So, because some people abuse opioids, that means they should be taken off the table for everyone.

That mentality led to the Prohibition Era. It didn't work then, and I see no reason why we should expect it to work now.

I also see it as a matter of penalizing innocent people. There are people who take opioids only when they're prescribed and manage to use them appropriately without abusing them. I know, because I'm one of them. When given a prescription for pain management, I prefer to use as little as possible. I'm even willing to put up with a certain amount of discomfort before I resort to the "big guns" of pain management.

Sometimes, I do without completely. My late sister, who was an RN (and by coincidence, this is the second anniversary of her death today) once told me that you can actually take four Advil at a time. That works very well for me, although it cannot be used for chronic pain.

So, because some people abuse opioids, I should be forced to do without should I ever find myself in a situation again where I need them?

I don't want to get into the whole "the government shouldn't be telling me what I can and can't put into my body." See if you still feel that way when you're in ICU after you've been violently assaulted for your cash so some hophead can pay for his next fix.

Note the provision for controlling opioid abuse in this plan.

I suggest that it is a better idea overall than we have now, and that you amend and promote it as you desire.

It won't change all of the factors driving the current surge in drug abuse, but it should guarantee that those who demonstrate actual need can get relief.

I cant tell you how often I get calls from just-discharged patients, saying their insurance is requiring "prior authorization" documentation from the Dr, for their pain script. I'm talking new amputees, mva patients, knee replacement patients....its sickening. I think it's a secret govt plan to reverse immigration back to countries south of us that sell all meds otc. (Not really, but then again maybe????) Its sickening.

That said, I had god-awful back pain from dad, and tried chiropractic as a desperate move, and its helping. A lot. Which is good because pain pills would never be prescribed me, nowadays. I dont care if its placebo-affect, I'll take it!

The people in the industry who want to boss around everyone else's health care have an awfully cavalier attitude towards chronic pain in general. For several years, I have been getting Synvisc-One injections in my right knee, to treat arthritis. It's a non-medicine treatment (basically grease for your knee), it works, and because it contains no medicine, it has no side effects and is safe for long-term use.

I was just informed on Monday, when I called for an appointment for another injection, that our insurance at work will no longer pay for it. Why not? Because "its efficacy is not proven." Bullshit. One of the requirements for FDA approval is evidence of efficacy, for the condition for which it is advertised. By definition, if it's approved for on-label uses, then it has been shown in trials to be effective.

I have zero doubt that some non-medical bureaucrat made this decision. (They probably read a study for some off-label use and didn't understand what they were reading.) The scope of treatments for which the insurance will pay is constantly shrinking, as premiums and deductables go up. The insurance company wants Synvisc-One users to switch to cortisone, but cortisone has terrible long-term effects. The only other alternative is surgery, which would be avoidable if the Synvisc-One was available. Aren't insurance companies these days all about encouraging patients to avoid surgery?

Under the proposal, patients who rely on opioid therapy would shift to non-pharmacological therapies like chiropractic care, deep tissue massage, and acupuncture.

And surprise, surprise:

The chronic pain task force that is writing the proposal includes three acupuncturists and a chiropractor. (An Oregon Health Authority spokeswoman said the task force composition aimed "to represent the variety of clinicians who would be involved in the management of chronic pain.")

Government bean counters push "alternative medicine" as a cheaper alternative, not necessarily a more effective one.

As chiropractors and other holistic health practitioners gain acceptance by the public at large, they make more money and gain political power.

There was a proposal in 2005 to open a "science-based" school of chiropractic at Florida State University. The Florida Legislature put forth the proposal without consulting the university; the bill was the brainchild of a practicing chiropractor and state senator, Dennis Jones, and was signed by then-governor, Jeb Bush. Florida has more chiropractors than all states but California and New York, so I'm sure there were political contributions involved.

The university's faculty, including two Nobel laureates, objected strenuously, threatening to resign, and the Board of Governors killed the proposal by a vote of 10-3 less than a year later.

We have no one else to blame. We elected these idiots. I don't think the committees making recommendations for major medical decisions should include practitioners who went to "medical" school in a mini-mall, nor by the politicians who put them on that committee.

Chronic pain is not ameliorated by deep tissue massage. Here's a hint, if you can get it at a resort as an amenity, it's probably not a medical procedure, nor its practitioner a doctor.

"A people that elect corrupt politicians, imposters, thieves and traitors are not victims but accomplices." ~ George Orwell

“Sometimes, I do without completely. My late sister, who was an RN (and by coincidence, this is the second anniversary of her death today) once told me that you can actually take four Advil at a time. That works very well for me, although it cannot be used for chronic pain.”

Watch this. NSAIDs have all sorts of bad effects on the gut, especially in elderly people, and most likely a higher death rate from the side effects than Opioids do.

Touting them as a safe alternative to opioids will only increase the death rate.

I'm a peaceful law-abiding person who isn't in chronic pain and who doesn't use recreational drugs either. Nevertheless I can imagine "going postal" over this kind of cruel, crude, illogical, stupid, and completely unjustified dictate. I mean, grab the pitchforks revolution time. Who the F do these people think they are?? I've read many articles about the issue of pain management and opioid abuse, and attempts to impose set limits on prescribed pain medication are just 100% wrong, factually and morally. I have a friend who has nerve damage from spinal stenosis and there is absolutely nothing that gives her substantial relief except opioids. She sees a pain specialist and over the past few years has tried everything everything. You name it. No relief. Now her lower spine is beginning the same problems. It's bad enough, and humiliating enough, that she has to get her monthly pain meds in a process that is identical to that imposed on people on parole. Except she's never committed any crime; just been a good person who gave selflessly in her career as as school nurse and as a caretaker to her elderly parents. Why wouldn't she just kill herself if she can't get pain relief?

"Um, I believe you forgot a witchdoctor and a shaman."

Hey now. Reverend UgooBoogoo has been great at keeping microdevils out of my dantian.

"That said, I had god-awful back pain from dad, and tried chiropractic as a desperate move, and its helping. A lot."

May be placebo. May not be. Pain is caused by so many different things it is really difficult to find the root cause and fix it. My mom has some issues and a chiropractor has able to help fix them. She was injured some time ago and no one noticed that some things weren't quite lined up. So forces weren't distributed correctly and she was getting muscle pains from overworked muscles. The pain wasn't actually at where the problem was. So the practor pushed things back into place and gave her some exercises to strengthen the support muscles and now she is more or less cured.

But like I said pain covers so very many things finding the real issue can be next to impossible. The diagnostics are crap. What works for one person probably won't work for the next one.

Why wouldn't she just kill herself if she can't get pain relief?

Maybe that's the point. That's one way to drive down medical costs.

You bring the pitchforks, I'll bring the torches. Others can bring the tar, feathers, and rails as needed.

Conan's Orwell quote is sadly too true.

I have arthritis in my hands. It really interferes with my life. With tylenol it is slightly (and I emphasize slightly) better. If it was much worse I would for sure need something stronger. My problem doesn't even compare to someone with cancer or hip joint deterioration etc. We need some sort of solution to pain.

On the other hand, when I had sciatica and could hardly get out of the car, I found that a morning regimen of stretching every single day fixed it and has kept it from coming back. Also I have to watch how I sit at work.
So sometimes, exercise can work. Chiropractic not so much.

Isab: Watch this. NSAIDs have all sorts of bad effects on the gut, especially in elderly people, and most likely a higher death rate from the side effects than Opioids do.

Oh, I know. My sister impressed upon me that you can't do this for an extended period of time. It's only something for one-time use, like recovering from minor surgery.

"We need some sort of solution to pain."

We await your future innovation Mr CC.

"I was just informed on Monday, when I called for an appointment for another injection, that our insurance at work will no longer pay for it. Why not? Because "its efficacy is not proven." Bullshit."

You've just shown an example of what I've said on my page about a medical "Visa card": if you do not pay, you do not get to say what your treatment is.

About the "bullshit", though - do you really insist that your money should go to things which are NOT proven to work? That's what you're insisting if you protest "efficacy", because the public is amazingly fond of homeopathy. Of course, there isn't a central database or anything to determine this accurately enough to include your personal experience.

I don't want to get into the whole "the government shouldn't be telling me what I can and can't put into my body." See if you still feel that way when you're in ICU after you've been violently assaulted for your cash so some hophead can pay for his next fix.

I had to look twice to see that this comment didn't come from Radwaste or Crid. Patrick, you know perfectly well that the hophead wouldn't have to assault anyone to get his fix money if his drug of choice was legal.

"I had to look twice to see that this comment didn't come from Radwaste or Crid. Patrick, you know perfectly well that the hophead wouldn't have to assault anyone to get his fix money if his drug of choice was legal."

Wow, are you nuts.

"Legal" does NOT mean, "free". I sure wish you'd think about this.

Especially about where you think an addict can earn enough money to pay for her drugs. Work is not a priority for such people.

...you know perfectly well that the hophead wouldn't have to assault anyone to get his fix money if his drug of choice was legal. ~ Rex Little at August 24, 2018 8:21 PM

Because, as everyone knows, hopheads hold down steady jobs and would pay for their legal fixes from their earnings.

You bring the pitchforks, I'll bring the torches. Others can bring the tar, feathers, and rails as needed.

I'd suggest substituting rails for kerosene, might smell worse in the short term, but deals with the long term problem more effectively

"Legal" does NOT mean, "free". I sure wish you'd think about this.

Especially about where you think an addict can earn enough money to pay for her drugs. Work is not a priority for such people.

Liquor isn't free either, and alcoholics aren't exactly known for their work ethic. But how many of them pay for their booze by committing violent crimes? A little panhandling or day labor, or whatever savings they accumulated before getting hooked, gets most of them by. And of course, some of them do hold steady jobs, as do some drug addicts.

Making drugs illegal raises their price to a level more users can't meet without resorting to crime. This is elementary economics, and I can't believe the point still needs to be repeated after all the times it's been made, here and elsewhere.

Rex, look at the results of Prop 47 in California. Possession of small amounts of illegal drugs was decriminalized. Petty crime rates soared as addicts stole packages from residential porches and broke into cars to secure enough money for their next fix. They did not turn to day labor or panhandling in large numbers.

Now, to your point, decriminalization is not legalization and may not drive prices down significantly. However, it does give a window into the mind of how an addict might react to not facing jail time for possession or use of his drug of choice.

"Reverend UgooBoogoo"

Or Pastor Petersen. Same same.

look at the results of Prop 47 in California. Possession of small amounts of illegal drugs was decriminalized. Petty crime rates soared as addicts stole packages from residential porches and broke into cars to secure enough money for their next fix.

Prop 47 reduced the sentences for just that sort of crime, so to blame the increase on addicts in particular is debatable at least.

decriminalization is not legalization and may not drive prices down significantly.

Exactly. To reduce the amount of predatory crime committed by drug users, you have to get the price down, which means that manufacture, importation, possession and sale all have to be legal.

California also changed most property crimes to misdemeanors, meaning no jail time. The upsurge in petty crime has more to do with that than decriminalizing drugs.

"To reduce the amount of predatory crime committed by drug users, you have to get the price down, which means that manufacture, importation, possession and sale all have to be legal."

Your position is that crack addicts will obey the law if they can get crack for less.

Just thought you should see it in print.

I can personally introduce you to a man who thinks beer is more important than his diabetes medicine. He has racked up over $50K in hospital costs this year. No, he can't pay it, we do. This isn't strictly anecdotal, as more than 15 THOUSAND Americans die each year accessing their alcohol cheaply, which you say is a good thing. That's the direct alcohol poisoning death toll, not the truly wonderful incidentals resulting from DUI and domestic violence.

Your position is that crack addicts will obey the law if they can get crack for less.

No, my position is that they will steal less if it takes less to feed their habits. Your reading comprehension assignment today is to look up "reduce" in any dictionary; then look up "eliminate" and note the difference between their definitions.

Based on your last paragraph, it appears you think alcoholic beverages should be illegal. I believe that's been tried. You might want to pick up a book on American history along with that dictionary.

The gubberment needs to get out of the drug suppression business and to quit trying to protect the druggies from themselves.
Do nothing, let the so called opioid epidemic run its natural course, and the survivor population will be less susceptible and healthier. Its not like most addicts actually are of any value to themselves or to society at large.
Quit handing out Narcan to the ODed druggies, let nature take its course and cull the herd of its unfit members. Think of it as evolution in action.

Exactly. To reduce the amount of predatory crime committed by drug users, you have to get the price down, which means that manufacture, importation, possession and sale all have to be legal. ~ Rex Little at August 25, 2018 7:10 PM

Legal drugs won't be free and will still have a cost. Addicts are not noted for holding down jobs; nor are employers noted for readily hiring junkies.

Addicts will still need to come up with enough money to pay for the next fix and doing so legally is not really in their wheelhouse. Petty crime will still be the default method of obtaining enough money for the next fix.

Granted, some addicts will be functional addicts, able to hold down a job and function within the law. Others, however, will not. Legalization will not solve that problem.

Day labor will solve some addicts' need to raise money quickly, but employment law has all but pre-empted many industries from employing casual labor. Licensing requirements and unions have taken others out of the running for hiring casual labor.

No, my position is that they will steal less if it takes less to feed their habits. Your reading comprehension assignment today is to look up "reduce" in any dictionary; then look up "eliminate" and note the difference between their definitions. ~ Rex Little at August 26, 2018 5:35 AM

Your position is that with legalization, addicts without legal means of obtaining money for their next fix will "steal less."

So, if they only steal your wallet and not your watch and wallet, that's okay with you?

Stealing less is still stealing and it's still crime. You haven't solved the drugs-associated crime problem with legalization.

The real issue with Rex's argument Conan is that places that have legalized various drugs (alcohol included) the drug isn't cheaper. In fact it is usually more expensive. It is just less risky to buy or own. Taxes and regulations are expensive.

And if you are looking for a crime rate correlation to legalization Colorado is probably where you want to look. At which point you will find there is pretty much no effect. Not property crimes. Not homicides. Nothing. Legalize or not didn't make much of a difference. You do have more DWIs with pot but you have less from alcohol.

What you do see are more general community effects. They brought the drug use out of the shadows and into public. So now weed smoke is everywhere in Denver and you have drunks wandering all around. Gives it a real New Orleans feel. Never know if someone is going to wander off into traffic or drop their pants and take a piss cause they are drunk out of their minds (on weed). So many cities are looking at bar type rules to try and confine things. Sure you can smoke, but you got to do it at home or in a bar. Not in public. Just like with alcohol.

This follows the trends you see in Europe when they legalized different things. And if other drugs follow those same European trends you won't see much crime effects until you get to PCP and bath salt type drugs. But those are very small numbers and somewhat self regulating since consumers don't survive long.

...and you have drunks wandering all around. Gives it a real New Orleans feel. ~ Ben at August 27, 2018 9:58 AM

I went to a software conference in Phoenix a few years ago. On the ride to the airport, the car passed through a suburban-looking area with several places that had people passed out drunk on the sidewalks; one of them directly under a billboard for a rehab center.

I wasn't expecting that in Phoenix. I've stayed in downtown New Orleans and saw fewer passed-out drunks on sidewalks than I did on that 20-minute ride to Sky Harbor - which, I have to say, is one of the friendliest airports I've ever gone through.

New Orleans has managed to turn drunks and panhandlers into a tourist attraction. A form of public clowns if you will. Most other places try to isolate such folk. You would prefer I said it has authentic LA flavor? I haven't been to LA in a while so I can't comment as such. But when friends were in Denver they had a high lady try to attack a bus driver, people were passed out in the street, public defecation was becoming common, and drivers had to watch out for people drunkenly stumbling into traffic. All typical stuff when public intoxication is permitted. That's why the parts of New Orleans where public drinking is permitted cars can't go there and the buildings have outdoor sprinklers. They've made their accommodations for those habits and don't let people public drink outside of those areas.

You would prefer I said it has authentic LA flavor? ~ Ben at August 27, 2018 3:57 PM

I don't care what city you use to describe it. I was just mentioning going to Phoenix and finding it surprising that in an Arizona suburb I was finding passed-out drunks on the sidewalks. I wasn't expecting that.

You might expect it in a party town like New Orleans, but I didn't see passed-out drunks there to the extent I did in that Arizona suburb.

I've only been to LA a couple of times and I spent most of those visits sitting in a car on the 405. By the time I got anywhere, it was too dark to see anything on the sidewalk.

I can understand that Conan. I don't know what is going on in Phoenix. I haven't been there in years.

The people I still talk to in Colorado are all thinking about applying bar laws to weed. They are sick of the drunks and loons all over the place not to mention the smoke and trash. As I said above an honest assessment of legalizing weed doesn't look like it has impacted the general crime rate at all. The prohibitionists have graphs showing a huge spike and the anti-prohibitionists have graphs showing a huge drop. They are both lying their asses off. Things are fairly flat. You still have illegal weed sellers. The black market appears to be down but not gone (who can say how much down really) mainly because taxed and regulated weed costs a lot more than black market stuff. The drug gangs were always more interested in the harder stuff with a higher profit margin anyways. So they aren't too affected by things. So not much change in general.

So given Colorado's experience with things I'm betting Jeff is right that the property crime increase in California was due to reducing penalties for property crime and not due to drug legalization.

One thing of interest is you are seeing the weed market segment like the alcohol market did. You have your wine snob types with their fruity or exotic weed which is mainly sold as a way to demonstrate wealth. Then you have your more blue collar beer type weed. And then there is the MD40/40 moonshine type stuff for your hopeless dregs.

You still have illegal weed sellers. The black market appears to be down but not gone (who can say how much down really) mainly because taxed and regulated weed costs a lot more than black market stuff. ~ Ben at August 27, 2018 7:02 PM

I believe it. There are still moonshiners and booze can be found both legal and cheap.

I'm betting Jeff is right that the property crime increase in California was due to reducing penalties for property crime and not due to drug legalization. ~ Ben at August 27, 2018 7:02 PM

That could be right, and probably is. However, Colorado did not decriminalize other drugs, even in small amounts. So, the addict has no fear of arrest for possession, as long as the amount he's carrying is personal use sized. In addition, with decriminalization, the courts no longer have the leverage of being able to force addicts to either attend rehab or face jail time.

The best the police and courts can get the addict on is the petty crime he just committed, usually a misdemeanor. According to friends and social media contacts back there, police don't even respond to petty crimes any more; they just tell the victim to call the insurance company.

Rehab doesn't work. It never has. The success rate is well below 5%. So court ordered rehab is pointless. Jail works for a bit in the sense it takes that person out of general circulation.

"However, Colorado did not decriminalize other drugs, even in small amounts. So, the addict has no fear of arrest for possession, as long as the amount he's carrying is personal use sized."

I have to admit I don't understand what you wrote here. Are you talking about Colorado or California? If small amounts weren't decriminalized then why don't people have to worry? When you talk about the police not showing up, is that in Colorado or California?

Okay, that was confusing. My bad. The addict in California has no fear of being arrested for possession. And, to Jeff's point, his petty crime to acquire money for his next fix has probably been downgraded to a misdemeanor. As such, the cops won't even bother to show up.

That makes sense to me. Thanks Conan. And I can't disagree with what you intended to say.

"Now, to your point, decriminalization is not legalization and may not drive prices down significantly."

You certainly didn't acknowledge that when I said it.

"Because, as everyone knows, hopheads hold down steady jobs and would pay for their legal fixes from their earnings."

I've known plenty who did. A few of them owned legitimate businesses at which I was employed. In my experience, they've generally been more productive that those using prescribed SSRI's.

"Here's a hint, if you can get it at a resort as an amenity, it's probably not a medical procedure,"

which has nothing to do with whether it is effective in treating health problems. Guidance and facilitation of physical exercise is also a commonly purchased resort amenity, and it is efficacious for resolving many health issues, including some causes of chronic pain.

"California also changed most property crimes to misdemeanors, meaning no jail time."

Yeah, Conan conVENiently forgot to include that.

"Legalization will not solve that problem."

Not COMPLETELY. Don't let the perfect get in the way of the better.

@Conan: "Because, as everyone knows, hopheads hold down steady jobs and would pay for their legal fixes from their earnings.:

So what are piss tests at work for if drug users don't hold steady jobs?

I once knew an alcoholic bank VP, who was clearly earning a larger salary than anyone in my family ever has. His secret was simply to not start drinking until the bank closed - but he was drunk by 6:30 every day. His family suffered a lot, but his work performance was never affected. I suspect a lot of addicts are similar.

And most marijuana users are NOT addicts - it's less addictive than coffee. The issue with a pothead is that it's likely that he started out lazy, and mellowing out with pot makes it worse - but the problem was there before the pot use. OTOH, I could see an extreme Type A personality using pot to relax a little and be less likely to drop dead by 50 - and it would do a lot less physical damage than that bank president's habit.

As for the crime rate under CA Proposition 47, it sounds to me like the main problem isn't addicts, but cops who don't bother with property crimes, aided by making it illegal to protect your property with anything that might hurt the thief. _Everyone_ wants more than they can earn, and addicts aren't the only ones lacking a moral compass to keep them from stealing when they discover that it's safe to do so.

If you want to drive down petty theft, legalize the victimless crimes that cops would rather pursue.