01 December 2010

Market Economics in Action









  1. Great post, I'm a primary care doc and I've experienced similar issues myself.

    I have an alternate hypothesis, though:
    This is what you would find if oxy were very price elastic, but rates of prescription narcotic use are way higher than ER docs experience with the risk of black tar landing you in the ER being very high.

    I'm a primary care doc - I see problem prescription narcotic users many times a day. The epidemic of prescription narcotic use chronically alters every aspect of my patient's lives, but it is rarely an emergency.

    The distinction matters because the pill shortage could be dramatically decreasing addiction rates while increasing ER visits.

  2. long time reader, first time commenter. Based on your experience as an ER doctor, I was wondering what your thoughts are on the drug use, specifically the drug war. Do you see legalization as an option for some drugs? What do you think of the Portuguese model of decriminalization and treatment?
    Will drug users just always be drug users?

  3. Your costs don't take into account externalities as it is obvious that the low price of opiate obviously doesn't bear the real cost to users as the risk of OD is higher which means that the cost of use is net-net higher as the ER visits are likely subsidized by us all.

    Which begs the question of whether we could pass that cost to producers somehow... taxation?quality control? etc?

  4. Just discovered your blog today and really enjoyed this post. Look forward to more.

  5. Nice analysis. Seems to me as if the drug pushers were maybe preparing the people for heroin use.

  6. I've definitely noticed the change with the pill poppers using heroin when they can't get their oxy. That is a big big change from the past when heroin addicts would go scrounging for pills when they couldn't get their heroin.

    In the Eugene area there has been a big heroin problem for years with the sweet young hippies. The heroin available now is so strong that they get addicted smoking it. Seems wholesome enough to them. They mix it with their American Spirit cigarettes. These are kids that eat organic food and think they're back to earth. Don't you know heroin is organic too.

    And no Ahmed, its not the drug pushers, its the pharmacutical companies making a killing off of oxycontin.

  7. Excellent post and your economish sounding analysis is extremely accurate. This breaks my heart that so many are trapped in the horrors of drug addiction. And drug dealers, both illegal and legal, are reaping massive profits from the trade.

    But I can guarantee you there is hope. Drug users do not necessarily always stay drug users. It is possible to break the chains of addiction and stop the cycle of destruction.

    My experience has shown the solution is spiritual in nature - this is not an issue that police or legal action can solve. It is a battle for the soul of a generation...

  8. My comment came out wrong. And plus its winters...

    What i wanted to write was that somebody from the general public wants the youth (future of tomorrow) to be misguided and devoid of any hope. In your time such things were low, so you made it good. But if the current trend, of drug use, keeps on going up then after 10 years or so i'm afraid there would be an 'intellectual' brain drain. Which will result in even more outsourcing of basic manufacturing processes or give rise to the influx of more immigrants. So in the end sooner these hidden men are brought to light and punished, the sooner will the present generation clean up its act and hopefully even more sooner take their country to new heights or moral and technological success.

  9. Kind of a late comment, but I wonder if the recent reformulation of Oxycontin may have something to do with the switch. The tablets are now a little thicker and are made with some sort of epoxy resin base, so that they cannot be crushed for snorting or injecting. I think it may still be possible to chew them, but otherwise, the street user doesn't have any easy way to get immediate release of the drug from the sustained-release tab.

  10. ding ding ding...the anonymous post from 12/8 got it right, the supply of the old OC 80s have gone down, but the new OP OC 80s that cant be crushed are everywhere for cheap. You want a similar feeling to when you sniffed the OC 80s....you do Heroin. Sad by true.

  11. I'm in the NW too (psychiatry) and have seen the same evolution. I think the Anonymi on 12/8 are to some degree correct re: the reformulation (although I also recall everyone disliking the Watson generic SR oxycodone, as they weren't injectable - loved seeing those prescriptions, hated seeing them off the market.)
    But in my little town, heroin is about -half- the cost per morphine-mg equivalent of the pharmaceuticals. Maybe two-thirds when compared to a hydrocodone/APAP formulation.
    And it's mainly tar around here, not white. We see a lot of abscesses too...

    People would prefer the pharmaceuticals if they could get them, I hear, and I don't think it's just any stigma of heroin. I am not seeing people in a position to care about perceived stigma, usually.

    As to WHY we are seeing so much heroin at such a low cost, whether it was just to meet market demand or some other reason, I don't know. But the rx-opioid abuse very, very clearly preceded the heroin use, and the heroin was to fill the void. (Also because we had some high-profile Tylenol ODs. So heroin was perceived as 'healthier.' I suppose it is, when compared to 15 grams of acetaminophen... )