#drugs

Shocking state of suicide

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The National Institute of Health (NIH) lists the top 10 categories of causes of death in America in 2015 as above. Heart disease was the highest cause leading to over 633,800 deaths. Cancer was slightly under 600,000. Respiratory disease came in 3rd at 155,000. Homicide, while not listed in the Top 10, was around 14,000. Total drug related deaths were around 50,000, equivalent to deaths from car accidents and murder combined. Death from heroin and illicit opioid overdoses exceeded 20,000.

F4BB85AF-601B-44CD-8232-83590DB4455E.jpegSadly suicides in the US totaled a shocking 44,193 in 2015, most prevalent in younger age groups. Over the last 15 years we can see that suicides per head of US population has continued to climb.

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In 15 years, the incidence of female suicides has climbed 45% per head of population. While male suicide outnumbers female suicides per head of population by almost 4x the relative increase in 15 years has been 16.3%. In aggregate total suicides have grown 20.4%, an awful statistic. Half of the suicides were the result of self inflicted gunshot wounds. 1/3rd of women tended to commit suicide by taking poison versus 10% by males.

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The detrimental economic impacts are also quite heavy, The National Institute of Mental Health (NIMH). Suicides cost around $51bn annually while homicide is around $26bn.

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Perhaps the most alarming part of the NIMH study was the 1.1mn people that made proper attempts to take their own life. Almost 10mn contemplated it.

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In Australia, suicide rates are also at a decade high of 12.6 people per 100,000 or almost identical to those rates in the US. 3,000 took their life in 2015. According to Beyondblue 3 million Australians suffer from anxiety or depression.

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The suicide rate in Northern Ireland has increased dramatically over the last 30 years – the male rate has increased by 82% in this time. Male rates remain consistently higher than female suicide rates across the UK and Republic of Ireland – most notably 5 times higher in Republic of Ireland and around 3 times in the UK.

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Since 2007, suicides in the UK have started to mildly trend back upwards from 10,8/100,000 to 10.9.

China accounts for 26% of the world’s suicides. According to the World Health Organisation (WHO), the country saw c.500 by women per day taking their own lives in 2009 or around 183,000 a year. At that rate some 1.5 million Chinese women have taken their own lives in the past eight years.

Japan is approximately down to 19.5 suicides per 100,000 but South Korea remains persistently high at 28.5.

It is a point worth reflecting on. There have been six people from my own high school year who have taken their own life. Seemingly happy and healthy on the outside, matters have taken a turn that not even friends could have detected until it is too late.

The most common symptoms that lead to suicide are due to depression or anxiety onset by

-substance abuse
-incarceration
-family history of suicide
-poor job security or low levels of job satisfaction
-financial insecurity
-history of being abused or witnessing continuous abuse
-being diagnosed with a serious medical condition, such as cancer or HIV
-being socially isolated or a victim of bullying
-being exposed to suicidal behavior

Worsening economic conditions are undoubtedly pushing more people toward suicide. Greece, which does not have a high suicide rate (8.8) compared to other EU countries (average of 11.6 people per 100,000), saw tough financial austerity measures leading to a 35% jump in suicide rates in a little less than 2 years, not dissimilar to Russia between 1989-1994. Each 1 percentage point rise of unemployment rates in men aged 20 to 59 was associated with a 0.19/100,000 population rise in suicide. Spain saw 20% higher suicides in 2015 vs 2008.

This is the mark of suicide prevention. Note that most countries have suicide prevention hotlines.

America

Australia

UK

Help is at hand.

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Drug (welfare) cheats are cheats

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The Australian government intends to conduct a random drug test trial in the Canterbury-Bankstown area for welfare recipients. What is the problem? Why should the taxpayer fund someone’s drug habits, surely something not conducive to job hunting. After all we rightly strip gold medals from athletes who take performance enhancing drugs, why not strip welfare from those who are literally ‘taking the piss’ for ‘refusing to take a piss’.

Narconomics – illegal drugs and correlation to financial markets

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BBC published an interesting report suggesting the recent purity of drugs like cocaine was causing higher incidences (+150% on 2013) of overdoses causing problems for A&E wards. A while back I read all 300 odd pages of UNODC’s narcotics report and concluded that narcotics markets are good economic indicators. The inverse correlation of  price and purity is profound. As economic conditions worsen, prices decline and purity goes up. The value proposition is in full effect. Moreover the substitution effect of traditional narcotics has to cope with synthetic drugs like ice, crystal meth, krokodil and oxi which give 5x the bang for 1/5th the price with 100x the side effects.

I am working hard with an American listed company to get a drug – which stops drug addiction – approved and sold in Australia where the ice epidemic is out of control.  Exciting stuff.

US heroin deaths up 6x since 2002! Why?

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The chart above shows the total number of U.S. overdose deaths involving heroin from 2002 to 2015 with a 6.2-fold increase in the total number of deaths over the period. Automobiles killed around 32,000 people last year or a little over 2x that of heroin overdoses. When adding non-methadone opioids (illicit fentanyl) overdose that number surged to 20,000, a 33% YoY jump on 2014 and 5.9x 2002. Why is it happening? The problem is that for many prescription painkiller users is that once their bottle ends, the addiction doesn’t stop meaning many switch to heroin to get the same ‘opioid’ hit.

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Looking at deaths caused by all illicit drugs, we are looking at 50,000, more than double the level of 2002. So illicit drugs killed almost as many as car accidents and gun murders combined in 2015.

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Overdose deaths from taking pain relievers has also been shockingly high. Drugs such as OxyContin which contain opioids have also found their way to creating problems in the US armed forces.

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The US Government has recorded stats on the use of illicit drugs by active duty military personnel. While still off the highs (no pun intended) of the 1980s, since the 1990s the trend has been climbing. The chart above shows the usage as a % of total active personnel. The USAF has the lowest incidence of drug abuse. Illicit drug use includes marijuana, cocaine, hallucinogens, heroin, methamphetamine, inhalants, GHB/GBL and prescription drug misuse.

Excessive use of pain relievers make up a large proportion of illicit drug use. Oxycodone is one of the more common type of opiate pain killer and it is highly addictive. In 2010, the US Food and Drug Administration (FDA) required the formulation of OxyContin be changed to make it harder to become addicted to.

A policy of zero tolerance for drug use among DoD personnel is likely one reason why illicit drug use has remained at a low level in the military for 2 decades. The policy was instituted in 1982 and is currently enforced by frequent random drug testing; service members face dishonorable discharge and even criminal prosecution for a positive drug test.

According to the National Institute on Drug Abuse (NIDA), “Suicide rates in the military were traditionally lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008. Substance use is involved in many of these suicides. The 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides from fiscal year (FY) 2005 to FY 2009 involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them.”

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As opioid overdoses rise, companies such as Adapt Pharma have seen sharp rises in the sales of products like Narcan (Naloxone) which basically revives victims from the dead. Narcan publicizes its price that is even insured meaning one can overdose and revive with a $10 co-payment.

“94% of insured lives in the US have coverage for NARCAN® Nasal Spray*. According to IMS Health, nearly three quarters (74%) of prescriptions for NARCAN® Nasal Spray have a co-pay of $10 or less**. For those paying cash, ADAPT Pharma has partnered with retail pharmacies to reduce out of pocket costs (Retail is $62.50/dose)…To expand community access, NARCAN® Nasal Spray is available to all qualified group purchasers for $37.50 per 4mg dose ($75 per carton of 2 doses). This pricing is available for all Qualified Group Purchasers, such as first responders (EMS, Fire Department, Police), community organizations and Departments of Health, regardless of size. This pricing represents a 40% discount off the Wholesale Acquisition Cost (WAC) of $125 per carton.”

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Price hikes have been a feature of naloxene. As of January 2015, Amphastar’s version of naloxone was up to $41 a dose, according to Fierce Pharma, a pharmaceutical industry news website. That follows a price increase from $17 to $33 a dose back in October 2014, according to data provided by Truven Health Analytics. So not only is volume spiking, so is price. Walgreens has expanded the availability of prescription-free naloxone to 33 states.

West Virginia health officials are responding to opioid overdoses by distributing more than 8,000 kits with Naloxone that can get people breathing again if administered in time. Money for the kits comes from a $1 million federal grant to West Virginia, which has had the nation’s highest rate of overdose deaths at 41.5/100,000 people.

Local emergency medical services agencies in West Virginia administered 4,186 doses of Naloxone in 2016, up from 3,351 the year before and 2,165 two years ago and that data doesn’t include uses by hospital emergency departments, urgent care centers, first responders and family members.

So layered on top of poverty, food stamps and deteriorating employment we now seem to have an America that is increasingly becoming high on opioids. I am working closely with a company which is developing the antidote and progress is good. It will knock out the addiction even including ice in Australia. Tests are promising.

Active duty US Military who’ve taken illicit drugs in past 30 days

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The US government has recorded stats on the use of illicit drugs by active duty military personnel. While still off the highs (no pun intended) of the 1980s, since the 1990s the trend has been climbing. The chart above shows the usage as a % of total active personnel. The USAF has the lowest incidence of drug abuse.  Illicit drug use includes marijuana, cocaine, hallucinogens, heroin, methamphetamine, inhalants, GHB/GBL and prescription drug misuse.

Excessive use of pain relievers make up a large proportion of illicit drug use. Oxycodone is one of the more common type of opiate pain killer and it is highly addictive. In 2010, the US Food and Drug Administration (FDA) required the formulation of OxyContin be changed to make it harder to become addicted to.

A policy of zero tolerance for drug use among DoD personnel is likely one reason why illicit drug use has remained at a low level in the military for 2 decades. The policy was instituted in 1982 and is currently enforced by frequent random drug testing; service members face dishonorable discharge and even criminal prosecution for a positive drug test.

According to the National Institute on Drug Abuse (NIDA), “Suicide rates in the military were traditionally lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008. Substance use is involved in many of these suicides. The 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides from fiscal year (FY) 2005 to FY 2009 involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them.

Methamphetamine price correlation to financial downturns

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The US Justice Dept and the DEA report the trends of meth prices and purity on the samples they buy from dealers. In the last 20 years, methamphetamine prices (US$/gram) have shown a 91% R-squared correlation (i.e. very high) to purity. 

It makes sense. When customers are struggling, they need more bang for their buck and if the dealer has any chance of them coming back for more hits they can’t cheat on the quality if they want repeat business. Therefore purity is paramount for the cash strapped drug user. When times are good, purity comes off because abusers are more ‘flush’ with cash and the access to ‘hits’ is higher so dealers can afford to scrimp a bit more on quality to expand margins.

Looking at the following chart we can see that the tech bubble collapse in 2000 and 2008 saw purity levels rise consistently. The latest data would suggest that the purity is heading back up, usually a sign that the economy is about to take a ‘hit’.

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There is a solution to all of this in the shape of Medicinova (4875) which is developing a medicine that weans drug users off the habit. The US NIH (Dept of Health) is part funding its development.