I'm sitting at my desk debating whether or not to take a Tramadol tablet (50 mg, generic for Ultram): an opioid. I usually take them near bedtime, when I do take them, but not too near since I take other medications then, and the combination can get my sleeping heart rate and blood pressure inconveniently low — or in some other way get me dizzy. I've had the Tramadol prescription for a number of months now, but have only taken a small number and wonder if I'm going to be counted by some activist or other as part of "THE OPIOID EPIDEMIC."
I think about such things since I've fitfully followed the opioid story in the newspapers and just listened to "Opioid Overdoses: Mass Casualty Zones in America" on 1A, the NPR discussion feature from WAMU in Boston that's replace The Diane Rehm Show.
Even in so respectable a venue, I heard few significant numbers. A literal epidemic is "the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic" (Wikipedia, "Epidemic").
What are the rates of opioid overdoses per 100,000 in various areas? Of those, how many per 100,000 population are fatal? How many are intentional suicides? How many are accidental overdoses with prescription drugs produced under FDA supervision? How many are accidental overdoses with street drugs? How many are accidental overdoses from people using the drugs improperly through ignorance of proper dosage and/or a desire to get high?
I'm an old man, and I've lived through a number of "epidemics" and "crises" hyped in part because people think, correctly, that the best way to get attention (and funding) is mongering fear. So there was an earlier crisis in painkillers — inevitably addicting for some portion of the population — and then a crisis in pain because many people in puritanical ("Suck it up; 'No pain, no gain'") American society couldn't get sufficient or sufficiently-strong pain-killing drugs. And now THE OPIOID EPIDEMIC!
(Rule of thumb: Last generation's solutions can make for some of this generation's problems.)
If there were generally knowledge of the relevant numbers, and their implications, we might have an informed discussion of what might be the most effective responses and determine what's politically possible. I'd like that: I spent the biggest part of my life in southwest Ohio, near Dayton, a center of the "epidemic"; and I'm taking, now and then, an opioid. I'd like lower-volume, logically-respectable discussion, starting with statistics using the phrase "per 100,000 population of ____."
Accidental overdoses from street drugs might be most immediately dealt with by providing FDA-tested, properly labeled drugs. Suicides are a different matter. Both involve serious discussion of difficult political problems. For one thing, if despairing people in Rust Belt America don't kill themselves, what are we, as individuals, communities, and a country, willing to do for them to relieve understandable despair?
* * *
One of the participants on the 1A panel had as her central talking point, "Addiction is a disease"; all right, but so is cholera — and central to preventing cholera epidemics were public-works sanitation projects. We have to look at drug use in its social context, and drug issues are social and political issues. So two-and-a-half closely-related things to end with: (1) Opioids are pain-killers, so we should expect some addicts. His second point was that we can't talk about "the drug" and "the user." There will probably be a number of drugs for one thing. More important is that social context. So (2) Remember that we did NOT have a heroin epidemic with former military heroin users returning from Vietnam. The great majority were able to leave their pain and heroin back in 'Nam. Those who returned to more pain in the US and available narcotics often went back on the needle. So there's that rule that with any pain-killer, a certain proportion of users will get addicted, to which we can add that opioids are psychoactive, and any drug that can get you buzzed will be abused. But the number of addicts and abusers can be reduced with social support, with reducing their pain, and with moving toward a society where we address compassionately and sensibly — using science and logic, figurative head as well as figurative heart — our problems and don't go immediately and exclusively for a pharmacological quick fix or criminalizing disease.
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