Social POTWR 2019 Vol 3: Examining Opioid Addiction In America

[Cubo de Sangre]

Greetings War Room Sherbros,

Welcome to the next installment of the Presidential sticky-threads. This one will be a round-table discussion on the extent, causes, and cures of the opioid "epidemic" in America. The panel is comprised of board members who have experience as some type of law enforcement, in the medical field, or having themselves abused these painkillers. Discussion will be lead by @nhbbear.

Cheers,

Cubo


Law Enforcement Panel:

• @A.C.
• @bushman505
• @cleetus
• @Gregolian
  
• @Protectandserve
• @ens189
• @sleepwalk

Medical/Care/Use Panel:

• @nicapica
• @exHeavyHippie
• @Final Rehab
• @hisandherpes
• @abiG
• @cornwallis
• @Lubaolong
• @HomeCheese
• @BudKing8806
• @second sight

***This is an ongoing series of sticky-threads that will take on various topics in varying ways. If you're interested in leading a discussion on something please take a look at this thread and then send me a PM with your ideas.

POTWR 2019 Vol 1: Shots Fired! Examining Police Shootings In America
POTWR 2019 Vol 2: Happy Happy Joy Joy

 

[nhbbear]

Hello, my name is Kevin, and I have been a police officer for sixteen years in a city of 30,000. In the immediate area of the city, there is approximately 150,000 people. My department has over 30,000 calls per year, and we average 3 murders and 20+ shootings per year. We also average 12 overdoses per week, and have 13 deaths on average, every year, from heroin.


I have been a supervisor for the last 8 years, with the last two as a lieutenant in charge of a shift of 16 officers. In addition to running my shift, I am also a district commander in charge of an area of 15,000 citizens. Before I became a supervisor, I was the defensive tactics instructor for the department for ten years. I was also a taser instructor for ten years. I am considered a use of force expert, and have testified and given depositions for court proceedings regarding the use of force by officers.



Enough about me, on to the topic of the day: Overdose Epidemic. I hope everyone can recognize the seriousness of this polarizing topic. I hope we can have a candid discussion on the topic of addiction, and I appreciate your participation in this discussion.


I want to that Cubo for hosting this discussion and thank the other participants for their input as well.



Thanks, Kevin aka bear

 

[nhbbear]

In the United States, we are in the midst of an epidemic. This epidemic has many causes, and few real solutions. Lives are being lost, families torn apart. The epidemic is HEROIN.


More Americans died in 2016 from opioid related overdoses than the number of Americans killed during the entire Vietnam war!



That number was 52,000, of which, less than 2000 was due to painkillers alone. The main culprit was fentanyl mixed with heroin-83% of those 52,000 deaths was due to a fentanyl/heroin mix.



In 2017-62,000 died an increase of 450 percent since 2000. Since 1999, over 183,000 people have died due to overdoses. When you look at the last couple of years, you can see that 2015, 2016, and 2017 account for almost that entire amount.



For example, The total number of overdose deaths in 2017 was over 70,000, which includes suicides and homicides. And over 500,000 people admitted to using heroin in 2017.



Just for additional background, in 2016, the number of car accident deaths was 40,000, and firearm deaths were 39,000, this year being the first year where overdoses outnumbered car accident deaths and gun deaths.



People addicted to painkillers are 40 times more likely to be users of heroin, and the overdose rate from prescription drugs fell significantly from 2010-2015 while the rate from heroin increased significantly.



2010 29% of fatal overdoses was due to methadone, which is used to treat heroin addiction. The latest drug used to treat opioid addiction is suboxone, which decreases the withdrawal symptoms while blocking the receptors, meaning that they will not get high from using heroin or other opioids. That is of course, assuming that they take the suboxone and do not trade it or sell it. And I know from interviews, that many keep suboxone as a “just in case” they can’t get the money for heroin, or they melt, and then inject that drug.



Heroin overdoses went from 6% to 25% from 2010-2015. Then Heroin overdoses jumped 73% from 2014-2015.



Again, the cause is likely due to that lethal mix of fentanyl and heroin, with Fentanyl being 50 times stronger that pure heroin, which is why people actually seek out this particular mix.



Od deaths fell 8% from 2016-17 probably due to an increase in narcan, which is used to reverse the effects of an overdose. I have seen people rise from the dead due to narcan, then they have the audacity to be angry that their high was ruined, even when you tell them that they almost died.



Deaths among those recently incarcerated are 120 times more likely than those they were not incarcerated.



Males aged 25-44 are most likely to die due to overdose, however, teens are the fastest growing rate of overdoses.



Now, to examine the causes of the high numbers of overdoses due to addiction.



Back in the 90s doctors were pushed to treat pain as a serious issue. Over 100,000 people suffer from serious pain. There was a push from pharmaceutical companies to push prescriptions for OxyContin. The doctors were told that the chance of addiction was very low, which is why in recent years, many states have successfully sued pharmaceutical companies for causing the addiction crisis in their states. My state was one of the states that successfully sued one company, and lawsuits are in the works to go after other companies as well for pushing their particular pain killers.



Now, how does a person go from using pain killers to heroin, then on to fentanyl/heroin mix that often leads to overdoses and death? The doctors went from the push to prescribing opioids to being forced to cut down on the prescriptions when it was learned that there was the addiction crisis. When the doctors began cutting off their patients, many continued to seek out pain killers by going to different doctors, which is called “doctor shopping.” Some of these people carried with them, their X-rays and mri results to present to prospective doctors. Some states, such as Florida, were infamous for giving out prescriptions for hundreds of very powerful pills to people claiming pain, or having their histories with them when they arrived, regardless of the fact that they did not reside in that state. These people would go from doctors office to doctors office, which were in strip malls along every major road, often several offices in the same mall right next to each other. So people would simply walk from office to office. One group of drug dealers from Boston took advantage of this and would send people with their pain histories to hit up these offices, then travel back with thousands of pills. These guys would send several people at a time, every single week. They made millions.



So, to continue the path of someone legally prescribed pain pills, to heroin-after being cut off, they would often buy the drugs on the streets. This obviously presents new problems-being law enforcement(hello) and dealing with violent criminals. When the cost of the illicit pills became too high(prices would range around $1 per milligram of hydro condone(Vicodin) to $5 per mg for OxyContin, the addicts would then either seek out, or be introduced to heroin, which is much cheaper, around $10 for the high that was costing them $100. Obviously, when they begin to use heroin, the high is less intense and the length of time for the high would decrease each time. Soon, they just seemed to be trying to stay ahead of the withdrawal symptoms, which are very unpleasant-pain absolutely everywhere, extreme anxiety, very sick to their stomach, shakes, seizures, and a whole host of other symptoms. Just like heroin, eventually they are introduced to fentanyl, which is so powerful, they often experience a high similar to when they first started. In the 1800s, when opium addiction became an issue, they called this phenomenon “chasing the dragon” which is simply trying to attain that first high that they experienced.



Soon, the amount of fentanyl increases, and they begin to overdose. Since the heroin/fentanyl mix is cut by street dealers, you never know how much heroin vs fentanyl you are actually getting. You may think you are using the same amount that you did yesterday, but end up getting an almost totally fentanyl mix, which leads to the overdose/death.



As i mentioned earlier, the distribution of narcan has lead to a decrease in deaths. Narcan used to be administered via needle injection to the now nasal spray that is given out at health departments to family members of addicts for when, not if, they will find their loved one overdosing. Having this lifesaving drug has lessened the risk of death, but it has also lead to addicts taking more risks, using more amounts of fentanyl, relying on the belief that someone will be able to save them via narcan. This is not always the case.



This is just a brief introduction to the heroin epidemic, so declared by President Trump. I will include some of my experiences with responding to overdoses, including the many times i have responded to an overdose death. I will also outline the different ways in which police departments, including my own, have begun to respond to overdoses. We have recently amended our responses to include peer counselors, that were once addicts-many of whom our officers have either arrested, or responded to their own overdose.



I hope you take this discussion seriously, and try to avoid falling into the trap that “addiction is a choice” “stop giving them narcan and lessen the amount of addicts, which lessens crime”- true, but heartless. Also”addiction is not a disease-cancer is a disease, addiction is a choice”. Addiction is a disease, with the brain chemistry changing and altering decision making, impulsivity, depression, anxiety, and other functions that rely on chemicals in the brain, which is an extremely complex organ



So, once again, i invite your discussion, experiences, and options on the matter, but remember to remain respectful, as their will be many posters reading these responses that have family members that are addicts, and may have lost a loved one to addiction.

 

[nhbbear]

Where did the heroin/opioid crisis even come from? Is it the result of people getting hooked on pain killers, then graduating to heroin? Or is it because of some other cause?


Since the US invasion of Iraq and Afghanistan in 2001, the production and distribution of heroin has increased dramatically. An estimation has stated that heroin production in Afghanistan has increased approximately 40 times what it was prior to the US invasion. In 2013 alone, that production increased 36%.


That year, coincidentally, or not, was when most of America started to say “oh shit, we have a heroin problem!” There was a big jump in the amount of heroin users from 2012 to 2013, and the numbers have been going up ever since. Obviously, we know that the heroin epidemic began before that, but it was around 2013 where we recognized that we were in the midst of an epidemic, which was seen in Europe and the rest of the world, which we will examine later.


So, back to Afghanistan. Their one and only major crop/export is heroin that they refine from their poppy plants. Weirdly enough, American troops have been guarding the poppy fields, allowing the farmers to cultivate and extract the sap that is ultimately turned into heroin.


Why in the purple fuck are American troops guarding the poppy fields? Reports state that American troops are protecting and allowing the farmers to grow their poppy plants to keep them happy and to keep them from supporting isis/al-qaeda. These farmers are paid to not refine the poppy into heroin, and many farmers who previously did not grow poppy, began to grow the plant just to be paid not to sell it. Why would these farmers grow this plant if they are not allowed to sell it? Well, the truth is that they do refine the poppy into heroin and ultimately sell it.


At the same time that the United States saw and increase in heroin use, viEurope has also seen an increase in heroin use. Currently, Europe has 1.4 million heroin addicts. Between 2009 and 2016, the number of overdoses increased dramatically, similarly to the trends seen in America. With fentanyl use increasing in Europe, overdoses began occurring in obscure fishing villages in Britain, which signaled that the epidemic was growing in Europe. Still, the numbers of overdoses in Europe pale in comparison to the United States, despite the dramatic increase over the last few years.


As stated, the poppy farmers in Afghanistan are responsible for approximately 80% of the heroin production worldwide, but there are other countries that are increasing their heroin production as well. South east Asia, specifically Myanmar(Burma), Thailand, and Laos have increased their hold on the heroin production in what’s called the “golden triangle.” Once exported from that region, the drug finds it way to Russia, and from there, it is smuggled into various countries for sale. This region accounts for approximately 15% of worldwide heroin production.


While significantly smaller in scale, heroin production in Mexico and central and South American counties has increased due to the high demand in America. Mexico accounts for 2% of production, but almost all of America’s heroin is smuggled in through the southern border from Mexico. The rest comes in on boats to states on the east coast, or into Canada, and then smuggled into the United States. The heroin produced in Mexico is low grade “black tar heroin” and the heroin from central and South America, specifically, Columbia, is higher grade. Columbian “China white” is very pure form of powder heroin, but also, “China white” is a type of fentanyl, specifically furanyl-fentanyl-but more on the different analogs of fentanyl later.


As for the production of fentanyl, China is the the number one culprit, followed by Mexico. Since fentanyl requires a lab with educated technicians, the production of the drug is usually not able to be made

by smaller outfits. However, once produced, fentanyl can be sold in several forms, including powder, liquid, and even pressed into pill form. These pill presses will even make the drug to look like legal painkillers and other pharmaceutical medications.


The Chinese sale of fentanyl has largely been via internet transactions and shipped in packages. The rest is smuggled into Mexico or Canada, then smuggled into the United States. The labs producing fentanyl in China, are both legal pharmaceutical labs and clandestine labs.


Since 2015, pressure from the United States on the Chinese government has led to a crackdown on the sales from the legal labs. Incidentally, this has caused a boom in the increase of clandestine labs. This has also created the opportunities for labs in Mexico and central and South America to pop up. Several labs have been raided in Mexico City, however, the production continues in labs in other parts of Mexico.


Other forms of fentanyl have begun to be created as law enforcement develops tests to detect fentanyl. Acytl-fentanyl was one such analog of fentanyl which is often sold via the internet. The aforementioned furanyl fentanyl was a popular designer drug that was coursing through New York City.


HOn a personal note, one of my best friends from high school lost his brother to acytl-fentanyl sold over the internet. My department responded to the call and found him deceased, sitting on the floor criss-cross applesauce(formally Indian style). I had to break the news to my friend that his brother had died of an overdose instead of a “heart condition” that they originally suspected. His wife cleaned up the scene, and after I told my friend what I suspected, he pressed the wife for information and she eventually cracked and even provided a package containing more of the drug. He brought the package to me and we attempted to test the substance in order to try to get answers earlier than a toxicology report, which takes at least six weeks to get back. The substance initially tested positive for cocaine, turning the test kit a very bright blue, then fading, indicating that it was not cocaine. It did not test positive for heroin, fentanyl, or any opioid test kits that we had. It was only after the toxicology report that we learned it was acytl-fentanyl that killed him, which will not yield a positive test for any traditional field test kits. I had a bit of a scare as I was logging the substance into evidence. As I was closing the zip lock baggie, I had to let the air out, which caused some of the powder to puff up into my face. I immediately washed my face and hands and luckily, I did not suffer any ill effects. This incident led a push to change the testing procedures, creating a policy that forbids any testing in common areas while creating a testing area in our DUI room. We also require two officers to be present for any testing.


Another analog of fentanyl is carfentanil, which is 100 times the strength of regular fentanyl, which is 50-100 times stronger than morphine. Carfentanil is used as an elephant tranquilizer. That’s right, it’s used on elephants. This stuff is used to mix with heroin, and is becoming more prevalent because it requires so much less , which means that they don’t have to smuggle as much, which reduces the risk to the dealers of getting caught. This deadly mix is also being sought out by addicts because it is a much stronger high for those that have a very high tolerance.


So, we have looked at the reasons for the increase in heroin production and fentanyl, as well as the smuggling and shipping routes from the producers to the users. Now, we will look at some of the treatment options and ways to combat the epidemic. Kmdxp

 

[nhbbear]

We have examined both the opioid crisis, and the path to addiction and the routes that these drugs take to flood our streets and invade our homes. So how do we fix the problem?


Recently, President Trump declares that the opioid crisis was a national health crisis. This move is supposed to increase the amount of money available for states to try and combat this issue. More money for states could mean anything from more treatment centers to more money for police to try and arrest the dealers that sell the substances causing the overdoses. There has also been a push to limit the availability of opioid pain killers being prescribed by doctors, reversing the trend from the 90s for doctors to prescribe powerful painkillers to patients.


But how much of the problem is actually due to legal prescriptions? 75% of heroin users have admitted that they first began abusing legal painkillers before turning to heroin and then fentanyl. But of this 75%, only 25% first became addicted to painkillers that were prescribed to them. The rest were either getting the pills illegally from friends or family members. They admitted to stealing the pills from family members with prescriptions for opioid painkillers.


As a society, we have been struggling to adequately treat chronic pain issues. Insurance companies often put pressure on doctors, and thus patients, to rely on the least expensive treatment for chronic pain, which is almost always pain medication. Physical therapy is more expensive than a monthly prescription for painkillers, and surgical options are expensive, and often may be too severe of an option-like using a shotgun to kill a wasp that is crawling on the wall of our bedroom. Even the less expensive treatments, such as chiropractic visits or massage therapy have a limited number of allowed visits. So the doctors treating patients faced with chronic pain have few long term answers aside from prescriptions for painkillers, which have been shown to have diminishing returns in terms of long term treatment-meaning, the longer you use a particular medication, the less effective it is.


In 1990, there were approximately 75 million prescriptions for painkillers. In 2010, there were over 210 million prescriptions for painkillers. So, clearly, the doctors and patients have been forced, or chosen to choose the least expensive options: prescriptions for painkillers.


Now, this next part is difficult for me on a personal level. I have spondololisthesis, which is a long word for a fracture in my lumbar spine(the lowest portion of the spine), which forces one of the discs to be pushed forward, out of alignment from the discs above, and below it. I also have three herniated disks, two in my lumbar spine and one in my thoracic spine(the middle of your back). Whether it is from a car accident, years of playing football, years of extreme skiing involving jumping off of cliffs or hard impact from jumps(probably not the most intelligent choice of recreation, now that i look back on it), or even being born with it-I live with a lot of back pain.


As I write this, i am sitting on two ice packs, and have taken two hydrocodone(Vicodin/norco), three tizanidine(xaniflex-muscle relaxers), as I do most nights to be able to function. I am forced to use this regimen due to work schedules and not being permitted to take any such medications before, or during work. So, basically, I have to deal with the pain for most of the day until i can take any medication. I currently see a chiropractor(which I am out of visits for and pay out of pocket), and go to physical therapy twice a week(I have just run out of visits for that). I have tried acupuncture, dry needling(acupuncture with electric current), deep tissue massages(very nice, but expensive), had nerve block therapy where they used an x-Ray machine to be able to precisely inject a nerve blocker into the part of the spine that is protruding and pushing into the bundle of nerves that run down the spinal chord(it seems to have permanently stopped the pain that used to run down my legs, causing any contact with, say clothing, to feel like either ice or fire, depending on the day-but has done nothing for the actual back pain. I also get monthly injections of toradol, which is an anti-inflammatory steroid to try and lessen symptoms, and every other month, I get a shot of kenalog, which is a stronger steroid for the same purpose.


I have recently(last week) met with a spinal surgeon to discuss a procedure to fuse my lumbar spine and the first thoracic disc together to try and lessen the amount of pain(and flexibility and mobility as a consequence). I am not a candidate for a procedure to insert an electric stimulator device that would send shocks to my spinal chord, lessening back pain. I also once, or twice, maybe three times() tried marijuana to lessen pain, but it only made me hungry, and after an edible carmel, found me face down on a kitchen floor for thirty minutes staring at my toothbrush. So, you could say that i have tried just about anything and everything to make my back pain manageable. As earlier stated, pain medications have lessening returns, meaning that they become less effective over time. I refuse to increase dosage, or switch to a more powerful medication, and simply try to lessen my discomfort to a manageable level, which is why I have a freezer full of ice packs that I use every night.


I rarely have days where I absolutely cannot move-unless I spent all day lying on a couch, or spent many hours in a car on long trips(my anxiety begins about two weeks before any vacation because I know I will be in a lot of pain for a couple weeks after any trip). I do not have loss of mobility or flexibility, though walking, which I enjoy, can sometimes be painful. And the gun belt I wear to work weighs 35 lbs, the vest is five, and a couple pounds for the boots. So to say that my job exacerbates my condition is an understatement. So, you can see why I am hesitant to agree to the surgery, and you can also understand why I would not simply want to take the easy route and blunt the pain with more medication.


So what do doctors do for people like me? Because of the crackdown on prescriptions for opioids, what options are left for those who suffer with chronic pain? This is one of the questions that doctors and patients have trouble figuring out. What if my doctor was pressured to quit prescribing pain medications to someone like me? Would they begin to try and buy painkillers on the streets, or switch to heroin? For the record, i certainly wouldn’t. I have seen too many wrecked lives to ever consider such an option, and no amount of pain is going to make me risk losing my wife or three children. Besides, i have stopped taking the Vicodin on quite a few occasions, and it is two days of anxiety and increased pain and discomfort, but i am on a low dose and do not have any bad withdrawal symptoms. But there are many people that are willing to make that often fatal choice. For them, those withdrawal symptoms are very severe, including throwing up, seizures, pain everywhere(your brain’s way to try and force you to take opioids), extreme anxiety and depression, and quite a few other symptoms too numerous to list.


I share that information with hesitation, but I feel that honesty and insight are important in such a serious discussion. I have also previously shared that i suffer from depression as well, mostly because of the back pain. This combination can often lead to a person becoming a heroin addict, living from one injection to the next. I think the difference is in the reason for using pain medication-to relieve pain versus trying to get high. I also have a very solid and supportive family, whereas some simply do not, or worse, they have no support or an abusive family unit.


So again, that leads back to the discussion of how some people end up hooked on heroin, which will almost always lead to overdoses.


One definite solution is that there absolutely has to be more treatment facilities to try and help addicts get clean. There are waiting lists for in-patient treatment facilities because there simply are not enough beds to keep patients long enough for them to get clean. Addicts that willingly check themselves into a treatment facility will often leave that program before they can get clean, which leads to them, back on the street and back on heroin.


Many cities and jurisdictions have been using “drug courts” which is an option for a person, dealing with addiction, avoids jail time if they are able to follow a program that includes narcotics anonymous meetings, as well as scheduled and random drug testing to try to ensure that the person is not using while in the program. The issue, however, is that these programs don’t really have that much follow through when the person is not adhering to the program and repeatedly test positive for drugs. It relies on their willpower to avoid using, with many addicts knowing that there is a slim chance that they will be punished for testing positive. Some will see it as a furlough to continue using drugs, rather than serve jail time and withdrawal while in jail. Some of these programs(every county/city runs it differently) may employ a “three strike” system, or some other way to manage those that fail the drug tests.


So, I see the solution to this problem is that we have to create more in-patient treatment programs that are the alternative to jail time for addicts that are arrested for either simple possession, or some peripheral crime caused by their addiction(theft to support their habit). And this would not be optional, it would be jail, or lock-down rehab.

 

[nhbbear]

The problem, of course, is going to be funding to set up these treatment facilities and the trained staff to run them. There are a shortage of doctors and therapists as it is, let alone if you created a bunch more facilities without the staff to run them. With President Trump declaring the opioid epidemic as a public health crisis, that could lead to more funding for treatment facilities.


Another problem is that many communities simply don’t want the drug clinics in their neighborhoods. There is the belief that “if you build them, they will come” meaning that their community would be flooded with drug addicts roaming the neighborhood, or they may be supportive of treatment, but “not in my neighborhood.” But the truth is, they are already here, already roaming your neighborhood. Many communities are opposed to methadone clinics, which are out patient administration of methadone to help addicts avoid withdrawal symptoms by giving out methadone on site. Methadone has been a traditional method to treat struggling heroin addicts. The newer treatment of heroin and opioid addiction has been suboxone, which is suboxone plus naloxone(narcan), which in theory, helps the addict avoid withdrawal symptoms while the naloxone prevents them from being able to get high, as it binds to the receptors in the brain where the heroin or opioids bind to. So even if a person taking suboxone would shoot up heroin, they would not get high, nor would they overdose. The problem here, is that this is voluntary, so they can choose to not take the suboxone and shoot up heroin instead. The suboxone also does create a minor high, which simply keeps the person addicted to the suboxone, which is certainly preferable to heroin.


Suboxone is also abused, as i detailed in a previous post, of searching under a bridge to find three people melting the suboxone, and injecting that when they could not obtain heroin. On a side note, all of those people are now dead due to heroin overdoses, one in 2017, the other two just a few months ago.


A growing number of people have championed marijuana as both a treatment for pain, as well as a tool to help addicts get clean. The theory here, is that the marijuana makes the withdrawal symptoms less severe. I would be 100% in favor of this alternative(for the record, I am pro-legalization for both medicinal and recreational marijuana), however, my experiences have been that almost all heroin addicts also smoke pot, and it doesn’t seem to be helping them.


There has also been building momentum for other drugs, such as kratom, which is from a species of evergreen tree that grows in south east Asia. Kratom, when taken in low doses, can act as a stimulant, and when taken in bigger doses, can be a sedative drug with some feelings of euphoria. Some people have claimed, anecdotally of course, since it has not been studied, that using kratom can reduce opioid cravings and can be used to get opioid addicts clean. The problem, however, is that there have been dozens of deaths linked solely to kratom, which when taken in large quantities, is fatal. So addicts that are taking kratom to kick the opioid habit, may try to take more of it to get that euphoric high, but end up overdosing on the kratom.


And finally, I would feel remiss if I did not included some mention of the success that countries like Portugal and Spain have seen from simply decriminalizing all drugs. Faced with its own severe heroin epidemic, and the highest rates for HIV and other drug related diseases, Portugal decriminalized drugs and increased availability to treatment centers. When someone is caught with less than a ten day supply of any drug, rather than a criminal action, they face administrative action where they come before a panel of specialists that try to dissuade the person from using drugs. They are then set free with either no penalty or a fine.


This move has been lauded by many as the cure to addiction, but the numbers are very confusing. After an initial surge in users, that leveled off and has stabilized. Looking at the numbers now, drug use has marginally increased, not the disaster that most fear would happen in the United States, should that happen here(I am somewhat in that category). What has happened, however, is that overdose deaths has dropped dramatically, as has new HIV cases.


What do all these options tell us about our opioid epidemic? Well, for starters, there is no one option that is a cure for all addicts. There are generalized responses that will certainly help those addicted that includes reducing the stigma of addiction; making treatment a much more accessible option for those that want to quit and presenting the choice of prison or rehab upon those that are arrested for, or because of drugs; increasing the availability of options, such as marijuana, as a possible treatment(though, I expressed my skepticism on this one); and changing the mindset of dehumanizing criminal actions for ones that rely on treatment and professional counseling that will target the reason the addict turned to drugs in the first place.


I don’t have all the answers, nor do I think anyone else does either, which is what makes this such a difficult and delicate situation. I think we need to look past the shambling, poorly dressed and dirty persons holding signs, asking for money that we know is to fund some form of addiction, and see a person that is struggling to survive a very difficult lifestyle that they have chosen. And yes, living as an addict is a terribly difficult existence filled with depression and anxiety about getting their fix, self loathing for their behavior and things that they do to get their drugs(prostitution, theft, panhandling), and separation from family and friends because of their addiction.


So, remember to be respectful, and offer thoughtful insight, and maybe we can have an enjoyable and educational discussion.

 

[nhbbear]

My apologies for being so verbose, but it’s kinda hard to give this topic even the briefest of coverage without some length

 

[nicapica]

My name is David. Addict for over 10 years.
Grew up in the Bay Area and have more or less seen this opiate epidemic from the start. I’m kinda short for time here’s one thing that came up during my last run 3 years ago. Fentanyl laced Black tar was everywhere I have never seen “ China white” or any other form of dope. The quality of the product in 2016 was trash I cannot imagine it getting better. My last od was due to fentanyl.

I still keep in touch with my friends from rehab (I went to an intense county funded rehab in oakland) and the one thing you see now is people being hooked on fentanyl. Like tar doesn’t get them high anymore so of course this leads to way more people dropping dead.

I’ll continue once I’m on an actual keyboard.

 

[Cubo de Sangre]

As a society, we have been struggling to adequately treat chronic pain issues. Insurance companies often put pressure on doctors, and thus patients, to rely on the least expensive treatment for chronic pain, which is almost always pain medication. Physical therapy is more expensive than a monthly prescription for painkillers, and surgical options are expensive, and often may be too severe of an option-like using a shotgun to kill a wasp that is crawling on the wall of our bedroom. Even the less expensive treatments, such as chiropractic visits or massage therapy have a limited number of allowed visits. So the doctors treating patients faced with chronic pain have few long term answers aside from prescriptions for painkillers, which have been shown to have diminishing returns in terms of long term treatment-meaning, the longer you use a particular medication, the less effective it is.

This is quite the pickle. It's just cheaper and easier to do the drugs.

 

[BudKing8806]

Very interesting read. I will try to devote some time to respond later tonight. The organization I work for does offer a medication assisted treatment(Suboxone) program that I have mixed feelings about.

 

[Protectandserve]

I've been a cop for 10 years in Southern California. My first few years we rarely ran into heroin. I mean like if you got a bust with any amount it was an oddity. We found way more meth than anything.

What we did find was pills. Opiates. Lots of em. Kids stole em from parents, had docs who prescribed them fraudulently or they got them from friends at parties.

About 3 years in our guy who worked the DEA task force told us we would start seeing heroin in a few years, I did not really think much of it since I never saw it on patrol.

Sure as shit with the crackdown on docs and opiates, heroin fucking sky rocketed. You were finding it on every dope arrest, shoplifters and even teens.

Heroin, needles and all the associated paraphernalia was now rampant.

About 2 years ago we got issued Narcan. We Narcan people regularly at houses, hotel rooms or in their cars. I've been on a call where one of our regulars took 4 things of Narcan from fire to come to. The Narcan fire has is about 2 of our doses that the PD carries.

Almost all my encounters with heron users I talk to them. Ask when they started, how, what they started with etc.

Nearly all say they started on pills. When they got too hard to come by they switched to heroin. Most started smoking it and shortly moved to injecting.

When you ask about the first time they injected heroin the look they get when they describe it cannot be put into words. It's just a wanderlust.

For the record I am absolutely not a dope cop. I do not go looking for drug arrests and never have. Which is unpopular at my agency as it is in many places. Many departments equate being out and arresting people for personal use quantities of drugs with being a rockstar cop. It has for sure cost me in career advancement, pay bumps on reviews and the like. While I dont think drugs should be legalized, I'd rather go after the crime associated with it (fraud, theft, burglary) than go out looking for dope.

We have had several officers get stuck by dirty needles. Which is fucking terrifying.

I've worked one stop that was cartel level transport of heroin and meth. This was years back and I later learned that the kilos we thought was heroin, later tested for pure fentanyl. It lead to some large busts for our narcs.

All in all I think the medical industry 100% over prescribed and still over prescribed opiates.

Personally I will not take any. I took one or two when I had my wisdom teeth out and it fucked me up. I did not like the feeling and it scared me.

 

[cleetus]

I'm a cop in NJ.

I grew up with a kick-ass cousin named Marc. He was 3 years younger than me, and we lived across the street from each other during elementary school and junior high. In high school my aunt and uncle moved about 30 mins away, but I still stayed as close as I could with them.

Me and Marc worked together at 2 different jobs, Chick Fil-A, and then with a tile company. I still remember being on a tile job with him and competing to see who could break the most tiles over our heads. He knocked himself out trying to bust 3.

I was going to college and Marc stayed as a full time tile guy. Eventually he started to change. He moved out of my aunt's house and got a place with his buddies. He skipped out on work and I saw him less and less on those weekends I was still doing tile. He started getting into weed and boozing. He was always a little "nutty", but fun. I met him at a midnight bowling place on night and saw he was fucked up - black eyed, and a bad attitude. He started a fight with guys in the next lane over nothing. I saved him from a beating and we went our separate ways for a while. I graduated and found a part time cop job that took me across state, and only saw Marc on occasion.

I get a phone call from my aunt that Marc got locked up for a DWI. I made a couple calls and found out he had active warrants for possession too. Long story short, Marc graduated from weed and booze to heroin.

Marc tried rehab, halfway houses, and the whole program, but wound up getting rolled a couple times in shithole Newark, NJ. I visited him a couple times, and what was once that fun, nutty kid was a shell of himself. Broken teeth, open sores, and some weird rash on his arms are what I remember most. I'd just had a kid and he wanted to hold my son. I wouldn't let him because I was worried about this unknown infection getting onto my kid. He was such a good hearted dude, and I wouldn't let him hold my kid....

Fast forward through more rehabs, getting kicked out of my aunt's house, moving in with MY parents, and getting kicked out of there for stealing, me looking for possible solutions for him , and boom - he moved to the west coast with his sister. I talked to him a bunch, he seemed to be cleaning up. The rashes and boils apparently were healing and he was doing great. I was so fucking proud of him.

His body washed up on a riverbank in Portland.

 

[Gregolian]

I still contend from what I see at work with juveniles that weed/boozer are gateway drugs still given all of them have graduated to pills then heroin and/or meth as adults

Not a gateway in the sense that you go "oh, this joint was fun let's inject ourselves with some crystal" but the drug dealers these people use sell OTHER shit too, get fucked up with their clients then sell them that other shit at the same time.

Almost every Burglary 2 charge I see is some transient person with a self-medication habit that has been trespassed from a grocery store and they steal food so they've committed a crime while being prohibited from a place and get dinged with a Burglary charge.

 

[cleetus]

I was a union rep for a while, and had to deal with my co-worker's addictions. Part of my job was getting help, and running interference with the administration to make sure they didn't lose their jobs.

One case in particular was rough. I got hired the same day as XX and we became fast friends. XX was a maniac from day 1. Fun as hell, crazy, and a TERRIFIC cop. He obviously had a checkered past, which gave him a leg up on me when it came to cop stuff. He'd seen and experienced a lot, that I was completely naive to. He was an awesome cop, but he's also an enabler.

We were hanging off duty one day and went to Pathmark. He ran inside and came out with a case of whipped cream. I was like WTF are you doing with that? I hope you don't think we're going to lick that shit off each other. He's like, "no, asshole. We're gonna do whippets." So he opens the case and starts pounding can after can. I wasn't interested in that, as I'd never done it, didn't want to do it, and it was like 3 in the afternoon - too early to get fucked up imo.

Years go by and XX started doing other shit. ALLEGEDLY coke off the dashboard while on duty, smoking weed now and then off-duty, and boozing it up whenever, also off-duty. Still a great guy, and still a fucking awesome cop even with all that going on. So he gets hurt chasing some asshole and fucks up his back.

He was put on light duty for over a year and had multiple operations. Well, what comes with back surgery? Pills, and lots of them (early 2000's btw.)

10+ years of pounding pills, and eventually XX becomes reckless. He realizes he has an issue and tried to get help. How'd they help? With DIFFERENT pills. So now he starts mixing. The feds crack down on pill doctors, and now it's a scramble to try to make the pain go away by any means possible. Oxys and percs turned into gabapentin, suboxone, and some others I can't remember. He gets wasted day after day, at work, and I cover for him. I drive him home, make excuses, whatever I needed to do as his friend. After 3 times of putting my own ass on the line, I take him home and his wife is there. She's wondering why we're in the living room at 1 in the afternoon instead of at work. I laid it out to her and told her we have to get him help. to this day it was one of the most gut wrenching conversations I had to have. One of my best friends is all fucked up with nowhere to go but dead. He'd hit rock bottom.

We get him set up with a rehab and send him off. He called me 3-4x a week over the 2 months he was there, crying and begging me to get him out of there. His wife was thinking of leaving him because of the timing of this mess - XX was going to miss his only kid's 1st Thanksgiving and Christmas.

XX put me in a bad fucking spot. I ran interference for him at work, played peacemaker with his wife, and tried to keep him sane.

He's still married, has a great little kid, and been straight for a number of years now.

Unfortunately, he's not the only addict I had to help at my PD. Some fare better than others, but I'm proud to say none of them got fired under my watch.

I have a different respect for those coping with heroin addiction. At some point it is no longer a choice. Yes it was their choice to take the shit in the first place, but this stuff really rewires your brain and body. Locking them up isn't the answer.

 

[Cubo de Sangre]

I have a different respect for those coping with heroin addiction. At some point it is no longer a choice. Yes it was their choice to take the shit in the first place, but this stuff really rewires your brain and body. Locking them up isn't the answer.

While there may not ever be an "answer", what do you consider to be reasonable steps to take at this point?

 

[HomeCheese]

We have a huge addiction problem in our society (not just opioids) and very few places for treatment. I have been told that 80% of our prison population ran into legal trouble partially because of a substance abuse problem. Instead of spending money to lock these people up we should be spending money on better and more treatment facilities.

The trick is to work with the children and young adults. This sounds simple but it's really true: If you can keep a person off drugs/alcohol/tobacco until they are 26 years old there is almost no chance they will develop a substance abuse problem. If they dive in to substance use before 26 it changes the brains chemistry and makes them susceptible to addiction.

As far as opioid go I think the research is pretty clear, it began with pills for many people. Much more could be done by states and insurance companies/health plans to combat bad prescribing practices. Most people fill their prescriptions via their health insurance so these companies know how many scrips these patients are getting. Also many states have a database for all opioids prescribed so they know who the doctor is, how many pills and who the patient is. It would be not too difficult to crunch the numbers and intervene on the heavy prescribers.

There are a lot of interventions available to insurance companies and governments but they are not doing a huge amount until the last few years.

 

[cleetus]

While there may not ever be an "answer", what do you consider to be reasonable steps to take at this point?

Rehab. There's no other answer. You can't just cold-turkey this stuff because you'll literally kill yourself. You need to be sedated for days and wake up when the worst of the detox is over. From there it's rewiring your head to understand what you lost and what you're looking for.

Every sober day is hard for these guys. The allure of the way it made them feel is always there. The drawback of this whole mess is they WILL replace one addiction for another. You just have to hope the new addiction is benign.

 

[nhbbear]

My name is David. Addict for over 10 years.
Grew up in the Bay Area and have more or less seen this opiate epidemic from the start. I’m kinda short for time here’s one thing that came up during my last run 3 years ago. Fentanyl laced Black tar was everywhere I have never seen “ China white” or any other form of dope. The quality of the product in 2016 was trash I cannot imagine it getting better. My last od was due to fentanyl.

I still keep in touch with my friends from rehab (I went to an intense county funded rehab in oakland) and the one thing you see now is people being hooked on fentanyl. Like tar doesn’t get them high anymore so of course this leads to way more people dropping dead.

I’ll continue once I’m on an actual keyboard.

Hey, David. Thanks for sharing. I am sure you will get into this, but I was wondering about actually overdosing, rehab, and any interesting circumstances surrounding buying heroin.

 

[nhbbear]

Very interesting read. I will try to devote some time to respond later tonight. The organization I work for does offer a medication assisted treatment(Suboxone) program that I have mixed feelings about.

I am sure you and I have some of the same feelings about suboxone/methadone/subutex. Kind of like a quickly adhered bandaid that acts like an insurance policy for those that have no intention of getting clean.

 

[nhbbear]

I've been a cop for 10 years in Southern California. My first few years we rarely ran into heroin. I mean like if you got a bust with any amount it was an oddity. We found way more meth than anything.

What we did find was pills. Opiates. Lots of em. Kids stole em from parents, had docs who prescribed them fraudulently or they got them from friends at parties.

About 3 years in our guy who worked the DEA task force told us we would start seeing heroin in a few years, I did not really think much of it since I never saw it on patrol.

Sure as shit with the crackdown on docs and opiates, heroin fucking sky rocketed. You were finding it on every dope arrest, shoplifters and even teens.

Heroin, needles and all the associated paraphernalia was now rampant.

About 2 years ago we got issued Narcan. We Narcan people regularly at houses, hotel rooms or in their cars. I've been on a call where one of our regulars took 4 things of Narcan from fire to come to. The Narcan fire has is about 2 of our doses that the PD carries.

Almost all my encounters with heron users I talk to them. Ask when they started, how, what they started with etc.

Nearly all say they started on pills. When they got too hard to come by they switched to heroin. Most started smoking it and shortly moved to injecting.

When you ask about the first time they injected heroin the look they get when they describe it cannot be put into words. It's just a wanderlust.

For the record I am absolutely not a dope cop. I do not go looking for drug arrests and never have. Which is unpopular at my agency as it is in many places. Many departments equate being out and arresting people for personal use quantities of drugs with being a rockstar cop. It has for sure cost me in career advancement, pay bumps on reviews and the like. While I dont think drugs should be legalized, I'd rather go after the crime associated with it (fraud, theft, burglary) than go out looking for dope.

We have had several officers get stuck by dirty needles. Which is fucking terrifying.

I've worked one stop that was cartel level transport of heroin and meth. This was years back and I later learned that the kilos we thought was heroin, later tested for pure fentanyl. It lead to some large busts for our narcs.

All in all I think the medical industry 100% over prescribed and still over prescribed opiates.

Personally I will not take any. I took one or two when I had my wisdom teeth out and it fucked me up. I did not like the feeling and it scared me.

I was that dope cop for many years, but my reasons were because I wanted to get the guys that were dealing and responsible for all the shootings, plus I wanted to get into the drug unit, but I soon learned that had little to do with actual drug work and was a popularity contest.

For the first ten years of my career, all we got was crack. Then the pills, then heroin, and now we have meth, fentanyl, and crack made a comeback. We recently got over five pounds of meth and five guns after a vehicle pursuit. Those guys actually came to town to kill someone.