken.

    How many pills should have been produced?

  32. 32

    @Mandalay:

    Oh please, Florida itself is the drug. It’s the only explanation.

    I’m in Polk County and I am working on a buzz just by being here.

  33. 33
    Capri says:

    It is very likely that those big pharmacies dispense the majority of every single drug out there. Which highlights how just how mainstream this problem is. In theory it would make it easier to measure and control, but perhaps not. I imagine CVS and WalMart push back a little more than a street pusher.
    My mother passed away last winter, and we found thousands of dollars of prescription painkillers in her cabinets dating back decades. She wasn’t shy about taking them when she felt she needed them- the over prescribing has been going on for a long time.

  34. 34
    zhena gogolia says:

    I’m surprised my area isn’t darker.

  35. 35
    Harbison says:

    When crack was a raging problem the media harped on the animals who were addicts and increased the criminal penalties. Now, with opioids, people are talking about the evil drug companies.

    Wonder why that is?

  36. 36

    @Enhanced Voting Techniques:

    My god, the pill use matches Trump’s base. This is really about mass drug abuse?

    Correlation is not causation. I think both Trumpism and opiate abuse are results of deeper social problems in those areas. People there feel helpless, so they turn to anything that will make them feel better about themselves, whether it’s drugs or politicians who tell them it’s all somebody else’s fault.

  37. 37
    rikyrah says:

    They need to go to jail 😠😠😠

    Something ain’t right about this

  38. 38
    MattF says:

    @plato: I think if you try to post a comment that has the name of a medication, the comment gets dumped.

  39. 39
    Haroldo says:

    The somewhat isolated, dark square in Northern Michigan is Ogemaw County. Its estimated 2018 population per Wikipedia is ~21,000. It is 97.5% white, and staunchly Republican (65% Trump in ’16). 14% of the population lives below the poverty line.

    Reading Wikipedia and the county’s website, it seems to be a county in trouble, made more so by opioids. I tend to agree with Roger Moore above, tho’ glomming onto prejudices is just plain moronic.

  40. 40
    ET says:

    I saw that graphic and it seemed “weirdly” bunchy. It is almost like you can see the doctor(s) in one area that are known to be the big suppliers and everyone would go to them.

  41. 41
    NY Robbin says:

    My .02: I was prescribed an opioid, among other things, after knee surgery last fall. I took it for a day or so after the original local anesthesia wore off. After a couple of days in a foggy drug-induced haze, I stopped taking it and relied on an Advil-like anti-inflammatory. The funny thing is, I found them completely ineffective after dental surgery a year or so before – ibuprofin was more effective. [shrug]

  42. 42
    Hunter says:

    I had a prescription for hydrocodone for a pinched nerve in my hip. I took one before bedtime, which is when it got painful, for about four days until it cleared itself up. It was just enough to take the edge off so I could sleep. (I should note that I have a high tolerance for pain, and I seem to be immune to most painkillers — I don’t even bother with over-the-counter stuff.)

    So much for my experience with opioids.

  43. 43
    geg6 says:

    I despise opioids. Not just because of the damage and deaths they cause, but they just don’t work well, IMHO. I’ve had injuries and surgeries (mostly dental, but they were major) and, every single time, I’m offered some sort of opioid for pain after the procedure. I used to argue with the doctors that I really didn’t need them and didn’t want them, that a higher dose ibuprofen works just fine, but they never listened. The one and only time I filled the prescription, I found that I couldn’t function at all (barely could walk, even after cutting the pills in half) and ended up so nauseated that I couldn’t eat either. Sleeping was horrible as it was filled with horrible dreams. Took them for a couple of days and never took another. Now I don’t argue about it. I just tell them to stuff the prescription where the sun doesn’t shine and go home and take enough nsaids to dull the pain. With some milk or yogurt to try to protect my stomach lining.

    The problem with opioids has been horrible here for over a decade. Happily, the epidemic seems to be calming a bit in my local area. Unfortunately, that may be because the worst of the addicts seem to have died off, based on what I see in the local obits (many fewer young people than even just a year ago). And a lot of the old school doctors around here have retired, so the ones remaining aren’t quite to so quick to pull out the prescription pad to provide pain pills for the most minor of aches and pains. As bad as it got here, it was worse just an hour or two down the road in West Virginia. I sure hope it’s gotten better there now, too. The wreckage of what Big Pharma created has been sad to watch at close hand.

  44. 44
    Gin & Tonic says:

    @NY Robbin: There are clinical studies showing that taking alternating OTC doses of ibuprofen and acetaminophen is at least as effective at reducing pain as opiates are.

  45. 45
    Betty Cracker says:

    Two women in my peer group have lost sons to this scourge and two others are dealing with addicted children. I’d love to see the people responsible jailed and penniless, their wealth confiscated to fund treatment programs for their victims. But that’ll never happen.

  46. 46
    Tim C. says:

    So this is where I’m confused by the map. Is the Pills per Person based on patients who take pills or on is it based on the total population of the county? Both would indicate horrific problems. But the second possibility is the worse one. Likewise, do they align with any consumption data? Are the poor/white/conservative counties in such terrible shape consuming all the opiates or are some being exported?

  47. 47
    hitchhiker says:

    My young brother in law was one of the canaries in this coal mine.

    He was a construction worker with a drinking problem who was injured on the job way back in the mid-90s, when oxycontin had just appeared on the pain drug market. He OD’d finally after 7 or 8 very rough years, during which he had no trouble at all getting his prescriptions filled, either here in Seattle or later in Traverse City, MI, where he and my sister went in an attempt at a geographic cure. He never worked again.

    He’s in the data set compiled by a very determined woman named Jaymie Mai, who worked for the WA state dept of labor and industry, which is the organization that handles what’s called workmen’s comp in most places. She saw a pattern in the early 2000s, back when the number of overdoses was under 20,000 nationally.

    Her peers didn’t want to hear it.

    Mai and Gary Franklin, the medical director at LNI, tried to raise a red flag by sending letters to providers that asked them to be cautious and follow prescribing guidelines. They also went to conferences to make the medical community aware of the dangers of overprescribing. Mai says they were shouted out of rooms, and that the medical provider community and pharmaceutical advocacy groups didn’t believe their data.

    This is one of those times when people who should know better screw up so hard you almost can’t believe it looking back.

    In 2005, there were 14,917 opioid-related overdose deaths in the United States. That year, Mai was an integral part of drafting a report that, drawing on the Washington state workers’ compensations system for its research, revealed there was a serious issue with how opioids were being prescribed.

    My sister successfully sued the Dept of L and I and collects a monthly check to this day. They knew better.
    https://www.bustle.com/p/how-jaymie-mai-blew-the-whistle-on-opioid-overprescribing-15-years-ago-17233171

  48. 48
    Brachiator says:

    @Harbison:

    When crack was a raging problem the media harped on the animals who were addicts and increased the criminal penalties. Now, with opioids, people are talking about the evil drug companies.

    Wonder why that is?

    There you go again with your bullshit. It wasn’t the media. You know that.

  49. 49
    Blue Galangal says:

    Has anyone overlaid this yet with Trump voters?

  50. 50
    C Stars says:

    I love opioids. I’ve generally found them effective for pain. But you take more than three in a row you start to get very unpleasantly constipated (or at least that’s what I’ve experienced). I had a series of medical and dental surgeries starting in March 2018, and all of them entailed various kind of opioids. The upshot was that I definitely became dependent. Not jonesing every day, but more like whenever I had any little ache or pain, I was convinced that a tylenol wouldn’t help and I’d go straight for the big stuff. But by about September all my prescriptions ran out, and that was the end of that.

    But reading this I am remembering a time about seven years ago when my husband cut his finger when we were on vacation in North Carolina. We went to some weird rural medical clinic–weren’t around any hospitals. He had to get a couple of stitches. Afterwards we went to a CVS to fill the prescriptions and found they included Oxy and percocet, huge bottles (50 pills each, I think?). They both had refills. When the pharmacist delivered the bottles he and I just looked at each other like WTF? Even the pharmacist said “Geez, what happened to you?” It was just completely out of proportion for the problem. A few vicodin would have been fine. Very strange. He took about one and a half of the oxy (which are incredibly strong and he hated) and then was done. We realized at some point a few months later that both bottles were gone from our medicine cabinet after we’d had several contractors in redoing our floor.

  51. 51
    C Stars says:

    @hitchhiker: Oh, I’m so sorry.

  52. 52
    Brachiator says:

    @hitchhiker:
    This is so sad. I am sorry for all your family had to deal with.

  53. 53
    Enhanced Voting Techniques says:

    @trollhattan: yes, and makes such horrible sense too that it makes one pause. The whole, they were stoner hippies in their youth and now conservative prescription drug abusers in their old age fits the “Id of the Boomers” narrative so well.

  54. 54
    Tim C. says:

    @C Stars: Yeah, My question is that is the over-perscription of the meds intentional? It reminds me a lot of the Pseudofed problem of the last decade. Sure, nobody in pharma companies was directly supplying pseudofed to the Meth Houses, it was all going to legit outfits and corner stores and the like. But 75% of the usage was being driven by the meth-cooks (in Oregon at least) There seemed to be a kind of willful pretend ignorance about it all too. The companies were certainly making money from all the sales that were then going to meth-making. Seems similar here where they were sure selling a shit-ton of pills and then doing their best to not know what was going on.

  55. 55
    Kay says:

    @Harbison:

    Wonder why that is?

    I know what you’re saying but 1. there are drug companies (none for crack) and 2. most of the initial use was legal.
    No one got busted for endlessly re-filling a prescription. Hence they weren’t in jail or prison. Tons of them are in prison now, I assure you. In and out and then back in. Because it is really hard to beat this addiction.

    No one ever talks about the “pain patches” but we saw a ton of that here. These people were absolute zombies wildly over-using those patches and it went on for years.

  56. 56
    Mandalay says:

    From today’s NYT:

    After three decades of ever-escalating drug overdose deaths, the tide of fatalities may have finally started to turn. Total drug overdose deaths in America declined by around five percent last year, the first drop since 1990, according to preliminary government data made public on Wednesday…

    …A decline in prescriptions for opioid painkillers was the major factor for the overall drop in overdoses. Fatal overdoses involving other drugs, particularly the deadly synthetic opioid fentanyl and methamphetamine, which has come roaring back over the last few years, continued to rise.

    That report is based on Provisional Drug Overdose Death Counts from the CDC, which dutifully points out that the numbers for every single state are “Underreported due to incomplete data”!!!

  57. 57

    @Roger Moore:

    People there feel helpless, so they turn to anything that will make them feel better about themselves, whether it’s drugs or politicians who tell them it’s all somebody else’s fault.

    In my considerable personal experience, they generate their own misery by their cruelty towards each other. That’s why Trump support crosses all economic lines. So does being a mean shit, and the unhappiness that causes. I wouldn’t even say Southern culture celebrates cruelty. Southern culture assumes it.

  58. 58
    jl says:

    The wisdom of Cole: ‘if you wreck yourself, then check yourself”?

    Thanks for post and links. I heard about this on the news last night, and wanted to find the report and data today.
    A truly full-service blog!

  59. 59
    Walker says:

    I have been proscribed both hydrocodone and OxyContin in the past for pain (different times). Hydrocodone was fine. It takes the pain off but does not seem to really seem to do much else. I have been careful, so I have never seemed to build an addiction to it.

    I took ONE of the Oxys. That was scary. The feel good feeling was so strong that I immediately (properly) disposed of that prescription.

  60. 60
    hitchhiker says:

    @Brachiator:

    Thanks. When my sister went to the hearing with the state’s L and I attorneys, they tried to shame her b/c her dead husband had been an alcoholic — as if the over-prescribing of oxycontin, known to be addictive to the state itself, was not what killed him. He was in his 20s when all this started, and they had a little boy. Going to AA was just not cutting it, and he tried. That’s the really sad part: how hard he tried.

    She of course had no clue what had overtaken him, until it was way too late.

  61. 61
    Kay says:

    @Tim C.:

    I think you have to add in that poor people have more health problems in general and these people have more health problems that are treated with pain pills because they do physical, menial jobs.
    They went to the places where a lot of people have back and knee and joint problems at 40, 50, 60, and problems associated with wear and tear. They are in pain.

  62. 62
    Doug R says:

    My wife has major bursitis pain in her right shoulder which I suspect is from RSI from too much computer mousing. She’s found high THC weed to help. Also, in a lot of jurisdictions you can get CBD capsules which ease pain and help you sleep. She’s found they work very well.

  63. 63
    WhatsMyNym says:

    I’m very familiar with some of the areas on the west coast. Lack of insurance/money and access to proper long term treatment are a big factor with those areas.

  64. 64
    jl says:

    The obvious concentration of pill dumping in East South Central and WV is disturbing. I’d like to read a report on how that happened. One reason probably access to care there among most miserable in the country, with a lot of abandoned workers who do physical labor, or who did before they were wrecked and thrown aside by their GOP overlords. Wonder if other factors contributed. Maybe similar worker population in Rust Belt, but look at the difference.

    Any commenters have insights?

  65. 65
    longhairedweirdo says:

    Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post.

    I make *NO* excuses for these companies per se, okay? But that’s a bit misleading. In the 90s, there were four major drug distributors; AmeriSource, Bergen (Bergen-something, maybe?), Cardinal, and McKesson. AmeriSource and Bergen merged, and 3 huge pharmacy networks joined in.

    Now, I can’t talk about the rest of the story, it’s just, that one line is a bit like “And the great majority of these zooming death traps are made by GM, Honda, Ford, Toyota, and Chrysler!”

    I also confess, I’m having a moment. When I worked for AmeriSource (in IT) I felt I could feel the respect for the laws, especially about diversion laws. If you mislaid *one* tablet of a schedule II drug, I believe the fine could be $25,000. Part of me is like “no, they weren’t *LIKE* that,” you see what I’m saying? I’m not saying I don’t *believe* it. It just… something strikes me as *missing*.

    Here’s a scary thought. What if the deregulatory state has made it so those companies no longer had to fear those fines? Now, one thing i learned was, pharmaceutical distribution was a very low margin business. There’s only one way to improve revenue, and that’s volume.

    Now, imagine this: one of them stops flagging *every* excess pill order; that one makes more money, and that one can now try to shave margins to increase volume (i.e., poach customers!) unless the others follow suit. And yes, one could also say “now, imagine this; one of them lets the local gangs break in to ‘steal’ drugs, and accidentally drop untraceable cash”, to create the same scenario. And you should, by the way, because face it, they *are* morally equivalent. But still: honest to goodness, can’t you imagine a corporate beancounter thinking “well, not the *really* bad excess orders; and it *could* just be people backfilling after a shortage…”?

    And while that’s bad, that’s also the nature of the deregulatory state. Seriously; look at Boeing, which might end up in serious mud all because of a too-light regulatory touch, and the corporate greed that took advantage of it.

    Pause again and note how the two go hand in hand: it’s not that the corporations were exactly *evil*, it’s that, the GOP said “we won’t try to hem you in, and make you scared of nasty fines or anything” and companies looked for ways to cut corners. This may well be the repudiation of deregulation as a paraphilia.

    Oh, one final anecdote: there was an outbreak of a germ in peanut butter. (Salmonella, maybe? E. Coli? I don’t remember. It was a *germ*, which is key: usually, first thing that happens to peanuts is roasting, which oughta kill ’em all!) You know, mere *months* ago, Big Ag had written up regulations for food that made it very hard to trace the source of the outbreak. Under the old regulations, it would have been trivial. Eventually, yes, they did find the source, but did you notice that on the last lettuce outbreaks, the media were all “what can you do? People just have to get used to getting sick!”

    The Republican Party’s corruption is now officially as ugly as the result of those last lettuce outbreaks, but smells far worse.

  66. 66
    jl says:

    OTOH, it amounts to only 36 pills per person per year! What’s the problem? Everyone can only zonk out one month a year. Maybe we need more?

  67. 67
    chris says:

    My neighbors next door in Columbus Co here in NC are definitely doing their part. It is by far the highest region in NC. My own county Robeson is not too shabby (very shabby) either. Very poor rural places. I’ve lost probably 1/2 dozen people over the last decade to this. Lost a 1st cousin about a month ago…(fentanyl OD..where they slipped it into his regular heroin) You can pick up the newspaper here and see these obits for <45 y.o. people. Its just so sad.

  68. 68
    mad citizen says:

    @hells littlest angel: I’m not a drug user/abuser, but do love music. That’s a great song. Similar to your idea, check out the Lawless soundtrack. Ralph Stanley does a short version of White Light White Heat. Mark Lanegan does it as well.

  69. 69
    C Stars says:

    @Tim C.: Absolutely. We were paying for everything out of pocket because we were out of network, and weren’t really paying attention because it was late at night by the time we got to the clinic, we had a tiny kiddo with us, and we just wanted the bleeding to stop. But now, looking back, it was very much in keeping with the place, just as you describe rural Oregon’s meth culture. We’ve vacationed in that part of rural North Carolina for many years for family reasons and it is always just a depressing, awful stereotype of the rural south. Treason flags everywhere and even, a couple of years in a row, a procession of two or three malnourished looking neonazis marching outside the grocery store. The majority of the locals are suffering from obesity and everyone smokes. It’s…not a good scene. So in a way it makes sense that for whatever reason the doctor decided to load us up with opioids along with the antibiotic (which was the only thing he actually needed).

  70. 70
    hitchhiker says:

    @jl:

    Highly recommend the book, Dreamland, which is a very readable and wrenching story of what happened, where it happened, how it happened, and to whom it happened.

  71. 71
    MomSense says:

    I guess I should be grateful that opioids make me violently ill. I still feel badly for the poor physical therapist who experienced the projectile puking after I was given my first and only oxy.

    When my oldest had his wisdom teeth taken out the dentist gave me a script for 14 Vicodin. I got really angry and said that was crazy and he could get maximum of 1-2 pills. I keep thinking about all the kids he went to school with who died from overdoses and wonder how many of them started because they were given them after wisdom teeth removal.

  72. 72
    Mandalay says:

    @jl:

    Any commenters have insights?

    I don’t trust the data and/or the reporting. Although the data is coming from the DEA, and is supposedly “public”, there is no link to it that I can find in any of the Post’s articles. And that 2012 map doesn’t look plausible. Miami, Fort Lauderdale and most of Virginia are clean as a whistle, while Charleston and Myrtle Beach are as bad as anywhere on the map? Well maybe, but I think we need to see the raw data that spawned the Post’s articles before getting too carried away.

    (This is not to minimize the overall problem – I’m just skeptical on those Post articles in particular.)

  73. 73
    Tim C. says:

    @Kay: @C Stars: Both of these make complete sense. A combination of factors. I lived out in the sticks for about 10 years before moving back to Portland. Urban and Rural poverty are a Venn diagram with some overlapping and some distinct features. My guess is also that in most Urban areas, there’s more likely to be better oversight on pills from larger medical networks as well. Final factor might be the way local law enforcement (in my experience, not saying I have data for this) tends to turn a blind eye more often in rural areas to the problems of their locals.

  74. 74
    sukabi says:

    @J.A.F. Rusty Shackleford: considering the piece last year? that oxy was being dumped in small town WV at a rate of something like several hundred thousand pills / person / year it appears that although small town USA has a problem that they are also being used as a conduit for pharma to the illicit drug trade.

  75. 75
    RL says:

    Pillbilly Blues
    https://youtu.be/7f8U00Yc2gY
    NSFW language!

  76. 76
    Kent says:

    My wife is a physician. She practiced primary care medicine in Texas for 13 years before we recently relocated back to the Pacific Northwest where she is licensed to practice in both OR and WA.

    She says that in Texas the state medical board was extremely conservative about prescription opiates and was quick to open investiations into physicians who were perceived to be over-prescribing opiates. Physicians across the state were well aware of this and tended to be circumspect and cautious when prescribing. By contrast, in OR there was a move in the 90s towards accommodating pain management and physicians were potentially criticized for not being sufficiently accommodating in their pain management.

    Looking at the differences in opiate abuse in these two regions, one has to wonder if that had any effect. Because Texas most certainly has plenty of the same lower class rural white culture that has become consumed by the opiate plague in places like West Virginia. Yet the addiction rates are dramatically lower in Texas.

  77. 77
    apsalar says:

    I’ve had kidney stones a few times. Nothing really makes the pain go away (except IV morphine but I only got that one time), but pills can take the edge off and make me at least functional. Every time I’ve shown up at the ER with a kidney stone, they’ve given me an Rx for either percocet or vicodin, but never more than about 10 pills at a time, and fortunately kidney stones don’t last that long so I don’t think I’ve ever finished the bottle.

    I also got some IV fentanyl when I was in labor waiting on the epidural. That stuff was not that great. The epidural was amazing.

  78. 78
    Fair Economist says:

    @Enhanced Voting Techniques:

    My god, the pill use matches Trump’s base. This is really about mass drug abuse?

    Not all, but there are strong correlations between heavy opiate use and unemployment, misery, and turning Republican, and biological and epidemiological reasons to think the opiate use is mostly the cause in that linkage and not the effect.

  79. 79
    Elizabelle says:

    How much of these opioids are prescribed for old people or people facing terminal diagnoses? Might that also skew the results? Some of these opioid users might be in the throes of cancer or longtime acute pain (spinal stenosis, etc)? Just curious about the age demographics too.

    This map is a shame. Europe does not do this.

  80. 80
    Matt McIrvin says:

    It’s interesting that the use of pain pills is generally very *low* in the belt of majority-black countries across the South.

  81. 81
    MoxieM says:

    I’m one of those chronic pain folks. I have only recently been prescribed any kind of opioid. This is after a long history of …stuff… Hell, my earliest herniated disk consult in my record is in 1974 (I was a full-time dance student). But wind the clock forward to now, and I have a lifetime’s accumulated issues, spine, nerve, spine/nerve, joint… (For those who understand this analogy: I had unmedicated labor, and my daily pain levels approach active labor quite often. ) More to the point in some ways, I live alone and I need to be able to do my own daily “stuff”–laundry (stairs), grocery, feeding & cleaning up after myself, dog care, yadda yadda. I’m not complaining! It’s just what it is. Some days I have a lot of trouble walking, and like that.

    So after making a full tilt go at yoga (chair, modified, chronic pain-, etc); acupuncture (+cupping)–my doc had been a Barefoot Doctor so her stories were fascinating; chiropractic; massage; water exercise; a wide variety of NSAIDS (developing ulcers, thx); um, what am I forgetting–oh, PT, including bad Back Bootcamp, 2x.

    I would much prefer some other choice, but put plainly: at this point, having a restricted script for a very low dose of Oxycontin has, for the las month or two, made my life do-able. Yesterday I drove an hour to go visit my visiting cousin! That was awesome.

    Finally, a funny note: state law where I now live has mandated that any Rx for opiates be accompanied by an Rx for Narcan. Administered by a shot. Of course, it’s not covered by my health insurance, mini laugh. But the big laugh–I live alone. By definition, were I to overdose, who would resuscitate me? My dog? (she’s clever, for a dog. But I think the lack of thumbs might be a challenge. heh.) Like the interference in women’s repro health (way worse, d’oh) this is a grand example of how legislating health care specifics can go haywire.

    I wish everyone a life free of bad chronic pain.

    edited for dumb typos.

  82. 82
    LongHairedWeirdo says:

    @Kent: The first thing I’d call out is whether West Virginia has *any* money. See, Texas has oil,and some IT (Microsoft and Amazon Web Services both have significant support centers out there). When there *is* money – when you’re thinking to yourself “if it’s too bad, I guess I can try the oilfields again,” or “I dunno, that community college did say they have an IT program, and I was pretty good at math and can help my friends with *their* computer problems,” that might help. Plus, money is like manure; if you’ve got a bunch of it, you’ve probably got some places you can spread it to good effect, which might mean a bit more flowing through local communities than there would be otherwise.

    I’m not saying there aren’t rural poor in Texas that are every bit as poorly off as some rural poor in WV – but I’m saying, I’d guess (pure-D guess!) that there might still be that tiny flicker of hope, some folks who won’t ever try the oilfields or that community college still get through their day with the notion “if this gets too bad, I *can* still break out of my rut.” (Side note: I have no idea if “the oilfields” is a good place to look for work, or if oil is *that* big a piece of the TX economy. My point is, I think there might be enough economic opportunity in Texas that it might make a difference, and that there might be *something* people see as an opportunity.)

    There’s been some interesting research saying, basically, “when people don’t have hopes, and dreams, and economic opportunity, there’s joblessness, broken families, drug abuse, crime, etc.,” and it’s interesting, because the same sort of research used to say the same thing, only it wasn’t about “when people don’t have hopes, dreams, and economic opportunity…”. (I don’t have to tell you the targets of the original research right? And the use of that research to profess that racism is justified? What’s so-horrid-it’s-funny is, some of those racism professors scold the victims of those bad economic times for acting like human beings *act* in those circumstances, not realizing the sick irony.)

  83. 83
    mr gravity says:

    @laura: Hi Laura! It’s Mike. From Tennessee. How you doin’?

    Just kidding. But I am located in the dark part of the map. And my GP when pushing meds always includes the disclaimer: “I don’t get a penny from the drug companies!” Why he feels the need to preface his pharmaceutical recommendations this way is……pretty obvious.

  84. 84
    MoxieM says:

    @Elizabelle: yeah, after my recent long post–I have lumbar spinal stenosis, among other things. What I wouldn’t give to go for a long walk!

    In Europe–where my kid lives, they don’t throw pain pills around, true. A Dutch friend only got Paracetamol for kidney stones (Tylenol). Ouch. And she was grumpy about it. OTOH, my kid’s mother “out-law”, was sent to the seaside for 3 weeks after a broken rib–she’s in her mid 60’s and it was an Rx, part of her medical care, all paid for–sick time is unlimited, so no worries about time off work. I would guess that in some circumstances this kind of care steps inplace of pain pills quite nicely.

    One of my kid’s friends is a newly minted German MD. If I ever get a chance it would be interesting to ask him his thoughts about opiates and pain medication (well, besides Arnica, the German cure-all.).

    My point really is, you can’t take the pills out of the equation in making the comparison since the social context is so different. People are so less stressed about health care in general, since it’s paid for, they have whatever time off they need, and so on. It’s a universal social good, not a scarce expensive resource. Hence, there is less “pill chucking” because it is very possible to do alternative things like PT, trips to a spa, massage, whatever.

  85. 85
    jl says:

    @mr gravity: Might be telling the truth. Kickbacks can be laundered through the PBM.

  86. 86

    @longhairedweirdo:
    What you’re describing is known as a race to the bottom, and one of the major functions of regulation is to keep it from happening. So yes, the idea that relaxing regulatory enforcement would effectively drive companies to cut corners to the extent the relaxed regulatory environment would allow is a well known problem.

  87. 87
    Bex says:

    Not sure how to link, but this July 8, 2019 Terry Gross NPR Fresh Air podcast is an eye-opener. “A Bioethicist’s Personal Struggle With Opioids.”

  88. 88
    Barbara says:

    @MoxieM: Wishing you the best in treating your pain. It is good to put off using opioids for as long as possible because, among other things, it appears that long term use makes you more sensitized to pain. Using them long term has not been shown to be more successful at alleviating pain than using NSAIDS, but totally agree about the downside of the latter. Sometimes they are just not an option.

  89. 89
    wv blondie says:

    Many years ago I had my wisdom teeth removed, and the oral surgeon gave me a prescription for Percodan. No warning or anything, just to take as needed. I took them for about three weeks – probably two weeks longer than needed, I discovered, when I realized that I felt fine but wasn’t getting anything done at work. So I quit. My roommate at the time teased me about it, saying that it wasn’t like I was going to get addicted or anything. Then a story showed up in People magazine, of all places, about how Percodan and Percocet could get you addicted in less than a month. Since then I don’t think I’ve taken anything stronger than Tylenol with codeine, and for no more than two days.

  90. 90
    WhatsMyNym says:

    @Elizabelle:

    How much of these opioids are prescribed for old people or people facing terminal diagnoses?

    In my limited experience – terminal patients will get morphine, if it won’t interact with any medication they are taking. Patients with back problems more likely to be offered nerve blocks or steroids.

  91. 91
    Uncle Cosmo says:

    @Nicole: Late to this, but FWIW:

    In my 20s & 30s I had an active case of arthritis in my spine, shoulders, hips, chest – controlled pretty well with a NSAID most of the time – but

    (1) One day I had a flareup in my thoracic spine, muscle spasms, could not lift my head. Rheumatologist sent me home for a week in bed, Tylox for the pain. I found that it didn’t kill the pain – the pain just kind of became beside the point. My nec No seeing God or nothin’. I got better & was never tempted to continue the drugs.

    (2) Down the line I would occasionally suffer muscle spasms in my lower back. Rheumatologist (who by now had been treating me for >10 yr) prescribed Valium 2 mg, trusting me not to abuse it. One, at most two doses in sequence would quell the spasms with no mental or emotional impairment. Again, no temptation to continue – at max I went through a 30-tab bottle in 18 months.

    When the MD retired he referred me to a colleague, who point-blank refused to prescribe the Valium because it was “adddictive”. Instead he gave me Flexeril. One 10 mg tab of that & 10 minutes later I felt as if King Kong has whacked me upside the head with his big feather pillow. Went back to the doc, he wouldn’t listen – so I fired his worthless arse.

  92. 92
    tokyokie says:

    @laura: Years ago, after reconstructive knee surgery, I was prescribed a painkiller (can’t remember which one). I think the bottle had maybe 25 pills in it. When I was about halfway through the bottle, I asked the orthopedic surgeon for a refill, just so I’d have some in hand while going through physical therapy. He exceedingly grudgingly gave it to me, but I never filled it because I never finished the first bottle. Just an example of how prescribing practices have changed over time.

    And as for teeth-grinding, I would think that a muscle relaxant like cyclobenzaprine would be a lot more appropriate, as it addresses the problem rather than the symptom. (I was a lifetime nighttime teeth-grinder and it’s worked for me.)

  93. 93
    Martin says:

    I recommend you all watch the ‘Drug Short’ episode of ‘Dirty Money’ on Netflix.

    It’s not about opioids, but it helps reveal the lengths the drug companies will go to make money, including setting up their own distributors, fake pharmacies, and so on. Also, look into the ‘Dollars for Docs’ investigation on Pro Publica.

    These two things combined allow drugmakers to provide kickbacks to doctors, then run the drugs through their own distribution network so that the feds wouldn’t be able to catch onto what they were doing. They lied about the addictiveness of the drugs, got people hooked, sold billions, and then started to make money on the treatments for the addiction. All of that money was healthcare spending that was burned, rather than used wisely. The economic loss then magnified several times by the loss of worker productivity. Holland boosted their GDP by 3% through increased bicycle usage and better health outcomes and lifespans. Think of what this country would do for a 3% GDP boost. Think of how much GDP has been lost to millions of stoned (and dead) Americans, and how many Republicans are like ‘yeah, that’s cool, look at their share prices’ as if that is a measure of anything that the nation should care about.

  94. 94
    jackmac says:

    I’ve had kidney stones on four occasions and the pain was truly awful and it was often a two-three day ordeal until the stone finally passed. I was typically prescribed opioids, but hated the fuzzy and disjointed feelings and how they only dulled the pain. A combination of OTC ibuprofen, Tylenol and a hot bath often temporarily worked as well. On my last emergency room visit for a kidney stone I was given morphine. Ah, temporary bliss. But I never took nor asked for it again. It’s now been several year since my last episode and I decided to be proactive and now tend to overhydrate myself to keep the plumbing moving and keep stones from forming. It’s worked so far.

  95. 95
    Martin says:

    @LongHairedWeirdo:

    I’m not saying there aren’t rural poor in Texas that are every bit as poorly off as some rural poor in WV – but I’m saying, I’d guess (pure-D guess!) that there might still be that tiny flicker of hope, some folks who won’t ever try the oilfields or that community college still get through their day with the notion “if this gets too bad, I *can* still break out of my rut.” (Side note: I have no idea if “the oilfields” is a good place to look for work, or if oil is *that* big a piece of the TX economy. My point is, I think there might be enough economic opportunity in Texas that it might make a difference, and that there might be *something* people see as an opportunity.)

    The problem is that the world shifted about 30 years ago from these resource-based economic drivers, to labor-based drivers. That is, the economic prosperity has less to do with what is there, and more to do with who is there. The large economic drivers in this nation are regions that are defined by talent, not resources, and talent is created and attracted. It’s created through education, and it’s attracted through quality of life. West Virginia may not have California’s climate, but it’s a fucking gorgeous and potentially chill state, albeit one with no infrastructure to speak of. The higher educational system there is fairly abysmal, resembling a lot of anti-tax states, land is cheap, with few convenient ways to get to it – airports and the like. And the state doesn’t provide many social benefits as well because they invested everything in removing mountaintops, rather than cultural and social benefits. This is pervasive throughout Appalachia and the south, and much of the midwest. I mean, Brooklyn of all fucking places is in a renaissance. But they have infrastructure, they have educational opportunities, they have quality of life, and people are willing to pay a lot of money for that. Same in CA. Same in MA.

    The WV government and industry leaders have failed the populace and the populace has rewarded them for it.

    There’s been some interesting research saying, basically, “when people don’t have hopes, and dreams, and economic opportunity, there’s joblessness, broken families, drug abuse, crime, etc.,” and it’s interesting, because the same sort of research used to say the same thing, only it wasn’t about “when people don’t have hopes, dreams, and economic opportunity…”. (I don’t have to tell you the targets of the original research right? And the use of that research to profess that racism is justified? What’s so-horrid-it’s-funny is, some of those racism professors scold the victims of those bad economic times for acting like human beings *act* in those circumstances, not realizing the sick irony.)

    There was this funny quote from Obama back in 2008. You might have heard part of it:

    You go into some of these small towns in Pennsylvania, and like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing’s replaced them. And they fell through the Clinton administration, and the Bush administration, and each successive administration has said that somehow these communities are gonna regenerate and they have not. So it’s not surprising then that they get bitter, they cling to guns or religion or antipathy to people who aren’t like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations.

    He was mocked for that comment. We are now a nation trying to prove that comment correct.

  96. 96
    chris says:

    @chris: Hi, doppelganger, greetings to you in NC from Nova Scotia!

  97. 97
    Barbara says:

    @Martin: West Virginia and Kentucky and Louisiana fell for the resource trap that some economists have identified as explaining why “resource rich” countries fail to lift up their citizens. Because they fail to see their people as the greatest resource that a jurisdiction can have, and instead focus resources and policies on exploiting the other resource, be it oil or coal. Infrastructure is planned based on the needs of getting the resource to market, things that would divert money from resource operators to other needs, like education, are underfunded. It takes serious political commitment and transparent government to avoid this predicament. Now that coal is fading fast, you see states that have failed to use resource based wealth to transition people to an alternative kind of economy.

  98. 98
    chris says:

    @Barbara: See “dutch disease.”

  99. 99
    Brachiator says:

    @Matt McIrvin:

    It’s interesting that the use of pain pills is generally very *low* in the belt of majority-black countries across the South.

    Countries? Maybe counties?

    It might be useful to compare the rates of use of various illegal drugs, and alcohol and marijuana. Different areas might have different preferences.

    Also, abuse of prescribed drugs vs drugs from illegal markets might account for some differences.

  100. 100
    BruceJ says:

    @Jerzy Russian:

    That area in Arizona encompasses a lot of retirement communities. Old people take more pain drugs.

  101. 101
    Barbara says:

    @Brachiator: My understanding is that abuse of opioids among minorities is rising faster than it did in the past. One reason it was lower is that pain relief is less likely to be prescribed to minority patients. This failure is unlikely to be due to legitimate reasons of medical practice. In other words, it was almost certainly because of discriminatory medical practice, although in this case of opioids it might have been a blessing in disguise.

  102. 102
    Brachiator says:

    @Barbara:

    My understanding is that abuse of opioids among minorities is rising faster than it did in the past. One reason it was lower is that pain relief is less likely to be prescribed to minority patients. This failure is unlikely to be due to legitimate reasons of medical practice.

    I would also suspect that increased access to health insurance and health care increased the number of people who could be prescribed opioids.

  103. 103
    Brachiator says:

    @BruceJ:

    The area in Arizona encompasses a lot of retirement communities. Old people take more pain drugs.

    That makes a lot of sense. If you could adjust for population age 55 and older, I wonder what the map might look like.

  104. 104
    Suzanne says:

    I hate opiates and I try to avoid them, though I did take them most recently when I injured my hand a couple of years ago. I took two.

    I will note that anti-opiate efforts have moved into the ridiculous, though. When I had Spawn the Elder and the Younger, I was provided Percocet for post-delivery pain/injury. This time with the Youngest, my doctor said that all they will provide in the hospital is ibuprophen due to increased scrutiny, and that if I needed something stronger, he would be happy to write me a scrip—but that it had to be filled at a pharmacy for me to take at home. That is fucken ridiculous. So during the most immediate healing period after her birth, I got basically nothing. They were willing to put two doses of fentanyl into my epidural line because my bones were bending due to Youngest being positioned posterior rather than anterior…..but some Vicodin during that first day was apparently a bridge too far.

  105. 105
    LongHairedWeirdo says:

    @Martin: Re: the Obama comment, yes, I know – and the worst part is, I’m betting they’ve eaten so much of the seed corn that even if there was a great, bipartisan upswelling of support for helping people get food, shelter, medical care, and *especially* education, it would still be another several years from *now* before they could see a truly large improvement. (That said: if everyone suddenly could obtain food, shelter, medical care, and education, there’d be more demand, stimulating the economy right now. Still: there wouldn’t be a major IT center opening in WV without an influx of folks to staff it… not yet.)

    The “cling” comment also… you know, what really bugs me, deep down, is how the GOP is just entirely, 100% shameless in lies. One fellow says “we have to continue the investigation into Trump; he could win. It’s like buying a life insurance policy, in case you die before you’re forty”. Context is obvious: “continuing an investigation, because there’s a possibility that it will become important, is like paying life insurance premiums, even though you don’t expect to die.” But even today, they insist that the investigation was an “insurance policy”.

    And here’s the other thing that frosts me. Everyone who is a loyal Republican who saw that text, and then lied about what it *really* meant (in the face of the actual *author* saying otherwise!) should be chilled, realizing they are 100% expendable, and able to be disposed out of a special chute, right in FRONT of the bus, to make sure all wheels get their shot at you. That should be breaking their morale. How could they be so stupid? (I mean, other than the brainwashing, where they constantly tell themselves Democrats are horrible, and if only the Republicans could do their job, like they did during, e.g., the Iraq occupation….)

  106. 106
    EthylEster says:

    @PaulWartenberg wrote: I’m in Polk County.

    Where my dad was born. He always pronounced is “Poke County”. A real Florida cracker.

  107. 107
    Nicole says:

    @Uncle Cosmo:

    When the MD retired he referred me to a colleague, who point-blank refused to prescribe the Valium because it was “adddictive”.

    Late to see your response, but it reminded me- at the hospital after my surgery, when they were writing me the prescriptions for pain management at home, I initially turned down the Valium. My best friend, who is a social worker, was there and she interrupted me with, “SHE’LL TAKE THE VALIUM, THANK YOU.” She later explained to me that doctors don’t often feel comfortable prescribing Valium and so when they do, YOU TAKE IT.

    (She was also able to explain how Valium and Percocet work differently as pain killers; that Valium doesn’t really numb the pain but relaxes you enough so you float above it and in some circumstances, that is more useful. So I took the prescription and yeah, the first night was great.)

  108. 108
    laura says:

    @tokyokie: the issue was clenching my jaw in my sleep, not grinding, and I wish my dentist would have ordered a bite gyard for sleep. I’m having 2 teeth pulled at the end of next month as the end result. The stress grinding lasted the duration of my parent’s deaths – mom from dementia and dad from brain cancer a solid decade of suffering and sorrow.
    The itching and sleep issues never made sense to me to result in opioids and the large amounts were so very scary, I could not even. We grew up warned about heroin, and despite the availability of other drugs for recreation and such that were around as a yoot, never, ever, ever was anything that would have tempted an otherwise foolish young virgin about heroin or heroin type stuff.

  109. 109
    evodevo says:

    @laura: Yes. This. I have several bottles from years ago in my medicine cabinet and have taken NONE…I don’t even fill prescriptions for them these days, just tear it up and throw it away. They don’t do anything for me – I rely on Advil or whatever…But the willy-nilly prescribing of this stuff just amazes me.

  110. 110
    JustRuss says:

    @jl: Looking at the high concentration in NorCal and Appalachia, I’m guessing many residents travel a considerable distance to see their doctor, so they’re more willing to give large prescriptions to reduce the number of trips the patient has to make for refills. If they believed oxy was safe, why not? Also, wouldn’t surprise me if their pharma reps encouraged such behavior.

  111. 111
    Procopius says:

    @Gin & Tonic: Interesting. I started alternating between acetominophen and ibuprofin last year because each has mortal risk. I think the ibuprofin if dangerous to the liver and acetominophen to the heart. I’m lucky enough that I don’t even need to take one or the other every day. I’ve got spandylosis, which most people develop after the age of 50, and mine only got bad enough to take a pain-killer after I was 80. I find doing a stretch of the ilio-psoas soon after getting up is effective.

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