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Small Towns Bus Opioid Addicts To Cities To Offset Costs!

Even As Climate Exacerbates Addiction Numbers Inequities Remain Glaringly Apparent!

Opioids have been linked to about 1000,000 deaths in the U.S. since 1999, including conservatively more than 160,000 annually in recent years

Opioid overdose is a public health crisis. In 2017, Baltimore City saw 761 drug and alcohol-related intoxication deaths, 692 of which were opioid-related. This is more than double the number of people who died of homicide. Baltimore City now has the highest overdose fatality rate of any city in the United States and this was done by design like in many other cities like Boston and Seattle or Houston! The CDC found that patients in noncore (the most rural) counties had an 87 percent higher chance of receiving an opioid prescription compared with those in large central metropolitan areas.

Currently, 71% of preventable opioid deaths occur among white men and women ages 25 to 54, and the number of deaths among individuals 55 and older is growing rapidly. Few opioid deaths occur among children younger than 15. The United States makes up 4.4% of the world's population, and consumes over 80% of the world's opioids. The US consumes approximately 99% percent of the world's hydrocodone. Hydrocodone was moved from a Schedule III to a Schedule II drug in 2014 because of its high abuse potential.

Ongoing assessments by climate scientists, including a recent report from the United Nations' Intergovernmental Panel on Climate Change, punctuate the pronounced effect that climate change is poised to have in the near future on the health and well-being of humans-particularly those with low socioeconomic status-throughout the world. To this end, to date, very limited scholarly attention has been placed on the effects that climate change may have on people who use drugs, in particular those with opioid addictions, and assessed their structural and social determinants of climate change vulnerability.

Since COVID-19, which has key lessons to offer on climate change's potential effects on addiction, the opioid epidemic has been rapidly accelerating in terms of its socioeconomic, and geographic reach. The opioid epidemic has been further deepened by increasing fentanyl contamination and co-use with stimulants such as methamphetamine and (crack) cocaine, spurring a heavy increase in overdose deaths. While opioid addiction has not significantly increased in the black community it has grown ten times over in predominantly White suburban areas. These trends highlight a looming confrontation between the world's complex overdose crisis and its equally intensifying climate emergency.

Conservatively opioid-involved overdose deaths rose from 21,089 in 2010 to 47,600 in 2017 and remained steady through 2019. This was followed by a significant increase in 2020 with 68,630 reported deaths and again in 2021 with 80,411 reported overdose deaths. Most States in the US refuse to report opioid deaths and many compassionate coroners in rural close knit communities opt to list them as Covid 19 deaths or heart attacks so that family insurance policies will pay for the funerals. Several factors have contributed to the opioid crisis: an increase in the prescribing of opioids, changes in illegal opioid markets, and greater demand for opioids among people in some formerly middle class groups that have experienced first time declines in real wages and social cohesion. Those factors have reinforced each other. In fact several recent studies have shown that the increase in White women's incarceration was driven by rising arrests in rural areas, where the opioid crisis has hit hardest.

Simultaneously statistics show that out of all the bachelor's degrees earned by African Americans, Black women are responsible for two-thirds. Also, Black women hold 70% of all master's degrees and 60% of all doctorate degrees earned by Black men and women. The white demographic decline which also affected graduate demographics is largely attributable to its older age structure when compared to other race and ethnic groups. This leads to fewer births and more deaths relative to its population size. Rising opioid fatality rates contribute to declining U.S. life expectancy, Conservatively Whites account for 80.7% of opioid overdose deaths.

Opioid prescriptions declined overall from 2016 to 2019, driven by a 44% decline in the number of prescriptions for opioids used to treat pain. From 2019 to 2023, prescriptions for medications used to treat OUD or rapidly reverse opioid overdose quadrupled, driven by an increase in buprenorphine prescriptions. Even though buprenorphine is only a partial opioid agonist and has mild addictive potential, some people still misuse the drug. Buprenorphine tablets are misused by crushing them and either snorting the powder or dissolving the power and using it as an intravenous solution when fentanyl is added this becomes a deadly combination. The mixture produces mild opioid effects, which may lead to psychological dependence and addiction. Although this and suboxone has a lower risk for abuse and addiction than full agonists such as heroin, it is still possible to become addicted to it, regardless of past opioid use. Although the rate of deaths of addicts from opioids is higher in the black and Hispanic communities due to lack of healthcare access, the number of addicts is far lower!

Climate change is undermining the mental and physical health of global populations, but the question of how it is affecting substance-use behaviors has not been systematically examined. In this narrative synthesis, we find that climate change could increase harmful substance use worldwide through at least five pathways: psychosocial stress arising from the destabilization of social, environmental, economic, and geopolitical support systems; increased rates of mental disorders; increased physical-health burden; incremental harmful changes to established behavior patterns; and worry about the dangers of unchecked climate change. These pathways could operate independently, additively, interactively, and cumulatively to increase substance-use vulnerability. Young people face disproportionate risks because of their high vulnerability to mental-health problems and substance-use disorders and greater number of life years ahead in which to be exposed to current and worsening climate change.

One public official after another, in states both “red” and “blue,” has pressed in recent years to treat increased opioid use as a public-safety problem as opposed to a criminal-justice matter best left to police, prosecutors, and judges. This is good news. But it forms a vivid contrast with the harsh reaction a generation ago to the sudden rise in the use of crack cocaine in predominantly black communities orchestrated by several factions in our government to stop the Black power movement, and from the harsh reaction two generations ago to an earlier heroin epidemic. Some experts and researchers see in the different responses to these drug epidemics further proof of America’s racial divide. Are policymakers going easier today on opioid users (white and often affluent) than their elected predecessors did a generation ago when confronted with crack addicts who were largely black, disenfranchised, and economically bereft? Can we explain the disparate response to the “black” heroin epidemic of the 1960s, in which its use and violent crime were commingled in the public consciousness, and the white heroin, fentanyl, and opioid “epidemic” today, in which its use is considered a disease to be treated or cured, without using race as part of our explanation?

Finally how do we justify paying for suburban and rural addicts to be shipped to large metropolitan and inner city hospitals for treatment so that their tax dollars pay for our addicts? The typical response from black constituents one New York Politician remarked, goes something like this: “Oh, when it was happening in my neighborhood it was ‘lock ’em up.’ Now that it’s happening in the [largely white, wealthy] Heights, the answer is to use my tax dollars to fund treatment centers. Well, my son could have used a treatment center in 1989, and he didn’t get one.”


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