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Today's depressing Massachusetts statistic

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The report implies that heroin use is being driven by prescription drug use, since there is a correlation between people using heroin and having a recent Rx for pills.

Personally I doubt the cause and effect there. We're still at a point where 15% of American teens use tobacco, and a third of Americans have tried cocaine. It's not a stretch to say that life choices are the primary reason behind opioid addiction.

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Neat opinion bro - But you fail to offer a counter-thesis for why these "life choices" are trending so heavily towards opioid abuse in the last decade or so.

While errors in regression analysis (including correlation vs causation) are not uncommon, the intuition of anonymous commentors is far more so.

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Between getting hooked on very expensive prescription opioids (oxy) and then switching to a much cheaper street drug like heroin? Yup, sure is a mystery.
Mf5hq

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Yes there is a correlation between rx meds and heroin use. The point is, people who have NEVER been prescribed a narcotic are taking them and then when they are not able to afford them, they try heroin.

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1. fentanyl and other high potency opioids appeared around the time you see that uptick.

2. DPH is doing a far better job at getting more timely information, and at getting more accurate information for the past three years. This means that they may be finding more of the opioid deaths to count than they were able to track down before - leading to better data, but numbers that may inflate the rise in deaths.

http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/county-level-pmp/...

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Does not start as a 'chemical issue.'
But it sure becomes one quite fast....

Where we live has a particular geomancy that lends it self to this--a particular lifestyle, rhythm, etc.

This isn't really about programs--there are plenty.
This isn't about Narcan....we have enough to administer to the same person 5 times in a week.

"Soul work" (Cornell West regarding American politics)) is what this dialogue needs...

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you cant buy a bag of heroin anymore without running the very real risk that its cut with fentanyl or carfentanil

which, btw, is one of the things that happens when you have prohibition.

i've heard that even pills are being faked now? idk how true that is, i've distanced myself from that world, but that used to be the 'safe haven' of opiates because you knew what you were getting. of course, this was usually to avoid being ripped off, not to avoid having your shit cut with fentanyl and ODing or nodding off while driving and crashing.

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It's those damn additives. Before those no one died or had problems with Heroin. I can't get my head around this one at all. Why would you ever take a drug that is all but guaranteed to ruin your life and within a fairly short time frame kill you?

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This Reddit post from a few years ago always stuck with me.

https://www.reddit.com/r/IAmA/comments/wnj2d/iama_heroin_addict_been_cle...

They just feel good, chill, happy, but they feel like this spooky drug 'heroin' hasn't delivered. They are just mellow. Oh obviously it has all been a lie they will think.

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what are you babbling on about lol. of course there were issues with heroin before. i never said there werent.

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Some get hooked on legal pills and then illegally obtained pills. After that supply is too expensive, their existing addiction leads them to cross over into street sources of opioids, including heroin.

Heroin is a pretty damn perfect drug - except for that addiction thing. And that street source quality control problem ...

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I don't consider "the problem" to be that heroin addicts are ODing on heroin laced with fentanyl. The problem is people experimenting with heroin and getting themselves addicted in the first place.

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You got all your "drug education" from DARE and you believed it!

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I am deeply concerned with how the state of Massachusetts is addressing this opioid crisis. Let me clear that when we say it is an epidemic I am somewhat confused as the concept of epidemics are that there are contagions that are spread among humans causing grave illness and sometimes death. AIDS was an epidemic. The opioid crisis is not an epidemic unless one wishes to consider the contagion bad thinking and bad ideas. One of the bad ideas is that Harm reduction (HR) has so permeated the government that those who question it are marginalized or ignored in the drug policy dialogue. An example of this is the initiative of Boston HealthCare for the Homeless’ safe injection facility (SIF). A program last night at BU School of Medicine was all HR all the time, there was no place at the table for a dissenting view.
The ever expanding policy of HR that includes “no wrong door” has resulted in the deterioration of neighborhood around Boston Medical Center. Active drug use, overdoses, drug dealing, assaults, thefts, zombies pushing baby carriages seeking K2 or ‘pins or anything to dull their feelings and most recently major crime ( a shooting and death) are relatively new to this area and I don’t think that we can use “the island closed” any more as an excuse.
We have flooded the streets with medication assisted treatments, access to clean needles, alcohol swabs, Chore Boy to facilitate smoking of your drug of choice, cotton and cookers, Narcan and the only results that one can see are more overdoses and repeat admissions (sometimes every week) to the “No wrong Door” spin cycle of detox. The persons were are supposed to be serving have no motivation to stop using. Most people stop using drugs when they have a reason to stop. Pregnancy is a great motivator and often time’s jail too is a motivator. A safe site provides no motives for one to consider giving up drugs. Avoidance of death is not a motive as evidenced in the recent statement to me from a patient, “I have been Narcan’d 17 time…” When consequences are removed from our actions the very concept of human agency evaporates (skin in the game). This is what has happened with the well-meaning idea of HR which has now become an ideology; life has become meaningless and therefore a vacuum in which people bounce between boredom and oblivion. Just take a look at our own little Hamsterdam At mass Ave and Albany St. There is nothing to hope for, nothing to fear.

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If you are so certain that you are right, perhaps you should offer your wisdom on a professional basis?

https://massanf.taleo.net/careersection/ex/jobdetail.ftl?job=160000WG

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Laugh grimly, but still...

Active drug use, overdoses, drug dealing, assaults, thefts, zombies pushing baby carriages seeking K2 or ‘pins or anything to dull their feelings and most recently major crime ( a shooting and death) are relatively new to this area [around Boston Medical Center]...

(emphasis and clarification added).

I lived a block from the (then-named Boston City Hospital) back in the early 90s and it was plenty nasty back then - and waaaay better than it had been in the 70s and 80s, to hear my long-time resident neighbors tell it.

Over the course of the 50 year old "War on Drugs", I don't see the current situation as anomalous. The fact that you would claim otherwise makes me suspect the reasoning in the remainder of your post. You seem to be looking at this with a short-term perspective of the last few years, with a particular animus towards policies of 'harm reduction'. Those policies, of course, are far from universal in other parts of the country with similar, or even greater, rates of opioid addiction.

So it seems that while HR policies may, as a broad category, be less than acceptably effective, it's hard to imagine that they are causative, as you imply.

But then again, quasi-Calvanist thinking is at least as narcotically addictive as any chemical opioid yet developed - so I am never surprised to hear it pop up in conversations about drug abuse.

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I'm an addiction researcher. We have in no way 'flooded the streets' with MAT. About 4 million people in the US have an opioid use disorder. Less than 400k get any sort of MAT. The vast majority of people with a substance use disorder are subjected to your idiotic abstinence only approach, and they relapse and die like flies. Imagine if we denied treatment to every diabetic who slipped and ate sugar or a carb, or every person with heart failure who ate a salty meal? Attitudes like yours are killing people, that's why smart people don't give you a seat at the table. Go think about what you and your kind have done before you whine about your voice being heard.

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Are you really implying that Walsh just up and decided to close the bridge? You, I, and everyone else here knows that the bridge was closed by the state since it had deteriorated and become a safety hazard. The state and the Cities of Boston and Quincy all have portions of blame on this, but it's not like the bridge started to fall apart in January of 2014.

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But with the governor's Department of Transportation's pronouncement, the mayor acted faster than he has on any other issue to close and demolish the bridge.

In the two years since, neither he nor the governor has advanced any plans to replace the bridge, or effectively replicate the substance abuse and other programs previously located on Long Island.

With fewer resources available for treatment, and more addicted homeless people now sleeping in the city streets, the loss of the Long Island Bridge is most certainly one of the factors driving the spike upward.

( I won't speculate whether the mayor and/or governor used the closure as the first step in ultimately making Long Island available for highly-profitable private development. )

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I'll give you this- both our current mayor or governor claim that addiction treatment would be one of their top priorities. Roughly 3 and 2 years in, it's looking bleak. I'm hopeful, but until the corner's turned, it don't look good.

And don't get me wrong, I want the Long Island shelter and other services back, but this is a statewide problem.

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... along with the state legislature and other elected and appointed officials. For years, they've been allowing the condition of infrastructure to continue a steady decline into disrepair and dysfunction.

Their dismantling of mental health services over they years hasn't helped either. Lack of treatment drives some mentally ill patients to attempt self-medication with dangerous and/or addictive substances. It's just one more thing that's made the situation worse.

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He shut the shelter with only a few hours notice, forcing homeless to scramble with no place to go. I would think he most have learned the bridge was condemned, soon after entering office. He should have made a contingency plan. What he did was deplorable.

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So the state declares the only means to access the shelter to be unsafe. What do you do in a situation like that? And if you want to put all of the blame on him for not having a plan B, why wasn't he handed a plan B by his predecessor earlier in the year? It's not like the bridge suddenly went into the shitter. 10 years earlier the buses were banned from using it.

I'm not saying that Walsh should totally skate on this, but blaming him for the bridge getting to the state it got to isn't right.

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OK, So it had been known for 10 years that the bridge was a problem. What then was the specific NEW emergency that required it to be shut with virtually no notice to those on the island? Why couldn't they have been given a 7 day notice? I'm not blaming him for the state of the bridge. I am blaming him for the incredibly short sighted, ill planned and inhumane method used to close the bridge.

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That is an answer for Beacon Hill, not City Hall.

Of course, the Walsh administration could have put together a plan in the 10 months they were in office, but the previous administration, as you note, had about 10 years to think about this and punted.

In the end, I blame the City of Quincy, but I don't want to detract from the discussion of the scourge of heroin.

Speaking of which, I happened to notice that the death rate for Boston stayed pretty steady for the past 15 years. But people can go on about how the spike is due to Long Island closing.

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In seven days, alternatives might have been found to temporarily repair the bridge or arrange for ferry or other alternatives to keep at least some programs still in service.

Burn the house down, force everyone onto the street, offer no hope of ever going back for many years, if ever. The property is just too valuable to let "those people" use it.

Olympics, car races, tax breaks for GE, change Bra to Bip-Da, "the isn't that bad", let's build a heliport!
   IMAGE(http://www.universalhub.com/files/uhub215_0_0_1_1.png)

The mayor's office says it remains committed to rebuilding the Long Island bridge that was shut last night

That was more than two years ago — he said it could take five years. Maybe I missed it, but has he done anything at all towards fulfilling that commitment?

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The graph shows shocking results; very discouraging on its own.

More data is helpful, as always, because without it, false conclusions can be made.

I'd like to see other states' data compared to the national average. Unfortunately, the source data are voluminous and difficult to parse.

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Part of it is the recent interest in far more timely data - DPH used to report out at a two-year lag, and they closed the gap.

That resulted in two things: the closer investigation of recent cases within a narrow time frame (meaning that it is more likely to identify cases because memory is fresh, files are current, etc.) and more complete coverage of the Commonwealth in reporting statistics.

Better and faster case identification and comprehensive reporting = more cases. That isn't the entire story, though, because there are also more lethal opioids on the street in the last few years then there were before and increased demand for detox centers pointing to higher addiction rates.

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That's a death rate chart, which really shows the effectiveness of Narcan and the ems system in general. Just listening to the scanner of my nearby moderately sized city, I'll bet the actual emergency call rate is 10x that or more. The survival rate isn't plotted and I didn't read the report, but I suspect those bad choices are self justified by the number of "I survived" stories going around. It would be interesting to have the death rate chart plotted with how many are first time overdoses too. I suspect once the body is weakend by one overdose, the patient figures they can survive or doesn't care, a subsequent overdose eventually gets them.

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I have long believed that there is far too much emphasis on prescriptions causing the heroin problem. Sure, when Oxycontin first came out, 20+ years ago, some weaned off it with heroin. Today, I'm told that doctors must fill out all kinds of DEA paperwork to prescribe it and prescriptions are rare. I think it's more of the traditional peer pressure "try this" than anything begun with a prescription.

Long an opponent of legalization in my youth, I reluctantly support it now. Tax, regulate and limit the purity and additives. Dedicate the tax money to treatment. The courts do nothing when arrests are made anyway.

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All that "paperwork" you are talking about is minimal. On top of that the sheer amount of opioids prescribed (not to mention stollen from pharmacies as in Baltimore after the riots there) results in huge amounts of extra unneeded pills that find their way from grandmas medicine cabinet onto the street. Its a real problem.

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Politicians don't want to touch this one. They'll talk about treatment programs, NARCAN, law enforcement, other ways of treating the symptom. They'll talk about "keeping drugs out of our community". It's a typical approach to danger and risk: believing that it originates only from outside ("build a wall"). I spoke to a politician who was running for office this November, someone who seemed brighter than average and who had worked with substance abuse issues, and asked him what he would do about the contribution of prescription pharmaceuticals to the addiction problem: for example, look at sales practices, incentives, etc. He seemed utterly gobsmacked at the question. It's hard to check an "epidemic", or whatever you want to call it, if you fail to at least seriously examine something that's contributing to it.

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