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How many opioid deaths are suicides (deaths from despair)?


washparkhorn

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Almost half of OD’s may be suicides. Despair has reached epidemic proportions in the US. 

‘Deaths Of Despair’

When doctors do look deeper into the reasons patients addicted to opioids become suicidal, some economists predict they’ll find deep reservoirs of depression and pain.

 

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In a seminal paper published in 2015, Princeton economists Angus Deacon and Anne Case tracked falling marriage rates, the loss of stable middle-class jobs and rising rates of self-reported pain. The authors say opioid overdoses, suicides and diseases related to alcoholism are all often “deaths of despair.”

“We think of opioids as something that’s thrown petrol on the flames and made things infinitely worse,” Deaton said, “but the underlying deep malaise would be there even without the opioids.”

Many economists agree on remedies for that deep malaise. Harvard economics professor David Cutler said solutions include a good education, a steady job that pays a decent wage, secure housing, food and health care.

https://khn.org/news/difficult-to-gauge-rate-of-suicide-among-deaths-from-opioid-overdoses/

Mental health is woefully ignored in this nation. The State Hospitals of yesteryear were horrible. But the failure to replace them with more humane access points was cruel. 

We reap what we sow. 

 

Edited by washparkhorn
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Despair has reached epidemic proportions you say?  Too many people reading the classics I guess.
 
I met a traveller from an antique land,
Who said—“Two vast and trunkless legs of stone
Stand in the desert. . . . Near them, on the sand,
Half sunk a shattered visage lies, whose frown,
And wrinkled lip, and sneer of cold command,
Tell that its sculptor well those passions read
Which yet survive, stamped on these lifeless things,
The hand that mocked them, and the heart that fed;
And on the pedestal, these words appear:
My name is Ozymandias, King of Kings;
Look on my Works, ye Mighty, and despair!
Nothing beside remains. Round the decay
Of that colossal Wreck, boundless and bare
The lone and level sands stretch far away.”
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Reading that article, the woman quoted seems to be speaking more to the intense suffering of keeping up the daily rat race of avoiding being sick from opiate withdrawal.  Acute alcohol withdrawal can kill you.  Acute opiate withdrawal won't kill you, but every cell in your body tells you you'd be better off dead.  And when you're done kicking, the post acute withdrawal lasts 4 months to 2 years which is a major reason relapse happens at such a high rate in the first 6 months.  So better options to treat opiate addiction need to be available to more people.

Two new options people need to be aware of are the Bridge device and NAD+ treatment.  Bridge is a neurostimulator you apply with 4 electrodes to  the ear.  It uses some kind of wave cancellation effect on the cranial nerves carrying autonomic fibers that generate the full body opiate withdrawal syndrome.  Acute withdrawal will be reduced by about 85% within 10-15 min of placement of the device.  You wear it 5 days then remove it, so whatever remaining withdrawal exists gets unmasked, but for heroin and short acting opiates getting through the first 5 days is essential.  Plus you don't need hospitalization.

NAD has a rebalancing effect on the brain to diminish acute withdrawal, but more significantly it has a major effect of reducing if not outright eliminating cravings and post acute withdrawal.  NAD also works very well for alcohol detox and PAWS and the benefits of several days IV infusion lasts for months.  Combined with other important supports and continued sobriety, most people reportedly don't need additional NAD.  

Treat the addiction and get through PAWS, and most people will experience significant improvement in mood.  Having a mood disorder that pre-dates addiction and not having a sober life worth defending due to various severe circumstances independently increase suicide risk.  How suicide is attempted or completed varies but people familiar with finding a vein/access to a large quantity of pills probably skew towards death by opiate OD.

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Anyone can become physically dependent (meaning will experience withdrawal on cessation of use) with any substance with addictive potential.  Heroin and opiates have a high addictive potential and apparently very nasty, although not life-threatening, withdrawal.

Those people are not necessarily "whole hog" addicts, meaning physical, psychological, and spiritual dependence.  Whole hog addicts exhibit a mixture of psychological defects including depression, anxiety, ocd and even bipolar disorder.  But none of these usually deserves an individual clinical diagnosis as they mostly disappear with sobriety (there are cases of comorbid disorders, but the diagnosis cannot be made prior to abstinence). 

For a "whole hog" addict, it is gross oversimplification to say he drinks/uses because he's depressed (or anxious, or ocd, or bipolar, or whatever).  Or even that hes depressed (or whatever) because he drinks/uses (he probably is) and it would be very unwise to treat such an addict with conventional treatment for depression or the other psychological ailments.  Whole hog addicts will go through the withdrawal over and over again and still come back to their drug of choice, or switch to another, because they can't seem to exist without pretending to control their mental state by drinking or doing drugs.  A lot of us that have survived it, or experienced it up close, or even those that still suffer refer to it as a long, slow, cowardly suicide.

It is probably safe to say that there are many latent "whole hog" addicts that haven't abused a substance sufficiently (or with high enough addictive potential) to unlock their full addiction.

It is probably also safe to say that there are a number of people who become physically addicted to opiates/oids and lack the willpower or stamina to power through withdrawal that they eventually succumb to overdose or other pathology without ever becoming whole hog addicts.

I don't know if anyone has attempted to sort physical opiate/oid addicts from whole hog ones.  Not even sure it can be done.  Certainly, social conditions can lead to the abuse of opiates/oids that leads to addiction, of either the physical or whole hog variety, but in a lot of cases fixing those conditions won't help those already addicted and probably won't stop the whole hog addicts from fulfilling that destiny.

Medical science doesn't understand addiction very well, so it's no surprise that social scientists get it wrong, too.

Edited by TwiceHorn
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13 hours ago, XYZ said:

Is “whole hog” what others in the old “alcoholic” thread called “spiritual malady”?

Pretty much.  The "whole hog" addict is characterized by having an indefinable, but strong unease when sober.  Such that they will weather repeated withdrawals, get their lives together temporarily, yet still return to their drug of choice, no matter how well things are going or the objective evidence piled up that indicates that using that substance is a personal disaster. Further, upon returning to use of the substance, it is extremely immoderate and simply cannot be moderated. As opposed to the physical addict, who just needs to get past withdrawals and they're fine.

Edited by TwiceHorn
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The first thing in my opinion is before they can come up with accurate statistics is that they need to quit limping in heroin overdoses and death with prescription medication overdoses and death. 

Another factor I am curious about is how many people that seriously need pain medications, but cannot get them do something foolish like move on to heroin or fentanyl that can be purchased on the street. I've been in chronic pain since I lost my leg at 38 years old and here I am 32 surgeries later hurting like hell and every time I've tried to get help and yes I mean a pain prescription I'm treated like a freaking Criminal. The last pain management clinic they sent me to wanted to do injections on both shoulders. They did and I heard worse for the next 2 months than I had previously. So yes I understand there's a problem out there but I guarantee you there's a lot of people hurt so bad they wish they were dead also 

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On 4/2/2018 at 5:47 PM, SHOOTER12 said:

The first thing in my opinion is before they can come up with accurate statistics is that they need to quit limping in heroin overdoses and death with prescription medication overdoses and death. 

Another factor I am curious about is how many people that seriously need pain medications, but cannot get them do something foolish like move on to heroin or fentanyl that can be purchased on the street. I've been in chronic pain since I lost my leg at 38 years old and here I am 32 surgeries later hurting like hell and every time I've tried to get help and yes I mean a pain prescription I'm treated like a freaking Criminal. The last pain management clinic they sent me to wanted to do injections on both shoulders. They did and I heard worse for the next 2 months than I had previously. So yes I understand there's a problem out there but I guarantee you there's a lot of people hurt so bad they wish they were dead also 

One option you might want to talk with your docs about is using buprenorphine (subutex/suboxone) for chronic pain.  Typically physicians need a special DEA license number to prescribe buprenorphine for treatment of opiate dependence which also requires that it is accompanied by a program of addiction treatment counseling/therapy.  However, buprenorphine can be prescribed by a physician using their standard DEA license number as an "off-label" use "for chronic pain."  The important piece for physicians prescribing off-label is that the patient's medical record MUST substantiate a diagnosis that involves chronic pain and the need for chronic pain management.  That is bar usually easily cleared under normal circumstances when people have a history of being on chronic opioid therapy.

Unlike all true opioids that are full opioid receptor agonists (Oxy/morphine/hyrdocodone/dilaudid/methadone/heroin etc.), Buprenorphine only partially stimulates the opioid mu-receptor.  This critical feature allows it to help with pain while having several advantages over full opioids when used chronically:

1) Non-lethal alone in overdose.

2) Tolerance doesn't appear to occur over time where you have to keep increasing the dose to maintain a steady level of pain control as is the case with full opioid agonists. 

3) The very long half-life means a patient can dose once daily and forget about it.  Also there is no roller-coaster of onset of drug effect and dip in effect between and before the next doses.  With full opioids, people often spend a large portion of every day "clock watching" and attempting to ration their dose to feel ok while not coming up short on their meds.  The mental relief from that alone probably contributes to the experience of better pain control.

Disad: Buprenorphine, as a partial opioid receptor agonist, is enough like a full opioid that you will experience substantial withdrawal with abrupt cessation though it usually starts about 2 days later.  The caveat to that is that the same properties also make buprenorphine easier to taper down and off of than true opiates provided you have a physician that knows a sensible algorithm for tapering to discontinue.

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2 hours ago, WhatTheBuck said:

42

Thank you there is a lot of good information in your post. I foolishly or maybe not, refuse pain medications 3 months ago because I was tired of having to jump through hoops and seeing the doctor every month which means missing a day from work every month. And went to Tylenol 4 instead. The relief they provided was minimal so I finally just quit taking them all together when the prescription ran out. I found out they were working better than I realized, especially after I went back to work in the field again climbing up and down embankments and header Banks not to mention climbing up and down off of equipment so I imagine I will be talking to my doctor Friday and admitting I was being hard headed made a mistake and should have listened to them

Oops quoted wrong posts was replying to Tripplehorn and thanks for the information again

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On 4/1/2018 at 4:59 PM, TwiceHorn said:

I don't know if anyone has attempted to sort physical opiate/oid addicts from whole hog ones.  Not even sure it can be done.  Certainly, social conditions can lead to the abuse of opiates/oids that leads to addiction, of either the physical or whole hog variety, but in a lot of cases fixing those conditions won't help those already addicted and probably won't stop the whole hog addicts from fulfilling that destiny.

Medical science doesn't understand addiction very well, so it's no surprise that social scientists get it wrong, too.

I think medical and behavioral science recognizes that the spectrum is wide and heterogenous making predictions about success a lot more difficult.  That complexity is just the way it is.  But from a purely observational standpoint, it is fairly well understood by folks whose careers are oriented around it and by those who observe friends and loved ones -they know when things are relatively better or worse, see changes and growth predictive of better outcomes and contentedness, all the while knowing that things can still change abruptly over time.  What's needed are tools to help give people a better chance to succeed in an effort that even under good circumstances remains tenuous in the short term and a constant vulnerability long term.

I mentioned it above, but NAD+ appears to be a very important tool to help a greater percentage of people advance beyond the first 6 months of sobriety when over 60% relapse despite the best available treatments .  After that first 6-12 months of sobriety (PAWS territory), it's game on for a chance at long term success for a greater percentage of people.  It isn't understood how NAD+ works in the brain, but to observers and people who have received it, it does something that nothing else available is known to do.  

NAD+ made national news last week when the journal Cell published a Sinclair study showing an NAD precursor NMN promotes angiogenesis in old mice hearts, essentially helping to reverse effects of cardiovascular decline with advancing age.  Also, the Mayo Clinic in MN has a study underway looking at neuroprotective effects of NAD in head trauma -they're giving NAD (or NR) and placebo to NCAA Div I offensive linemen over two seasons and performing before and after MRI's of the brain (CTE related study).  In another study, mice given NAD or placebo after a controlled brain injury showed appx 30-50% less cell loss post-brain injury in the NAD group.  Not 3-5% less cell loss, up to 30--50% less.  

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  On 3/31/2018 at 6:51 AM, Neonmoon said:

Maybe...and this is a hypothetical...but just maybe they are depressed because they are addicted to drugs. 

That's certainly one facet.   Mood is a dynamic balance of multiple networks that use different neurotransmitters.  I'm fairly convinced there's a percentage of the population whose mood balance is more heavily weighted through the endogenous opioid system as opposed to serotonergic or other pathways.  A rough guess as to who those people are?  People who take a normal appropriate dose of an opioid painkiller, typically prescribed by a doctor for an appropriate reason and experience heightened energy, usually accompanied by a noticeably better mood or euphoria.  I don't receive that response.  Most people don't.  Others have to work for it over time.  Within that group of people who do, there will be a percentage of folks who experience clinical depression for various reasons.  It wouldn't surprise me one bit to learn that those people might be more responsive to a lower calibrated dose of an opioid-like antidepressant whereas they may get a much smaller or no benefit from and SSRI. 

But yeah, you don't come across too many happy addicts and sobriety first goes a long way to feeling better for most.  It goes without saying that any benefits of antidepressants and other psychotropic medications likely get steamrolled by active alcohol and opiate dependence.

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Is chronic pain more prevalent in the US than in other countries? Is it common for doctors to prescribe opioids for chronic pain in other countries? Why does the US have a seemingly huge number of people addicted to opioid painkillers but I don't hear much about similar epidemics in other countries?

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21 hours ago, triplehorn said:

I think medical and behavioral science recognizes that the spectrum is wide and heterogenous making predictions about success a lot more difficult.  That complexity is just the way it is.  But from a purely observational standpoint, it is fairly well understood by folks whose careers are oriented around it and by those who observe friends and loved ones -they know when things are relatively better or worse, see changes and growth predictive of better outcomes and contentedness, all the while knowing that things can still change abruptly over time.  What's needed are tools to help give people a better chance to succeed in an effort that even under good circumstances remains tenuous in the short term and a constant vulnerability long term.

I mentioned it above, but NAD+ appears to be a very important tool to help a greater percentage of people advance beyond the first 6 months of sobriety when over 60% relapse despite the best available treatments .  After that first 6-12 months of sobriety (PAWS territory), it's game on for a chance at long term success for a greater percentage of people.  It isn't understood how NAD+ works in the brain, but to observers and people who have received it, it does something that nothing else available is known to do.  

NAD+ made national news last week when the journal Cell published a Sinclair study showing an NAD precursor NMN promotes angiogenesis in old mice hearts, essentially helping to reverse effects of cardiovascular decline with advancing age.  Also, the Mayo Clinic in MN has a study underway looking at neuroprotective effects of NAD in head trauma -they're giving NAD (or NR) and placebo to NCAA Div I offensive linemen over two seasons and performing before and after MRI's of the brain (CTE related study).  In another study, mice given NAD or placebo after a controlled brain injury showed appx 30-50% less cell loss post-brain injury in the NAD group.  Not 3-5% less cell loss, up to 30--50% less.  

That's certainly one facet.   Mood is a dynamic balance of multiple networks that use different neurotransmitters.  I'm fairly convinced there's a percentage of the population whose mood balance is more heavily weighted through the endogenous opioid system as opposed to serotonergic or other pathways.  A rough guess as to who those people are?  People who take a normal appropriate dose of an opioid painkiller, typically prescribed by a doctor for an appropriate reason and experience heightened energy, usually accompanied by a noticeably better mood or euphoria.  I don't receive that response.  Most people don't.  Others have to work for it over time.  Within that group of people who do, there will be a percentage of folks who experience clinical depression for various reasons.  It wouldn't surprise me one bit to learn that those people might be more responsive to a lower calibrated dose of an opioid-like antidepressant whereas they may get a much smaller or no benefit from and SSRI. 

But yeah, you don't come across too many happy addicts and sobriety first goes a long way to feeling better for most.  It goes without saying that any benefits of antidepressants and other psychotropic medications likely get steamrolled by active alcohol and opiate dependence.

You seem pretty knowledgeable from a scientific perspective so let me drop this on you.  I have a theory that for patients who are in severe pain, the "salience" or addictive effect of a narcotic/addictive substance is attenuated if not eliminated.  Thus, for those who receive "unnecessary" prescriptions (pain insufficiently severe or they continue taking it past the point of severe pain), the addictive potential is much higher.  Is there any support for that notion?

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48 minutes ago, XYZ said:

Is chronic pain more prevalent in the US than in other countries? Is it common for doctors to prescribe opioids for chronic pain in other countries? Why does the US have a seemingly huge number of people addicted to opioid painkillers but I don't hear much about similar epidemics in other countries?

Anectodal, but I have a family member with terminal cancer in a lot of pain.  Opiates were a piece of cake to get, and covered by insurance.  Medical marijuana on the other hand costs a lot of money and has onerous requirements making it almost impossible to obtain.

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50 minutes ago, TwiceHorn said:

You seem pretty knowledgeable from a scientific perspective so let me drop this on you.  I have a theory that for patients who are in severe pain, the "salience" or addictive effect of a narcotic/addictive substance is attenuated if not eliminated.  Thus, for those who receive "unnecessary" prescriptions (pain insufficiently severe or they continue taking it past the point of severe pain), the addictive potential is much higher.  Is there any support for that notion?

I agree with that observation.  Similarly, people with a history of opiate dependence who have been opiate free can receive a short exposure to opiate pain medicine when it is given for acute pain and they won't typically have the same experience of cravings or altered mood when they stop as soon as the acute pain subsides.  Alternatively, sober opiate dependent people who use (relapse) opiates recreationally only once or twice can experience an episode of sustained elevated cravings putting them at a high risk of full blown daily habit.  Different brain pathways are lighting up resulting in variable responses between conditions of opiates with or without acute pain.  

It would be a helpful nudge in the right direction if all docs hewed the quantity of pain pills dispensed for acute pain/post-op pain closer to the predicted duration.  There are probably numerous reasons docs don't, but one cynical view is that docs don't want to fend off a steady stream of refill requests.  Give enough to more than reasonably be able to say "no reason you should need a refill, period" and not waste time and energy debating and appeasing the caller.  But that excess buffer amount has real consequences for a significant number of people. 

If a person gets energized by those initial exposures to normal doses of opiates for acute pain, it appears they need to be especially careful of the longer term risk of developing emotional/physiologic dependence with opiates laying around.  I wouldn't say absence of that energizing effect is protective, however.

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Thanks.  With that being true or at least plausible, then I can see that the relief from boredom and psychic pain (present in depressed New England, Appalachia, and the midwest), further tempts people to prolong their prescriptions beyond medical (severe pain) necessity.  In which case, the regionality of the opioid crisis begins to make more sense.

 

Of course, social milieu plays a huge part in addiction and relapse and partially explains the regional prevalence of meth.  So patients in those regions are likely to either recreationally abuse or be familiar with recreational abuse before getting their own scrip for that sprained back or root canal

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10 hours ago, XYZ said:

Is chronic pain more prevalent in the US than in other countries? Is it common for doctors to prescribe opioids for chronic pain in other countries? Why does the US have a seemingly huge number of people addicted to opioid painkillers but I don't hear much about similar epidemics in other countries?

https://www.nbcnews.com/storyline/americas-heroin-epidemic/dangerously-addictive-painkiller-prescribed-patients-who-shouldn-t-have-received-n767311

https://www.nbcnews.com/news/us-news/feds-say-5-nyc-doctors-took-bribes-drug-maker-prescribe-n857476

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

$$$$

Edited by WhatTheBuck
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21 hours ago, XYZ said:

Is chronic pain more prevalent in the US than in other countries? Is it common for doctors to prescribe opioids for chronic pain in other countries? Why does the US have a seemingly huge number of people addicted to opioid painkillers but I don't hear much about similar epidemics in other countries?

 

https://www.bloomberg.com/news/features/2017-10-05/the-lawyer-who-beat-big-tobacco-takes-on-the-opioid-industry

It's all about marketing.  If you build it, they will come.

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It's fairly well documented elsewhere, but "pain management" was largely ignored by US medicine until Purdue Pharma decided to change the standard of care so it could sell more Oxycontin, which was a patented, time-release oxycodone pain reliever.  So US docs went from underprescribing to overprescribing and it "worked" for all painkillers, not just Oxy.  Purdue (no connection to the University) argued, apparently without basis, that the time-release formula had less addictive potential than more conventional formulations.

 

What's odd to me about the suits against McKesson and similar (drug and medical supply suppliers), is why would they ship vast quantities if there wasn't already a demand, that is, a large prescribed patient base?  Maybe there's something about medical economics I don't understand.

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3 hours ago, BearSchlong said:

In the 90's, a marketing tactic used on physicians was to designate "Pain" as "The fifth vital sign."  Also pushed "First, treat the pain."  Posters, print media, the whole shabang.  

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On 4/5/2018 at 3:11 PM, TwiceHorn said:

You seem pretty knowledgeable from a scientific perspective so let me drop this on you.  I have a theory that for patients who are in severe pain, the "salience" or addictive effect of a narcotic/addictive substance is attenuated if not eliminated.  Thus, for those who receive "unnecessary" prescriptions (pain insufficiently severe or they continue taking it past the point of severe pain), the addictive potential is much higher.  Is there any support for that notion?

I have had more than one physician tell me this exact same thing. When I first had my leg injury back in 96 I thought taking pain medication with everything I had due to fear of addiction. Granted I have been on and off of various strengths of hydrocodone ever since. However when I did not have pain I didn't take it. When I was working for myself I realized that when the pain got too bad for me to bear that hey I'm the boss I'm going to go sit down until I'm not hurting. That work wonders as long as I was working for myself. When I first got home with the leg injury I was on 10 mg Norco for 36 straight months and when I got done with it I put it down never had one physical or psychological problem with it. Unfortunately as my body falls apart as I get older I have been back on and off of them for years now. I have a doctor's appointment this past Friday and she asked how long it was going to be until I retired. I told her about five to six more years and she asked what I was going to do about pain relief then. I replied frankly if I start to hurt I'm going to go sit down in my damn recliner until I don't.

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7 minutes ago, SHOOTER12 said:

I have had more than one physician tell me this exact same thing. When I first had my leg injury back in 96 I thought taking pain medication with everything I had due to fear of addiction. Granted I have been on and off of various strengths of hydrocodone ever since. However when I did not have pain I didn't take it. When I was working for myself I realized that when the pain got too bad for me to bear that hey I'm the boss I'm going to go sit down until I'm not hurting. That work wonders as long as I was working for myself. When I first got home with the leg injury I was on 10 mg Norco for 36 straight months and when I got done with it I put it down never had one physical or psychological problem with it. Unfortunately as my body falls apart as I get older I have been back on and off of them for years now. I have a doctor's appointment this past Friday and she asked how long it was going to be until I retired. I told her about five to six more years and she asked what I was going to do about pain relief then. I replied frankly if I start to hurt I'm going to go sit down in my damn recliner until I don't.

Really sorry to hear of your struggles.  Glad addiction hasn't compounded it.

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2 minutes ago, TwiceHorn said:

Really sorry to hear of your struggles.  Glad addiction hasn't compounded it.

Believe me I thank God for that continuously. Anytime I've had the opportunity to not take it, such as when I made an office for extended period of times and able to sit down when I need to and don't have to do any lifting because of my shoulder problems I'm always afraid the something's going to happen I'm going to get sick I'm going to have withdrawals whatever, but so far not one thing. As I said I thank God for it daily hell I've got enough problems without that. 

Edit, after some of the nightmares I've read about withdrawal I don't even want to think about it. I read so many cases about the hell addicts have gone through with both physical and psychological addiction it seems like a true to life Horror Story

Edited by SHOOTER12
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