Opiods and Insanity
The Market Ticker - Commentary on The Capital Markets
2017-10-27 07:00 by Karl Denninger
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Opiods and Insanity
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64,000 dead last year, roughly, from unintentional drug overdoses. (ed: I'm not sure I trust that number, although it's allegedly official.  Nonetheless, it's huge.)

An over 100% increase in opiod deaths in the last few years, and several hundred percent among synthetic opiods such as fentanyl.

Most abuse deaths start with prescription drugs.

There are myriad overlapping issues involved here.  The profit motive among drug companies and doctors figure into the problem.  The utterly ridiculous amount of synthetic opiod (100x as strong in "neat" form as heroin) that comes in from China (illegally) to Mexico and then the US is a major component as well.  Congress passed a law a few years ago (by voice vote -- unanimous consent!) that made cracking down on abusive prescription opiod shipments harder and, in some cases, impossible -- lobbied for by, you guessed it, the drug industry.

Then there's Afghanistan.  Guess what one of their primary crops is?  Why are we there again, exactly?

Opiods have their place in pain management, most-particularly in patients where nobody cares if addiction occurs.  Hospice is the obvious (and utterly defensible) example.  But I can tell you with absolute certainty that when those meds are "diverted", even when it's detected literally within hours and the person who did so couldn't have ingested all of it yet (they'd be very dead), it is basically never investigated and prosecuted despite being a serious criminal offense.

I'm not guessing here folks -- I know this as fact.

We desperately need to stop treating all drugs the same at the same time.  There is a fair bit of evidence emerging that in places that have legalized marijuana opiod death rates are impacted for the better -- that is, they grow slower or even go down somewhat compared with locales that have not done so.  It's logical, incidentally -- marijuana has known positive impacts on how people feel when suffering from a number of conditions, and there's evidence it's directly helpful in others.  Cancer and glaucoma are just two of many examples; one in that it greatly improves tolerance of chemotherapy, and in the latter there is evidence of direct benefit.  Ironically one of the "side effects" listed from smoking weed for glaucoma would be beneficial to a large number of people -- it was observed to lower blood pressure!

Of course being stoned is incompatible with a number of occupations, but then again what you're stoned on isn't really all that material, is it?  I find it especially galling that those who are anti-marijuana are perfectly ok with you having a prescription for an opioid that produces a high -- so long as a doctor gave it to you.  If being stoned is bad then it's bad no matter the path that led you get stoned, right?

The temptation is strong to declare "war" on some malady like this, but usually what we wind up doing is jailing a lot of people and making no real dent in the problem.  The opiod epidemic is multi-faceted, but it is blatantly obvious that the drug companies have "pushed" these drugs, understated the potential for addiction (possibly intentionally with a motive of profit) and both physicians and others in the chain of supply have either said nothing or winked and nodded while cashing the checks.  The number of prescriptions for these drugs is staggering and vastly beyond any defensible evidence of appropriate use.

At the same time the illegal supply of synthetic opiods flooding into the country from precursors that are in the vast majority sourced from China is an outrage, and one that should be met with immediate and strong trade sanction.  There's simply no excuse for this and we as a nation should not be trading with nations that are, through their actions, intentionally poisoning our citizens.

We can hit China in the wallet on this, hard -- and we must.  I recommend we burn a million dollars of their T-bills and bonds on the White House lawn for every American that ODs on fentanyl until their sourcing of same into this nation, directly and indirectly via Mexico, stops.

There are answers to this problem but they are not going to be found through shooting first or, even worse, protecting those who have stoked and profited from generating this epidemic, whether those be drug companies, doctors or the Chinese.

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Goforbroke
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This appears to be Trump's new cause ... I guess failing at the wall (I will be totally surprised if this is ever build as he originally promised and with Mexican funding), at repealing ObamaCare, draining the swamp, locking her up, and (so far) tax reform means he must turn to yet something else.

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Rollformer
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64,000...in a single year, more than the total American body count in Vietnam...Staggering.
Badmoonrising
Posts: 191
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State of Disrepair
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It's all about profit, isn't it. Bastards.

Well, since my last post about healthcare and not seeing a doctor, I finally did make an appointment because of prolonged sore throat. Too much yelling "What in the heck is going on in the world." Anyways, when I called my doctor they said that I was no longer in their system and they would schedule me for appointment at there first available date, 4 weeks later. No joke.

So, this visit and blood work cost me $80,000 in premium charges for the past ten years I have been paying and not going. Yeah, this system is broken all right. It ain't gonna be repealed, they are just going to make it worse.

Please someone, give me some hope, what has govt made better for us lately?
Vernonb
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East of Sheol
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Quote:
Of course being stoned is incompatible with a number of occupations, but then again what you're stoned on isn't really all that material, is it? .... If being stoned is bad then it's bad no matter the path that led you get stoned, right?


Exactly. If a person is incapacitated or incoherent the cause does not matter - even if it is an underlying medical condition. I also wonder how much productivity SSRIs cost American firms each year.
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As far as drug diversion no one in governemnt seems to care anywmore unless you are a small time player cutting in on their territory. The crime lords make out like bandits. I used to work doing purity testing on Morphine Sulfate in the early 1990s by the Kilo. I had to go through a screen procedure by the DEA to even handle the material and strict inventory was taken for what came in and out of the vault. We used to get emergency requests from hospitals when it appeared patients were not responding - due to suspected diversion and dilution of certain opiod pain killers including Fentanyl.

You can bet the primary source (by number of counts) for diversion is hospitals and medical centers. But we had entire truck shipments hijacked en route. All it takes is one big score to flood the market.

The trucks were unmarked and required special seals to insure no tampering with contents until they arrived at the destination - usually clinics and hospitals. We had to tell government agents everything before shipping which only compromised security of the shipments and allowed organized crime to do major planning for theft and diversion. All the major theft was likely an inside job from informed parties - especially those in government - state and federal.




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Bagbalm
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I wonder if there isn't data withheld about WHO dies of drug overdose? I remember reading a similar and rather persuasive argument that all the abortions supported late in the last century actually resulted in a decrease in crime.
Sure, any drug overdose you hear about on the news is usually a white upper-class young person who has an extensive family horrified at what happened. But I suspect the majority of them were unemployed already addicted people who were a net drag on society and source of crime to support their habit. If they hadn't caught a dose of illegal Chinese fentanyl in their drugs they would have come to the same end much latter.
It's also similar to the deaths from smoking. Want to keep Social Security payments down? I have to wonder how many billions were saved by the slow way tobacco smoking was revealed to result in early deaths. The same now with dietary guidelines. They not only cut down on retirement payments but manage to extract most of a family's wealth from being passed on to the next generation.
Think government isn't capable of making that monstrous a cold-blooded calculation? History says otherwise.
Tickerguy
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Oh I have no doubt.

That's not the only thing that is grossly underreported. Avoidable medical errors are another, for obvious reasons (liability), and yet the REPORTED number is 200,000 per year.

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Flappingeagle
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It's ok, it was all for a good cause.

https://www.forbes.com/forbes/welcome/?t....

Does it seem like 1/2 of the country is on one, or more, of MJ, Coke, Crack, Meth, Booze, Heroin, Mushrooms, Opioids, or something? It does to me.

Flap

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Rufust445
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Well, half of them did vote for Hillary... The traffic death rate is creeping back up, but still below this 64K rate.

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Rollformer
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The scope of this is amazing, until recently I live in an upper-middle class suburb of Philadelphia. In the past year or so, I witnessed the following overdose deaths.

* The helper of a friend who had a small floor installation business.
* The sister of a friend.
* A dear friend's secretary's boyfriend.
* Another friend's high school daughter taken on a date to a dangerous nearby city to score heroin. They were carjacked, robbed, and she was beaten and left for dead in a park. Fortunately she survived and is thriving, and the perp is doing 10-15.
* Not related to opiates, a friend who was a republican committeeman shot twice in the head by a rabid anti-Trumper. Now, in fairness, the guy was a known lunatic before Trump was even running, but it does go to show that violent lunatics are not the exclusive purview of the Right.
Nadavegan
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@Bagbalm: I suspect you are spot-on in your assessment. Witness my tale of two counties:

Last year, while living in one of the wealthiest counties in the South, I underwent shoulder surgery of the most painful kind. I was given one bottle of Oxy for pain killer, enough to last a few days. Well, labrum surgery results in pain and discomfort for up to a year, and can result in extreme pain for as long as two weeks. My one bottle ran out in 5 days, and in order to get another one in this very upscale area, I had to beg, borrow, and steal for a refill. (And by the way, even after 10 days, kicking them was a bitch. 2 days of headaches and itchy skin.)

Three years prior, while living in one of the poorest counties in Appalcahia, I had a severe disc herniation to three lumbar discs. After grunting through the pain for 5 weeks, I finally went to a doctor. This was a trusted doctor, too, and very much into lifestyle management before prescriptions. But as I hobbled in, his very first question was, "Do you need an opioid?" NO. I was horrified at the suggestion.

But my experience speaks to the point: the drugs are so much easier to get in some places than in others. Could it not be because the elites know that their policies are killing rural areas, and there is nothing on deck to replace the industries lost? Farmers, miners, road workers, construction, manufacturers - all able bodied but out of work. And if they ever got wind of who was responsible, we'd see a lot more Blair Mountain insurgencies. Well we don't want that, so let's make it easy for them to just euthanize themselves. I spent a lot of time around some frightful hillbilly coal miners, and if they ever got real angry, **** would get real in a hurry.

On the other hand, we in the suburbs are so comfortable. We have our stable jobs and steady routines. We have been bought and sold and are no threat. We have the status quo, that is our opioid. We just drift on a cloud of comfort, our freedom and dignity slowly atrophying until one day we are dead. Just how the elites want it.
Lenguado
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Quote:
violent lunatics are not the exclusive purview of the Right.


?????? Huh?

Have you been watching the news at all? Pretty much every recent "violent lunatic" in the news lately - antiFa, Scalese shooter, Vegas Shooter, etc, etc, etc have been left wingers.

Not saying that there aren't violent folks on the right - but the overwhelming evidence is that the majority of them reside on the left, cough cough Harvey Weinstein and Hollyweird buddies cough cough ...

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Goforbroke
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A friend of a friend owns a funeral home. He gets one death a day due to drug overdose.

Not to mention the incredible damage the drugs are doing to young families with kids who are then raised by grandparents, friends ... anyone.

Sigh.

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Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our Light, and not our Darkness, that most frightens us. -- Marianne Williamson
Rollformer
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@Lenguado: Perhaps I should have added a sarc tag. My current situation dictates that MSNBC be on all day on the idiot box. I think antifa could burn down Richmond, and they would Photoshop swastikas on the participants before showing the video.
Mdyoung216
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I took opiods for over a year before and after hip surgery. After I had the surgery I cut down to half a pill from six a day and I stopped. Felt pretty crappy for a week, but I never thought about going out to buy heroin. People take these drugs because they choose to. At some point personal responsibility comes into play. I voted for Trump, but I have to laugh when he says another "Just Say No" program is going to stop people from using drugs. Plus I think the government getting involved makes things worse in some cases. Guy is taking the pills to get high, and now because of government pressure the doctor cuts him off, so he goes on the street to buy the stuff that kills him. Just keep giving it to him. How many people are given methadone. So what's the difference.
Ckaminski
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Seriously. All of it should be available over the counter.

You want to kill yourself with meth? Sure. But here's medical grade ****, not crap brewed up in some Chinese sweatshop.
Whitehat
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New York City
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some information that is somewhat related and very useful. taking care of two dying cancer patients recently, something became apparent. the oxycontin/oxycodone **** is not as good as plain old morphine sulfate ER and IR. both drugs have immediate and extended release formulations and most patients are proscribed both and use a base level of the ER and use the IR when necessary. when well managed the IR is usually not often needed. what i observed and thankfully the urgent care center also agreed is that the morphine did a much better job at lower dosage and without any serious side effects. this was discovered when one person was brought in for urgent pain management and the staff physician used morphine. one patient also noticed that she was getting ****ing paranoid on the oxycrap. i noticed less confusion and disorientation in both almost immediately. two separate cases are not a study, but it might help someone reading here when dealing with terminal care.

it seems like the doctors were trained to default to the oxycrap, probably due to all of the marketing. yet morphine has a very good track record for severe pain and can be used at very high doses when necessary without depressing body functions or interfering too much with life.

in regards to dilution and other acts of theft. you are safest when these products are delivered in pill form as this is harder to adulterate. however you must make sure that the person takes the medication. it can become an issue as they decline. a secondary option is a concentrated liquid form that is dosed sub lingual. this form is not easy to steal, unlike IV and other inject able forms. we had a closed door scandal at our local hospital as some of the staff were diluting syringes filled with drugs with saline and the doctors were wondering why patients were in agony during awake procedures. these syringes are handled by many people after the hospital pharmacy or department staff loads them. a low level or any other position would be a perfect in for a junkie or dealer. best part with one of our local scandals is that the dirtbag did not lose his job, only was banned from the special procedures area. all hospital employees should be subject to regular, not random, drug testing by federal law. there would be a lot of job opportunities opening if this happened.

if you have someone that is going through this, you must be very vigilant as they might not be getting their pain medicine appropriately.

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Tickerguy
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Yep......

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Ckaminski
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Quote:
diluting syringes filled with drugs with saline


1, this sounds like there ought to be tamper-evident syringes you can use, or even a bag that shreds the serial number if torn, and has to be opened in the patients room - for narcotics, I can't fathom why this isn't already the norm. Even with the insane prices hospitals charge for drugs this can't add more than a dozen or two pennies to the costs.

Can you vape opium poppies? Just cut out the middlemen...
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