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posted by janrinok on Sunday June 17 2018, @05:43AM   Printer-friendly
from the just-stop-the-pain dept.

The US Drug Enforcement Administration's decision to restrict prescription drugs containing hydrocodone (a popular opioid painkiller) was associated with a 'significant' increase in illicit trading of opioids through online markets, finds a study published by The BMJ today.

In this study, the term opioids refers to drugs that are usually available by prescription but here are sourced illegally through the dark net and are not prescribed by anyone.

The findings show that the proportion of sales of opioids through illicit markets doubled over the study period and sales of more potent opioids also increased. Overdose death rates have quadrupled in the US since 1999, and 40% of all deaths involve prescription opioids, which are primarily used for pain relief.

In October 2014, the US Drug Enforcement Administration decided to move hydrocodone opioids from schedule III to schedule II (a more restrictive category), making it more difficult for patients to access these drugs on prescription and stopping automatic repeat prescriptions.

There is concern that opioid users will source drugs from illegal online markets called 'cryptomarkets' rather than from pharmacies. Users only access these cryptomarkets via the 'darknet', where people can sell and buy drugs anonymously. Although the legitimate supply of opioids may have decreased, overall consumption will remain unchanged if users decide to source them from illicit markets.

So an international research team set out to investigate whether there was a link between the 2014 reclassification of hydrocodone opioids and an increase in trading of illicit prescription drugs on cryptomarkets. Using web crawler software, they compared sales for prescription drugs containing hydrocodone with other prescription drugs and illicit opioids from 31 different cryptomarkets operating from September 2013 to July 2016 (before and after reclassification).

They looked at three pieces of information from each product listing placed by a seller: the drug type on offer, the country from where products would be shipped, and the number of reviews the listing had received, to compare usage in relation to the 2014 reclassification.

The researchers found that the sale of opioids through US cryptomarkets increased after the 2014 reclassification, with no significant changes in sales of sedatives, steroids, stimulants, or illicit opioids.

[...] They also report a change in the type of drugs purchased after reclassification. Oxycodone purchases decreased, and fentanyl (a stronger and potent than hydrocodone) moved from being the least sold product to being the second most popular prescription opioid bought from cryptomarket sellers based in the USA. Fentanyl is currently the leading cause of opioid overdose in the USA.*

The researchers outline some study limitations. For example, there may have been a general increase in demand that was unrelated to the 2014 restriction, and the source and destination of the drugs cannot be independently confirmed.


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  • (Score: 5, Interesting) by Subsentient on Sunday June 17 2018, @05:54AM (19 children)

    by Subsentient (1111) on Sunday June 17 2018, @05:54AM (#694166) Homepage Journal

    What I'd be interested in is seeing the percentage of those sales that's actually used for chronic pain rather than to get high. I have a feeling it's higher than people are assuming.

    My 70 year old mother has chronic arthritis that has put her in tears on countless occasions, and while knee replacement surgery has helped a lot, there's still times when the *only* thing that can touch her pain is something like Percocet, which her doctor prescribes her.

    I fear we might trade one evil for another. By limiting the availability of these painkillers, we might make it much harder for anyone to get effective pain relief for anything more severe than a mild headache.

    --
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  • (Score: 5, Interesting) by anubi on Sunday June 17 2018, @06:33AM (9 children)

    by anubi (2828) on Sunday June 17 2018, @06:33AM (#694170) Journal

    About the last thing I am afraid of is a 70 year old grandma hooked on Percoset!

    With the technology we have today, we can make damn near unlimited supplies of any chemical we want. If the Percoset works for that woman, I'd just as soon we give her all she needs. I mean, stringing her up like this is like tying someone over an ant hill. I can see no benefit to anyone having someone bear avoidable pain just for the sake of "she may get addicted". If there is a drawback ( like shortening of life expectancy, whatever ), explain that, and let her make an informed decision.

    Personally, I would trade ten years of incapacitated pain for one week of happy blissful life with family, to say goodbye, and get it over with. What makes this doubly painful is knowing not only I am incapacitated, but I am also burdening others with my situation, people whose time would be spent far better doing almost anything else but taking care of a dying guy whose gonna die anyway.

    --
    "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
    • (Score: 2, Interesting) by Anonymous Coward on Sunday June 17 2018, @06:43AM (2 children)

      by Anonymous Coward on Sunday June 17 2018, @06:43AM (#694172)

      We could really use chemputers under $5k. Print painkillers or recreational drugs on location.

      • (Score: 2, Interesting) by anubi on Sunday June 17 2018, @07:05AM (1 child)

        by anubi (2828) on Sunday June 17 2018, @07:05AM (#694174) Journal

        They are probably coming!

        Likely an offshoot of DNA sequencing. They may well use DNA as the assembly agent. And make custom molecular arrangements just like life does.

        --
        "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
    • (Score: 4, Insightful) by Magic Oddball on Sunday June 17 2018, @09:26AM (1 child)

      by Magic Oddball (3847) on Sunday June 17 2018, @09:26AM (#694194) Journal

      Personally, I'd rather trade ten years of incapacitated pain for ten years of having my pain treated. We're all "going to die anyway" at some point, and people who earn money but leave no mark on others' lives (or worse, a negative one) are in many ways more burdensome & less mourned than those who can't earn money but leave a positive mark in even a small way.

      • (Score: 1) by anubi on Sunday June 17 2018, @10:48AM

        by anubi (2828) on Sunday June 17 2018, @10:48AM (#694204) Journal

        ... and people who earn money but leave no mark on others' lives (or worse, a negative one) are in many ways more burdensome & less mourned than those who can't earn money but leave a positive mark in even a small way.

        Well said!

        --
        "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
    • (Score: 2) by sjames on Sunday June 17 2018, @01:10PM (3 children)

      by sjames (2882) on Sunday June 17 2018, @01:10PM (#694233) Journal

      Interestingly, even with addiction risk, the painkillers might increase lifespan. People in pain tend to not take care of themselves properly and certain;y tend not to get enough exercise. Not to mention producing too much cortisol and other stress hormones that may slow healing.

      As for the overdoses, part of the "increase" is just an accounting trick. It isn't unusual in painful terminal conditions to see patients willingly take potentially unsafe amounts of painkiller for the sake of a somewhat comfortable end of life. We used to say those people died of their underlying condition reasoning that without the pain killers, the stress of the pain would have killed them anyway (after all, they're in a weakened condition) and it would have been a lot less pleasant. Now the DEA wants to call that an opoid death.

      In the end, it;s just the latest excuse to put boots on heads.

      • (Score: 1, Interesting) by Anonymous Coward on Sunday June 17 2018, @02:10PM (2 children)

        by Anonymous Coward on Sunday June 17 2018, @02:10PM (#694244)

        It isn't unusual in painful terminal conditions to see patients willingly take potentially unsafe amounts of painkiller for the sake of a somewhat comfortable end of life.

        In the book "Final Exit", Dr. Derek Humphrey illustrated the use of Seconal as a way of insuring that if one decided their time was at hand, it would be a clean way to go. Now, personally, I wonder about a jug of nitrogen released in a closed compartment, like a car. There has to be some way of cleanly shutting down when that time comes. I flat do not want to be strung out by the medical establishment only to be permitted to pass on once the resources I had intended for my offspring to be diverted to hospital charges. I am quite aware the technology exists to keep me "legally" alive damn near indefinitely, even though I died long time ago, and I fear that being used just to wheedle my end of life wishes against my wishes.

        • (Score: 2) by sjames on Sunday June 17 2018, @03:03PM (1 child)

          by sjames (2882) on Sunday June 17 2018, @03:03PM (#694253) Journal

          There is truth in that, but not all opoid overdoses near end of life are necessarily deliberate suicides. Rather, it is accepting a risk of hastening death for the sake of being pain free.

          The points aren't entirely unrelated though. If we're stingy with needed opoids, there will be more outright suicides.

          • (Score: 0) by Anonymous Coward on Monday June 18 2018, @08:03AM

            by Anonymous Coward on Monday June 18 2018, @08:03AM (#694448)

            I wonder if any of the anti-painkiller rhetoric is being pushed by life insurance companies. Die of cancer even while taking huge amounts of morphine means they have to pay out. Take away the pain relief and some people will suicide. With many policies, hey presto, no payout for suicide. Asshole Mutual Life is then the big winner.

            Given the amount of number crunching they do, they would know exactly how many people would do this, and how much more profit they would make with stricter drug rules, and whether it would be worth the 'lobbying' those laws would cost.

  • (Score: 5, Insightful) by Magic Oddball on Sunday June 17 2018, @09:58AM (5 children)

    by Magic Oddball (3847) on Sunday June 17 2018, @09:58AM (#694200) Journal

    You said what has been going through my head since this clusterfuck of a farce started, as my 67-year-old mother is in the same kind of position, except possibly worse. (She has pretty bad osteoporosis, arthritis, fractured & degenerating vertebrae, and ruptured discs.) She had a really good quality of life in spite of her physical issues up until the stupid crackdown struck, and once she was dropped to a minimal amount of painkillers, her quality of life went down the toilet.

    Nobody seems to be able to quite explain why the well-being of people who choose to abuse dangerous illegally-obtained drugs is placed so far before that of law-abiding citizens like our mothers. (Including the asshats who, when I described the above in an Ars Technica comment last year, sent me private messages urging me to not fall for her "manipulative" "drug-seeking" behavior.)

    What makes the whole mess even more frustrating is that it's flaming obvious that the concentration of people who become addicted to opiates is directly correlated to the a region's economic situation — the more people are unable to find decent jobs, live under the constant stress/anxiety of barely scraping by on multiple underpaid part-time jobs, or otherwise are deeply unhappy for socioeconomic reasons, the more people turn to drugs that make them feel good. Our government could at least attempt some sort of practical solution, even a short-term one like the huge 'public works' projects that put countless people to work during the Great Depression, but that wouldn't fit into the priorities of either major political party (let alone the increasingly power-mad DEA).

    • (Score: 4, Insightful) by Anonymous Coward on Sunday June 17 2018, @10:28AM (3 children)

      by Anonymous Coward on Sunday June 17 2018, @10:28AM (#694203)

      Nobody seems to be able to quite explain why the well-being of people who choose to abuse dangerous illegally-obtained drugs is placed so far before that of law-abiding citizens like our mothers. (Including the asshats who, when I described the above in an Ars Technica comment last year, sent me private messages urging me to not fall for her "manipulative" "drug-seeking" behavior.)

      They're not placing the abusers of drugs above those who actually need the drugs for their chronic pain. It's worse than that.

      Marijuana is well on the way to being made legal. If that happens, what will all the drug warriors in the DEA and local police forces do to justify their jobs? (not that there still aren't other drugs illegal, but it'll be harder to justify the ever-expanding budget) So, they make something currently legal, like prescription opioids, as close to illegal as they can. This lets them arrest doctors for prescribing needed dosages, er, I mean, running horrid 'pill mills'.

      After the doctors who will prescribe opioids are gone (either arrested, lost their licenses, or too frightened of those two possibilities to risk writing more prescriptions for long-term patients), some of those who were dependent (not addicted, dependent; there's a difference) on the opioids will turn to street drugs in desperation. Yay, more people to rot in jail, er, I mean, more opportunities for the DEA and local police to protect the public from ne'er-do-wells.

      Others who won't or can't get street drugs will choose suicide instead, as their pain overwhelms them. Yay, Social Security no longer has to pay disability and/or retirement benefits to those people, which helps keep those programs solvent a bit longer, maybe even a couple more election cycles!

      So you see, they're not putting lives of chronic pain patients behind junkies' lives. They're putting them behind their government agencies' budgets and jobs.

      They're not stupid. They're evil.

      • (Score: 0) by Anonymous Coward on Sunday June 17 2018, @11:00AM (1 child)

        by Anonymous Coward on Sunday June 17 2018, @11:00AM (#694206)

        what will all the drug warriors in the DEA and local police forces do to justify their jobs?

        Why don't you ask that in places where it's already legal? I visited Washington recently and saw dozens of marijuana superstores.

        • (Score: 0) by Anonymous Coward on Monday June 18 2018, @03:02AM

          by Anonymous Coward on Monday June 18 2018, @03:02AM (#694402)

          Marijuana is illegal by federal law in every square inch of the entire United States. That the federales aren't currently enforcing that law in states that have legalized it, to various degrees, in state law doesn't change federal law at all. Remember, the feds can start enforcing it any time they want.

          Besides, you don't get promotions unless you produce bodies. The system needs bodies. The cops need bodies in their jails, the judges need bodies in their courtrooms, the prisons need bodies on the forced labor processing lines and call support phones.

          They don't care if it's a body with opioids in it or marijuana in it. They need bodies. Any body. You'll do. You'll do just fine.

      • (Score: 2) by ElizabethGreene on Sunday June 17 2018, @03:06PM

        by ElizabethGreene (6748) Subscriber Badge on Sunday June 17 2018, @03:06PM (#694255) Journal

        If that happens, what will all the drug warriors in the DEA and local police forces do to justify their jobs?

        This is not an unreasonable question to ask. Drug enforcement is a $51 billion per year industry.* That's a lot of people with nothing to do.

        * Bias warning, the $51 Billion statistic comes from the pro-legalization Drug Policy Alliance. For scale, the Federal Drug Control budget appropriation is ~$5 Billion per year. The real number probably lies somewhere between these two data points, depending on what is considered in scope.

    • (Score: 0) by Anonymous Coward on Monday June 18 2018, @12:58AM

      by Anonymous Coward on Monday June 18 2018, @12:58AM (#694383)

      This. I am someone who could use hormone supplementation. Would feel much better and have more strength. I am forgoing it bc the only thing worse than having chronically low levels is having a sudden withdrawl bc a scrip did not get renewed or filled due to the stupid stupid schedule iii classification. All because some bodybuilders abused it. Let them abuse it, and let us all use it in peace.

  • (Score: 2, Interesting) by Anonymous Coward on Sunday June 17 2018, @02:31PM (1 child)

    by Anonymous Coward on Sunday June 17 2018, @02:31PM (#694248)

    I am sorry for your grandma. Nice https://en.wikipedia.org/wiki/Appeal_to_emotion [wikipedia.org]

    However, if you do some volunteer work at a methadone clinic you would come out with a very different opinion. A vanishingly small portion of those people are there because they are in chronic pain. They are addicts. You do not sound like an addict. So you probably can not even comprehend what they are like. They will do anything to get it. I mean anything. We can walk away and not think twice about it. But an addict is not like you are me. Once addicted though they will do anything to not feel like hell. The side effect if you are not in pain is basically the flu plus massive muscle cramping. I have had addicts tell me 'I would love to buy a torture rack just to stretch out'. Think of always having the flu, and a fever, and feel like your arm is twisting of all the time. Now try to function.

    The people who take them for pain usually do not even 'like' taking them. They do not want them but they take them. The addict on the other hand seeks them out. They are chasing the dragon. Take this one town in West Virginia. https://www.npr.org/sections/thetwo-way/2018/01/30/581930051/drug-distributors-shipped-20-8-million-painkillers-to-west-virginia-town-of-3-00 [npr.org] Most addicts take upwards of 30+ Vicodins a day, less if they can get oxys. I seriously doubt your grandma is downing them like that. By my math they have 200-300 addicts in their small town. At *least* 10% of their population is hooked on pills. Could be more but this is one of those articles where they make one pill look like another (poor reporting).

    The casual addict usually finds 'hey these mellow me out and and I feel pretty good'. Then they find they are hooked on them. Then have to take them just to feel 'normal'. Also you need to be careful when taking them for pain as well. As it dulls it out so when they wear off the pain feels 100x worse than it was before so you take more. Then if you get into it you can have pain, plus the flu like symptoms, plus the muscle cramps, and hot flashes.

    The clinc my wife goes to has well over 600+ people there everyday. There are at least 15 in a 100 mile radius just like that or bigger. I think you slightly underestimate how bad it is. You do not know because you probably do not see it. A functioning addict can hide it very well. It took me two years before I even knew my wife was taking pills. One of the conditions of being in those places is being clean. I personally know of 10 people who decided they were not going to be clean. So they got 'kicked out'. They went right back into it. Getting kicked out is very common. I hear about people getting kicked out at least a few times a week.

    Then take the 'i am not a drug dealers'. These people would buy 2-3 100+ bottles at a time and sell them at 2-3 bucks a pill. Usually bought on SS or medicaid. So their cost was 0. I have dealt with coke dealers who are more considerate. I had an 70 year old woman threaten my wife with an ass beating from her two sons over 50 bucks. I *enjoyed* converting her clients to methadone clients.

    So until a balance is made. It is going to suck for a lot of people. The over reaction will be swift and very painful.

    • (Score: 3, Interesting) by ElizabethGreene on Sunday June 17 2018, @02:53PM

      by ElizabethGreene (6748) Subscriber Badge on Sunday June 17 2018, @02:53PM (#694250) Journal

      There is an argument that making opiates available for free will reduce the number of users because there is no profit in it for dealers to sell it. This includes street dealers, and the dealers that go from doctor to doctor in their shiny Lexus with boxes of free samples. Have you given this approach any thought? Since you are literally the boots on the ground I'd be fascinated to hear your thoughts.

      I'd also love to know if any of your patients have tried Ibogaine therapy. I've heard it's the closest thing we have to a cure for the physical parts of opiate addiction, but that's not backed up by any data.

  • (Score: 3, Interesting) by HiThere on Sunday June 17 2018, @06:06PM

    by HiThere (866) Subscriber Badge on Sunday June 17 2018, @06:06PM (#694307) Journal

    As long as the pain is sporadic, then opiates are a reasonable choice. If it become chronic, IMMEDIATELY switch to something else. Almost anything else. (Well, you've got to be careful, as everything has it's downside.) Chronic use of opiates is less effective than aspirin. Habituation sets in, and then you are both addicted and in pain and likely to kill yourself with an overdose.

    Admittedly the formal studies of this are minimal. Government regulations are quite restrictive. But that's the synopsis. The sample sizes were so small that one can't be sure that reasonable portions of the population wouldn't react differently. Anti-inflamatories have their own problems, so you need to watch the dose carefully to avoid stomach, liver, and kidney damage (depending on which one). There are reports that marijuana is effective, but I don't know of any decent studies. There were reports back in the 1950's that LSD could ease suffering, though not pain, even of terminal cancer...but you can't find that anymore. Some people report similar results with mushrooms or peyote, but I don't know of any studies.

    --
    Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.