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Two podcasts about drugs
May. 21st, 2019 10:53 amDrugs & Stuff. “Episode 24: Sheila Vakharia Connects the Dots between Harm Reduction and Social Work” Drug Policy Alliance. 5/8/19.
A really thoughtful articulation of harm reduction as a philosophy.
Today, Explained. “Follow the drugs” Vox 4/24/19. Transcript here.
I'm still chewing on this one.
I am so deeply conflicted about the whole Purdue Pharma debacle. They clearly broke and bent the law, evaded regulators, used false advertising, hid their research, et fucking cetera.
But there just isn't a lot of evidence, historically, that it's the drugs themselves that drive drug use epidemics. Social and especially economic conditions correlate with changes in drug use, and especially problem drug use, though which drug is ascendant tends to go in cycles.
I don't quite understand the connection between dependence on a prescription drug and chaotic use of street drugs. That's the entire point of medication assisted treatment for opioid addiction (which they specifically articulate in this podcast) that prescribing an opioid can help make someone's life less chaotic. There's a ton of data on the efficacy of medication assisted treatment. So how can you believe that suboxone is safe and effective and helps people get their lives back together also believe that oxycontin is necessarily leads to chaotic use and people's lives falling apart?
It seems to be based on this corruption idea. Suboxone is safe and effective for people who are already ruined, but we need to keep any more innocent people from being ruined by exposure to opioids.
This is not to say that opioids are a particularly good treatment for back pain. The best treatment is physical therapy, which is incredibly expensive. So, yeah, poor people and vets get substandard treatment (i.e. opioids) because it's cheaper
Also, fentanyl (which is legitimately terrifying) gets lumped in with oxycontin because they are both synthetic opioids. But the root causes are totally different. As far as I can tell, the increase in fentanyl ODs has to do with changes in global trade and the dramatic increase in pharmaceutical production (and pharmaceutical production expertise) in China in the last decade. Fentanyl used be super rare and now it's super cheap.
And a pet peeve. It is more appropriate to describe fentanyl as fast-acting vs "strong". It's basically the opposite of methadone, where the dose hits very quickly and is flushed from the system more quickly (as opposed to methadone which hits slowly and is flushed from the system slowly). So, I hate hear fentanyl described as some kind of sci-fi super-potent drug. It's about how it's metabolized
Anyway, I am trying to make sense of how to be furious at Purdue Pharma while still remembering how drug epidemics work, and knowing the difference between drug dependence and chaotic use, and knowing that I would rather have people using pharmaceuticals than street drugs (which are always more dangerous). And also being so thankful that I have been sober for 19 years and that fentanyl was an exotic luxury back when I was shooting dope and not a dangerous contaminant.
A really thoughtful articulation of harm reduction as a philosophy.
Today, Explained. “Follow the drugs” Vox 4/24/19. Transcript here.
I'm still chewing on this one.
I am so deeply conflicted about the whole Purdue Pharma debacle. They clearly broke and bent the law, evaded regulators, used false advertising, hid their research, et fucking cetera.
But there just isn't a lot of evidence, historically, that it's the drugs themselves that drive drug use epidemics. Social and especially economic conditions correlate with changes in drug use, and especially problem drug use, though which drug is ascendant tends to go in cycles.
I don't quite understand the connection between dependence on a prescription drug and chaotic use of street drugs. That's the entire point of medication assisted treatment for opioid addiction (which they specifically articulate in this podcast) that prescribing an opioid can help make someone's life less chaotic. There's a ton of data on the efficacy of medication assisted treatment. So how can you believe that suboxone is safe and effective and helps people get their lives back together also believe that oxycontin is necessarily leads to chaotic use and people's lives falling apart?
It seems to be based on this corruption idea. Suboxone is safe and effective for people who are already ruined, but we need to keep any more innocent people from being ruined by exposure to opioids.
This is not to say that opioids are a particularly good treatment for back pain. The best treatment is physical therapy, which is incredibly expensive. So, yeah, poor people and vets get substandard treatment (i.e. opioids) because it's cheaper
Also, fentanyl (which is legitimately terrifying) gets lumped in with oxycontin because they are both synthetic opioids. But the root causes are totally different. As far as I can tell, the increase in fentanyl ODs has to do with changes in global trade and the dramatic increase in pharmaceutical production (and pharmaceutical production expertise) in China in the last decade. Fentanyl used be super rare and now it's super cheap.
And a pet peeve. It is more appropriate to describe fentanyl as fast-acting vs "strong". It's basically the opposite of methadone, where the dose hits very quickly and is flushed from the system more quickly (as opposed to methadone which hits slowly and is flushed from the system slowly). So, I hate hear fentanyl described as some kind of sci-fi super-potent drug. It's about how it's metabolized
Anyway, I am trying to make sense of how to be furious at Purdue Pharma while still remembering how drug epidemics work, and knowing the difference between drug dependence and chaotic use, and knowing that I would rather have people using pharmaceuticals than street drugs (which are always more dangerous). And also being so thankful that I have been sober for 19 years and that fentanyl was an exotic luxury back when I was shooting dope and not a dangerous contaminant.
