I think community policing here in our town has been fairly good, and the response to heroin in particular seems sane and humane. (And yeah, I know heroin is a whitish drug problem, but whatever.)
heroin is a whitish drug problem
It is? I'm clearly behind on my drug demographics and/or stereotypes.
3: Not exclusively, but here on the outskirts of Appalachia, yeah. It's for people who can't get or can't afford pain pills anymore.
Police here carry Narcan/naloxone to respond to overdoses and we're part of a pilot program where people, mostly family members of heroin users but also users themselves, can get trained to administer it. My understanding is that the bulk of the children coming into foster care right now here are doing so because of heroin. Last weekend, five adults overdosed in the same mobile home full of children, and I assume none of them have custody right now.
When our town's police responded to the bad situation that led to Val and Alex's parents losing custody, they gave the kids stuffed animals that they keep for that purpose. Alex slept with his every night for years after that. I told our police chief this and he got a little choked up, saying that was exactly what they wanted with that program, to be able to give some tiny measure of solace at the worst times. But they don't always hear when what they're doing is working, and I'm glad Chief Anderson has gotten the positive support he has.
It's for people who can't get or can't afford pain pills anymore.
Yeah, pretty much. It is miserably sad for the persons affected and the society in which they are immiserated.
There are several rich potential threads' worth of discussion hiding in the prescription-opiates-to-heroin-addicts'-progress: "I blame George W. Bush something Afghanistan something Iraq something"; "Doctors were afraid of being sued by patients claiming chronic pain, now are afraid of the DEA"; "Poor and underemployed Americans will take anything that makes their wretched suffering tolerable"; "Everything is Reagan's fault"; etc., etc.
3: I wasn't up on this either, but heroin is big in Concord and Weston--among whole families. No longer the black junkies of the inner-city. As a stereotype, that's so pre-1980.
For a primer on the Heroin epidemic in small town NE, let me recommend the program Anthony Bourdain did on it in his current series on CNN: episodes come around regularly, it should be easy to catch. His developing journalism puts the rest of the network to shame. He starts in the resort town where he first worked in kitchens, as a kid/student, material he wrote about well in Kitchen Confidential.
The book hooked me in those passages, for two reasons: I had had that restaurant experience, the shared labor, ethos and camaraderie, including sex. All of that was and is anomalous in my experience, and Bourdain describes it very well. The second was the debt he acknowledged in the introduction to Down and Out in Paris and London, which warmed my heart and told me what an aware and conscious thinker he is.
If this is going to be the heroin thread, I just learned that one of the founders of Canned Heat* died Pulp Fictionequely:
On April 5, 1981, during a break between sets at The Palomino Club in North Hollywood, Hite was handed a drug vial by a fan. Thinking it contained cocaine, Hite stuck a straw into the vial and snorted it. The drug turned out to be heroin and Hite turned blue and collapsed. Some roadies put Hite in the band's van, and drove him to a nearby home where he died of an overdose*Not the high tenor/Kermit guy who died eleven years early of barbiturate overdose.
The police chief's response is the liberal dream police chief response. We work for the people. Holy shit! Someone tell the NYPD, who have now burned through every bit of 9/11 goodwill, and then some.
9 - There's a real Brer Rabbit aspect to that which would be funny if it weren't an attempt by the police to get the mayor of the largest city in America canned for telling his son that black people need to be extra cautious around cops. "Oh no! Our protests, which were fueled by resentment of years of police harassment of minorities, have led you to show us up by stopping ticky-tacky arrests for nuisance crimes!"
I'm really not trying to just be a jerk when I say that the NYPD slowdown, if it's real, might genuinely be an improvement. Depends on the details -- if they're slowing down responses to 911 calls about ongoing violent situations, that's really bad. But a 66% decline in the rate of arrests for lowlevel 'quality of life' offenses? Might not be a problem at all.
Yeah, I had the same thought. I wonder whether it will make any difference to quality of life, other than an improvement for minorities. If De Blasio were more clever/more of a troll, he'd make a speech about those stats and laud the PD for being responsive to minority concerns.
12: Or take credit for the drop in crime!
On the NYPD, this take by a liberal cop in suburban NY is interesting. The idea that the cops owe their ultimate allegiance not to their political leaders or even the people but to the laws themselves seems... problematic. As the Nashville chief pointed out, cops exercise discretion in which laws to enforce all the time. It's hard to imagine how a police department could operate effectively if they didn't.
But a 66% decline in the rate of arrests for lowlevel 'quality of life' offenses? Might not be a problem at all.
This was also my thought.
This is sort of the counterpart to protesters getting police officers lots of paid overtime.
If some fatuous econ professors aren't salivating over the prospect of a natural experiment in disincentives, I'll eat my hat.
2: Sort of, but I think he's also being compared to police leadership in highly-Democratic incorporated cities, who are, most charitably read, not doing much about their forces' poor attitudes.
Also, maybe I'm misunderstanding, but why would it be different for them to have policing under a consolidated city-county government rather than a county government? In either case it's the countywide electorate the head is responsible to. I'd put the difference more in the demographics of the county (which FWICT is almost entirely Nashville proper, to the extent such a thing exists anymore).
And what does eating your hat disincentivize?
23: That's a salient differencs, but the layer of insulation doesn't seem to produce great chiefs with other big city governments. I'd bet its main advantage is that it makes the system inhospitable to tough-on-crime maniacs like Arpaio.
(No, spellcheck, not Arapaho.)
It sort of feels on topic to point out the the Pope, like the Nashville police chief, appears to have a basic connection to reality.
3/6: I thought crack was the stereotypical black drug. Heroin has been stereotypically white since Trainspotting. It's certainly become a big problem in Vermont in recent years.
5
"Doctors were afraid of being sued by patients claiming chronic pain, now are afraid of the DEA"
This bugs me. (To be clear, the thing that bugs me is the meme that doctors are and/or should be lawsuit-wary, but I can't tell from this what you think of either version of it and either way I agree with you that it's a popular meme.) The myths that doctors need to be afraid of lawsuits constantly, or more generally that our society is unreasonably litigious, is annoying and probably harmful. (I don't have statistics handy to prove that it's a myth, but can probably dig them up if anyone is genuinely curious.) Not the worst one out there, but worth pushing back against when we can be bothered.
On the election of minor administrative officials: I wonder if we could essentially empanel juries for these elections. Choose 30 random people, hold a tiny election campaign (debates, town hall meetings, meet-and-greets, flyers from interest groups) for their benefit, just for this one office, and have them deliberate and vote. A lot less turnout-dependence, utterly uninformed voters, and advertising money. A little more sampling noise.
Yea, I think the whole NYPD work slowdown is definitely going to make a good thesis topic somewheres.
29: To the limited extent that I understand matters, it is simultaneously true that the DEA has railroaded doctors for what were arguably defensible prescribing habits, and that opioid prescribing habits in the U.S. are totally out of hand. Austin Frakt says the U.S. accounts for 99% of global consumption of hydrocodone (ingredient in Vicodin) and 80% of oxycodone.
The earliest crackdown was on pill mills (doctors passing out Oxy scrips with inappropriate laxity). That's how some possibly innocent docs got caught up on the dragnet. Then came measures to prevent doc shopping, like statewide databases to prevent the Rush Limbaughs from getting scrips from multiple practices.
The newest thing is cracking down on the pill diverters: patients who get opioids on legitimate prescriptions and then sell them. One rural doc told me about a patient who had been on Oxy for years for back pain. The doctor ran a blood test for opioid metabolites and found none. He confronted the patient and told him he was going to have to cut off his pills. The patient said, "Doc, you can't do that. I won't be able to make my truck payment!"
Newt just got prescribed reasonably heavy opiates for his collarbone (which I think was a good thing to do), but about twice as much as he needed (that is, pills to cover twice as many days as he was actually in pain for). I guess I don't know whether how long intense pain from a broken bone lasts is that variable, or if the prescribing doctor was slapdash about overdoing it.
I actually don't know what you're supposed to do --pitch the extras back at the pharmacist? Flush them? What everyone I know actually does is shove them in a cupboard until either there's some pain-related emergency or an enterprising acquaintance finds and pockets them.
36: Here you go. A lot of communities have programs to collect them, otherwise it looks like you can generally just throw them away.
or an enterprising acquaintance finds and pockets them.
Scavenger hunt at LB's place!
36: Earlier this year I tried to offer my oral surgeon the plentiful opiates she'd prescribed me, zero of which I ended up taking, figuring maybe she could give them to low-income/uninsured patients or something? I was sternly upbraided for the suggestion, I guess it would have been illegal for her to dispense them directly, or maybe she was just offended at the suggestion she might see low-income/uninsured patients, wasn't clear. She suggested I could probably bring them to the pharmacy but that was too much hassle so instead they're sitting in a cupboard somewhere.
30/31: I actually just discussed this with my relative, a minor elected official in Cape Cod, the other day! A decade of town meetings have definitely taken a toll on their faith-in-direct-democracy.
Another day and a half in sunny Portugal (tonight I attempted to convince a French in-law that the Freakonomics genre is Bad for the World, boring and/or annoying the rest of the room) before we head to Vienna. I lost my wallet on the transfer in the Azores, but an in-law recruited a soap opera actor to pick it up from the police station for me, so hopefully that will all work out.
Sadly, your wallet was actually claimed by his evil twin, and Iberian Fury going to have to marry the heir to a local Mafioso in order to get it back.
36. At least in this country you're supposed to give unused drugs back to the pharmacist for safe disposal. You are NOT meant to flush them, as if everybody flushed all their unused drugs it would lead to a contamination problem (You are aware that most water in highly urbanised areas is reprocessed?)
Keeping them for next time is also possible, but check that they don't lose efficacy over time
42: I don't think that pharmacists can take them here. In my town there used to be days when the town would collect them --once or twice a year--but now you can leave them in a sealed box at the police station/
43. Yes, but you give them to somebody for safe disposal. It can't be hard to find out who. (googling "Disposal of unused medicines New York offers this.)
if everybody flushed all their unused drugs it would lead to a contamination problem
Not clear that it would be noticeably worse than the drugs getting into the environment after passing through someone's body first, which is the status quo.
46 makes it sound like you might be able to get high from drinking the urine of an opiate addict. Is that true?
Don't understand 46. Of course drugs get into the environment by passing through people's bodies, but a lot of them are metabolised into something else on the way. Are you arguing that exacerbating the problem of drugs in the water through human waste by throwing a lot of additional, unmetabolised drugs into it in addition doesn't make it worse?
Urine concentration of a recent user is 20 ug/mL. Oral dose is 50 mg. So drink 2-3 L of urine.
as if everybody flushed all their unused drugs it would lead to a contamination problem
Considering how rarely most people have unused drugs and how much water a typical person uses, it seems likely to me that flushed drugs would be so diluted that they're harmless.
Doesn't everybody else save their urine in jars?
50: I think that oral contraceptives are getting into the water supply, and some people think that this may be affecting fish.
And since my parents insisted on stopping at my grandmother's place on the way to the airport this morning, I had to listen to her complaining that Times Square would be unsafe tonight because of "all those idiots, you know, those black rioters or whatever." Glad to be on a plane back to my bubble, where the worst I have to listen to are tenured professors denying climate change or complaining about feminism.
tenured professors denying climate change
Who does this in your bubble? Tim's mother is a bit of a skeptic, but she's in way exurban Toronto.
50. You'd think so, wouldn't you? But it ain't necessarily so.
47: This works for some psychedelics. I think peyote is one of them.
56: Measurable doesn't necessarily mean harmful, as your link says.
"Measurable doesn't necessarily mean harmful."
Hot damn, I sense a business opportunity even more compelling than selling fake vegan butter.
I know nobody clicks the links, but the one in 37 does actually address all this:
Some people are questioning the practice of flushing certain medicines because of concerns about trace levels of drug residues found in surface water, such as rivers and lakes, and in some community drinking water supplies. "The main way drug residues enter water systems is by people taking medicines and then naturally passing them through their bodies," says Raanan Bloom, Ph.D., an environmental assessment expert in FDA's Center for Drug Evaluation and Research. Bloom goes on to say "many drugs are not completely absorbed or metabolized by the body and can enter the environment after passing through waste water treatment plants."
"While FDA and the Environmental Protection Agency take the concerns of flushing certain medicines in the environment seriously, there has been no indication of environmental effects due to flushing," says Bloom. In addition, according to the Environmental Protection Agency, scientists to date have found no evidence of adverse human health effects from drug residues in the environment.
"Nonetheless, FDA does not want to add drug residues into water systems unnecessarily," says Hunter. The agency reviewed its drug labels to identify products with disposal directions recommending flushing down the sink or toilet. This continuously revised listing can be found at FDA's Web page on Disposal of Unused Medicines.
Speaking of medication, I'm now taking nitroglycerin patches. I put it off until after Christmas because the warning label said I might get migraines and that's not the true meaning of Christmas. Apparently, the same vasodilating effect that works against angina is supposed to allow more blood into my tendons and thus the healing can being. This is apparently an off-label use as it isn't mentioned on the Wikipedia page.
Also, if all the chest pains that I have been attributing to heart burn go away, I've will have learned something really fucking scary.
To stay on topic, nitroglycerin is indeed excreted in through urine. Also, in bile. I don't know how bile gets out of the body. I suppose through the brohole.
62: You should hammer on one of the patches to see if you can make it explode. Do not be actually wearing it when you try this.
Also I hope your heartburn does not go away.
How many narcotics have to be flushed down the toilet before I can get high from eating a trout caught in a local stream? That's all I want to know.
Maybe you can use your urine as an explosive.
"Measurable" amounts are probably 4-7 orders of magnitude lower than physiologically active doses, depending on the potency of the drug. Mass spectrometers are really sensitive if you're looking for a particular compound.
(To avoid any confusion, let me clarify that 65 was a joke. I believe that deliberately flooding a stream with narcotics in an attempt to subsequently induce intoxication by ingesting fish from that stream would be (a) unlikely to be successful, (b) inefficient whether or not it was successful, and (c) immoral.)
Don't dismiss an interesting idea before it's been tried. I mean, there are weaknesses in the last step of the plan, but other than that, it has potential.
If the amount of the drug in tap water is measurable, does that mean it's too strong to work as a homeopathic remedy?
65/67: Start with goldfish. Dump a bunch of pills in its bowl, then swallow it at your leisure. Far less immoral than flooding an otherwise pristine stream with opiates.
70: What would be the point of that if he already had the pills? I think you're missing the point here.
71: The point is SCIENCE!
Any fool can get high. It takes a special fool to get high from eating goldfish.
||
Police say he cocked the gun, lowered the hammer, and then for some reason turned the gun around toward his face right as it fired. Based on witness statements, investigators believe it was an accident.
"It's a shame. It's a damn shame. I never figured him to be irresponsible with a handgun," next door neighbor Dallas Collins said.
[I haven't yet followed all the links, but many of them look irresistible.]
|>
60: I fear your "Silk Road meets Uber for Oxycontin" idea will meet with persecution from the statist pigs.
73 sounds like sweet karma. Dude was threatening to shoot his wife's dog, then accidentally shot himself.
69: An analogy I read recently is that homoepathic "remedies" are so dilute that they wouldn't even contain a single molecule in the volume of all the Earth's oceans.
When one of the kids was teething we bought teething tablets that were labeled homeopathic but actually did list active ingredients at some percentage. I think it worked out to a few hundred molecules per tablet, and that was molecules of some plant extract so probably a couple molecules of any given chemical. They did seem to work though, probably because when put in the mouth the tablets turned into a sticky paste a teething baby might like.
33
29: To the limited extent that I understand matters, it is simultaneously true that the DEA has railroaded doctors for what were arguably defensible prescribing habits, and that opioid prescribing habits in the U.S. are totally out of hand.
Maybe so, but that's not what I was talking about. I was talking about the facts that the cost of malpractice insurance has been dropping, and weren't a big factor in high health care costs to begin with.
I don't know whether or not doctors in general actually worry a lot about getting sued, but I can't find any evidence that they need to. And the idea that they need to was a big argument against health care reform (and probably still is somewhere or or will be again somehow, since Obamacare is far from perfect, but anyways).
I have a regular headache but not any worse than I had yesterday. Also, I still have heartburn. So I guess the nitro is going to be tolerable.
I find the number of clearly not homeopathic things labeled homeopathic to be annoying, if only because it makes pointing out the fundamental absurdity of homeopathy more difficult. "Homeopathy is ridiculous because it doesn't contain any active ingredients ok that does but it's not actually homeopathic" just doesn't have the same ring to it. They're both dishonest stuff, since they pretend to be medicine, but somehow the double dishonesty of non-homeopathic homeopathic stuff really rankles.
I suspect that the malpractice fears that physicians have has a lot less to do with actually having to pay a lot of money for the insurance (which, given how much a lot of them make could not possibly be a serious burden for the ones you usually hear complaining I mean come on) than it does with being upset that patients might dispute their actual competence/talk back/etc. And, I mean, not all of them have this problem by any means but there are an awful lot of medical practitioners with issues about not ever having their authority disputed and I suspect that it's a serious factor here. (There's probably some reasonable psychological factors involved given the number of potentially life-or-death decisions they have to make in conditions of massive uncertainty, but it's still something that causes trouble.)
I was talking about the facts that the cost of malpractice insurance has been dropping, and weren't a big factor in high health care costs to begin with. I don't know whether or not doctors in general actually worry a lot about getting sued, but I can't find any evidence that they need to.
The reality is once again more complicated. It is true that the cost of malpractice claims (or, more generously, the cost of "defensive medicine") is a minor factor in overall healthcare expenditures, and a negligible driver of cost trend. It is equally true that doctors worry about them, and are right to do so. Defending a malpractice claim is an emotionally wrenching experience for the clinician, regardless of the merits of the claim. The majority of physicians will have to defend at least one malpractice claim in their career (the figure is lower for general practitioners and pediatricians, but almost 100% for high risk specialties). Given that most malpractice claims are dismissed without any kind of payment to the claimant (about 80%), we can infer that the majority of physicians will have the experience of facing a meritless (in their eyes) malpractice suit at least once in a professional lifetime. And it's fair to assume that every doctor knows a peer who has faced one.
In that environment, doctors are understandably prone to believe overestimate the systemic significance of frivolous lawsuits. (And of course American doctors as a class are second to none in the self-pity department whenever anything threatens their income.)
Our whole system for dealing with medical liability is fundamentally fucked, and neither party wants to deal honestly with it (though the Republican brand of dishonesty is incomparably more loathesome).
To stay on topic, nitroglycerin is indeed excreted in through urine.
It comes IN through urine? Is this one of those completing-the-electrical-circuit things?
There should be a Self-Pitying Career Olympics! It'll be a round-robin contest among doctors, police officers, and professors. Any other contestants?
Lest I sound too sympathetic to the physician view of malpractice costs, I should point one reason malpractice payments (awards and settlements) are as high as they are is the failure of the physician professional bodies to police the bad actors in their ranks: the ~3% of practicing physicians who account for a third of malpractice payments.
And it's fair to assume that every doctor knows a peer who has faced one.
Is this sure? Aren't some fields massively more prone to lawsuits (surgery) than others (um...rheumatology maybe)?
I agree with everything else you say, thanks for the perspective.
Kermit, I assume you've seen the studies that imply that if doctors just apologized when things went wrong like decent human beings, they'd be much, much less likely to be sued. (And yes, I know that apologizing might be viewed as admitting fault, but it seems like perhaps it would save some money overall?)
85: Yes. IIRC, some jurisdiction (California?) was experimenting with creating a safe harbor for providers to apologize without it being admissible as evidence of liability for exactly that reason.