5 ms·

So what can be done? I usually update my theory about the situation when I read new articles, but now I'm really at a loss. I'd love to help these people, but I

by gragas 10y ago

So what can be done? I usually update my theory about the situation when I read new articles, but now I'm really at a loss. I'd love to help these people, but I can't see a fool-proof solution. Some questions come to mind: - Is it the role of the government to keep people safe from themselves? If so, how? - Would harsher drug laws make things better or worse? - How big of a role does purported economic opportunity have to do with drug abuse? My theory used to be that structural unemployment was the root of this epidemic; those born into the quickly receding middle class---those who relied on low-knowledge/low-skill jobs for a modest living---are hit the hardest since they did not anticipate such a shortage of low-skill jobs. - What does religion have to do with this? - What does culture have to do with this? - Are members of the military more or less affected by opiod drug abuse? - Does providing safe places to take drugs alleviate the problem, or does it make it worse?

yaacov 10y ago
One thing that would help is making Suboxone more freely available. It's a pretty safe drug that effectively treats the physical symptoms of heroin withdrawal, making quitting a lot more possible. For no good reason whatsoever, the FDA makes it really, really hard to get. Here's an article by a psychiatrist about the way Suboxone is regulated now: https://slatestarcodex.com/2015/02/02/practically-a-book-review-dying-to-be-free/ https://slatestarcodex.com/2015/02/02/practically-a-book-rev...
- rincebrain 10y ago
  I wouldn't say "no good reason" - suboxone is, itself, a habit-forming opioid.
mirimir 10y ago
What can be done? Well, there are lots of naive junkies out there. You can wait for them to kill themselves. Or you can stabilize them, and help them break their addiction. That works. The evidence is clear. Religion? Well, addiction is perceived rather like possession by the Devil. Or at least, weakness. Lack of faith. Really, as Bill basically said, those dirty addicts deserve to die. It's just that Purdue Pharma managed to addict lots of people by rewarding doctors to over-prescribe, and flooding distribution chains in the southeastern US. Maybe economic collapse is part of the problem. But there's a good chance that things will be manageable after the Purdue mess has been handled. Edit: In a dead comment, revmoo mentioned kratom, a natural opiate analog. The DEA decided last year not to ban it, after massive public comment. Advocates claim that it helps addicts break their addictions. https://www.theguardian.com/us-news/2016/oct/14/kratom-dea-ban-reversal-culture-shift https://www.theguardian.com/us-news/2016/oct/14/kratom-dea-b...
3131s 10y ago
Legalize so that purity is consistent and so that addicts aren't afraid to call in overdoses, fund drug treatment centers with corresponding 'sin' tax money, distribute naloxone freely, legalize and further explore potential treatments like suboxone, kratom, and ayahuasca, and stop over-prescribing opiates for pain treatment.
acover 10y ago
Death can be prevented in opioid overdoses if patients receive basic life support and the administration of naloxone soon after opioid overdose is suspected. Naloxone is effective at reversing the cause, rather than just the symptoms, of an opioid overdose.[1] The root of the problem is doctor prescribed opiates.[2] Prescription pain killers that were marketed as non-addictive turned out to be highly addictive. These are still widely prescribed. For example, oxycontin had revenues of over $2 Billion in 2013.[3] [1] - https://en.wikipedia.org/wiki/Opioid_overdose https://en.wikipedia.org/wiki/Opioid_overdose [2] - https://en.wikipedia.org/wiki/Opioid_crisis https://en.wikipedia.org/wiki/Opioid_crisis [3] -https://www.drugs.com/stats/oxycontin https://www.drugs.com/stats/oxycontin
- zkms 10y ago
  > The root of the problem is doctor prescribed opiates. This is an extremely simplistic view that elides...most of what is going on, such as: 1) How poisoning/overdose deaths are reported by medical examiners -- something that varies a lot by region and over time 2) The increased introduction of fentanyl (and fent analogues) into the heroin supply 3) It doesn't factor crackdowns on pill mills and crackdowns (both from DEA and also self-directed) on opioids prescribing in general Opioid use is not inherently dangerous. Indeed, long-term use of pharmaceutical-grade opioids is remarkably safe (especially compared to other painkillers or other drugs such as alcohol) -- opioids don't tend to cause organ damage. There are several actual circumstances where opioid use gets dangerous to life and they are: 1) Dosage/concentration uncertainty 2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues) 3) Poly-drug use: combining opioids with benzos or alcohol to exploit synergistic effects When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl. The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use. Indeed, an overwhelming majority of so-called "opioid overdoses" involve other drugs (and most often it's either alcohol or a benzodiazepine). The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns).
Baeocystin 10y ago
I think it is pretty clear that treating a medical problem like a criminal one is close to the worst possible choice. And it isn't like there aren't other models we can learn from. Portugal springs to mind. https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/ https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-h... There's a lot of interesting detail to be learned from studying their system, but the tl;dr is that after decriminalization, deaths in Portugal due to overdose plummeted.
zkms 10y ago
These overdoses are an an expected and predicted consequence of opioid prohibition. See, before opioid prohibition, deaths from opioid use were quite rare. You ever heard a pothead drone on about "it's nearly impossible to overdose from smoking marijuana"? The same thing applies to smoking opium. It's nearly impossible to overdose on that. But prohibition (which optimises for potency/volume, in order to reduce the risks of ending up in a concrete box) has pushed us from opium smoking and oral laudanum to injectable heroin to fentanyl and now (in the late 2010s) we're at fucking carfentanil (which is so potent it's been used as a chemical weapon). This is the "iron law of prohibition" at work: https://en.wikipedia.org/wiki/Iron_law_of_prohibition https://en.wikipedia.org/wiki/Iron_law_of_prohibition The current USian "opioid crisis" is another manifestation of opioid prohibition pushing people from safer, cheaper, less disruptive and deadly drugs to more deadlier ones. Two decades ago some USian opioid users could go to pill mills and get prescriptions for pharmaceutical grade opioids but the DEA kicked down doctor's doors a bunch and that ended up pushing people to the illicit market. Maybe next time you see those scary increasing graphs of opioid deaths vs time, give that a thought? Sum up all those deaths (compared to the baseline, prior to the increased LEA focus on "pill mills) and ask yourself: are all those needless deaths worth it? The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and fent analogues) even is a thing. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. The only way out of this hell is a total unconditional surrender in this "war on drugs".
- alsetmusic 10y ago
  > See, before opioid prohibition, deaths from opioid use were quite rare. You ever heard a pothead drone on about "it's nearly impossible to overdose from smoking marijuana"? The s I'm not an expert. Can you please link to studies to verify this? We're talking about overdosing and I don't think marijuana falls into that category.
  - stevenwoo 10y ago
    LD50 for marijuana? http://www.mindthesciencegap.org/2013/03/25/how-safe-is-marijuana-a-toxicological-perspective/ http://www.mindthesciencegap.org/2013/03/25/how-safe-is-mari...
deleted 10y ago
[deleted]
eli_gottlieb 10y ago
I hate to be harsh, especially since I've always stayed as far away from hard drugs as I humanly can, but for God's sakes, the first step is simple. The first step is to stop treating a medical problem as a moral fault. Stop punishing people for their affliction. Rehabilitate at least enough users that you can darn well ask them what's driving this. They know; it's their lives. Ask people, and then find ways to address the problems in their lives that they point out. Stop treating this as alien! It's all around us, every day, every city, every year. We have no right to ignore this kind of mass suffering as if we can do nothing!
- duncan_bayne 10y ago
  Are you claiming that choosing to indulge in drugs that you know are addictive and potentially lethal is without a moral dimension? Especially if you have dependents? You may be conflating the medical consequences of addiction with the decision to start using.
  - tcj_phx 10y ago
    > Are you claiming that choosing to indulge in drugs that you know are addictive and potentially lethal is without a moral dimension? There is usually very little to the "choice" that addicts once made. My girlfriend was injected with meth amphetamine when she was 11 (by an "angry" 14 year old). That experience solidly messed up her brain chemistry, and no one knew how to help her. Her doctor used Depot Provera to chemically castrate her at around age 19-20. This likely made her suicidal, as is frequently the case [1]. Should my girlfriend be punished for her doctors inability to help her? [1] http://www.sciencefriday.com/segments/looking-beyond-condoms-for-male-contraception/ http://www.sciencefriday.com/segments/looking-beyond-condoms... - caller at 8min30sec was similarly made "manic and suicidal" with Depot Provera. She overdosed on me a year ago, likely because of the benzodiazepines that the mental hospital got her hooked on (she thought heroin would get her through benzo withdrawal, but really each amplifies the other's effect). I called 911, they did their job, and the police decided they didn't need to make the situation worse. Here's the link to my comment from 13 days ago: https://news.ycombinator.com/item?id=13846763 https://news.ycombinator.com/item?id=13846763

by gragas 10y ago

yaacov 10y ago

One thing that would help is making Suboxone more freely available. It's a pretty safe drug that effectively treats the physical symptoms of heroin withdrawal, making quitting a lot more possible. For no good reason whatsoever, the FDA makes it really, really hard to get. Here's an article by a psychiatrist about the way Suboxone is regulated now: https://slatestarcodex.com/2015/02/02/practically-a-book-review-dying-to-be-free/ https://slatestarcodex.com/2015/02/02/practically-a-book-rev...

rincebrain 10y ago
I wouldn't say "no good reason" - suboxone is, itself, a habit-forming opioid.

mirimir 10y ago

What can be done? Well, there are lots of naive junkies out there. You can wait for them to kill themselves. Or you can stabilize them, and help them break their addiction. That works. The evidence is clear. Religion? Well, addiction is perceived rather like possession by the Devil. Or at least, weakness. Lack of faith. Really, as Bill basically said, those dirty addicts deserve to die. It's just that Purdue Pharma managed to addict lots of people by rewarding doctors to over-prescribe, and flooding distribution chains in the southeastern US. Maybe economic collapse is part of the problem. But there's a good chance that things will be manageable after the Purdue mess has been handled. Edit: In a dead comment, revmoo mentioned kratom, a natural opiate analog. The DEA decided last year not to ban it, after massive public comment. Advocates claim that it helps addicts break their addictions. https://www.theguardian.com/us-news/2016/oct/14/kratom-dea-ban-reversal-culture-shift https://www.theguardian.com/us-news/2016/oct/14/kratom-dea-b...

3131s 10y ago

Legalize so that purity is consistent and so that addicts aren't afraid to call in overdoses, fund drug treatment centers with corresponding 'sin' tax money, distribute naloxone freely, legalize and further explore potential treatments like suboxone, kratom, and ayahuasca, and stop over-prescribing opiates for pain treatment.

acover 10y ago

Death can be prevented in opioid overdoses if patients receive basic life support and the administration of naloxone soon after opioid overdose is suspected. Naloxone is effective at reversing the cause, rather than just the symptoms, of an opioid overdose.[1] The root of the problem is doctor prescribed opiates.[2] Prescription pain killers that were marketed as non-addictive turned out to be highly addictive. These are still widely prescribed. For example, oxycontin had revenues of over $2 Billion in 2013.[3] [1] - https://en.wikipedia.org/wiki/Opioid_overdose https://en.wikipedia.org/wiki/Opioid_overdose [2] - https://en.wikipedia.org/wiki/Opioid_crisis https://en.wikipedia.org/wiki/Opioid_crisis [3] -https://www.drugs.com/stats/oxycontin https://www.drugs.com/stats/oxycontin

zkms 10y ago
> The root of the problem is doctor prescribed opiates. This is an extremely simplistic view that elides...most of what is going on, such as: 1) How poisoning/overdose deaths are reported by medical examiners -- something that varies a lot by region and over time 2) The increased introduction of fentanyl (and fent analogues) into the heroin supply 3) It doesn't factor crackdowns on pill mills and crackdowns (both from DEA and also self-directed) on opioids prescribing in general Opioid use is not inherently dangerous. Indeed, long-term use of pharmaceutical-grade opioids is remarkably safe (especially compared to other painkillers or other drugs such as alcohol) -- opioids don't tend to cause organ damage. There are several actual circumstances where opioid use gets dangerous to life and they are: 1) Dosage/concentration uncertainty 2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues) 3) Poly-drug use: combining opioids with benzos or alcohol to exploit synergistic effects When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl. The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use. Indeed, an overwhelming majority of so-called "opioid overdoses" involve other drugs (and most often it's either alcohol or a benzodiazepine). The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns).

Baeocystin 10y ago

I think it is pretty clear that treating a medical problem like a criminal one is close to the worst possible choice. And it isn't like there aren't other models we can learn from. Portugal springs to mind. https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/ https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-h... There's a lot of interesting detail to be learned from studying their system, but the tl;dr is that after decriminalization, deaths in Portugal due to overdose plummeted.

zkms 10y ago

These overdoses are an an expected and predicted consequence of opioid prohibition. See, before opioid prohibition, deaths from opioid use were quite rare. You ever heard a pothead drone on about "it's nearly impossible to overdose from smoking marijuana"? The same thing applies to smoking opium. It's nearly impossible to overdose on that. But prohibition (which optimises for potency/volume, in order to reduce the risks of ending up in a concrete box) has pushed us from opium smoking and oral laudanum to injectable heroin to fentanyl and now (in the late 2010s) we're at fucking carfentanil (which is so potent it's been used as a chemical weapon). This is the "iron law of prohibition" at work: https://en.wikipedia.org/wiki/Iron_law_of_prohibition https://en.wikipedia.org/wiki/Iron_law_of_prohibition The current USian "opioid crisis" is another manifestation of opioid prohibition pushing people from safer, cheaper, less disruptive and deadly drugs to more deadlier ones. Two decades ago some USian opioid users could go to pill mills and get prescriptions for pharmaceutical grade opioids but the DEA kicked down doctor's doors a bunch and that ended up pushing people to the illicit market. Maybe next time you see those scary increasing graphs of opioid deaths vs time, give that a thought? Sum up all those deaths (compared to the baseline, prior to the increased LEA focus on "pill mills) and ask yourself: are all those needless deaths worth it? The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and fent analogues) even is a thing. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. The only way out of this hell is a total unconditional surrender in this "war on drugs".

alsetmusic 10y ago
> See, before opioid prohibition, deaths from opioid use were quite rare. You ever heard a pothead drone on about "it's nearly impossible to overdose from smoking marijuana"? The s I'm not an expert. Can you please link to studies to verify this? We're talking about overdosing and I don't think marijuana falls into that category.
- stevenwoo 10y ago
  LD50 for marijuana? http://www.mindthesciencegap.org/2013/03/25/how-safe-is-marijuana-a-toxicological-perspective/ http://www.mindthesciencegap.org/2013/03/25/how-safe-is-mari...

deleted 10y ago

[deleted]

eli_gottlieb 10y ago

I hate to be harsh, especially since I've always stayed as far away from hard drugs as I humanly can, but for God's sakes, the first step is simple. The first step is to stop treating a medical problem as a moral fault. Stop punishing people for their affliction. Rehabilitate at least enough users that you can darn well ask them what's driving this. They know; it's their lives. Ask people, and then find ways to address the problems in their lives that they point out. Stop treating this as alien! It's all around us, every day, every city, every year. We have no right to ignore this kind of mass suffering as if we can do nothing!

duncan_bayne 10y ago
Are you claiming that choosing to indulge in drugs that you know are addictive and potentially lethal is without a moral dimension? Especially if you have dependents? You may be conflating the medical consequences of addiction with the decision to start using.
- tcj_phx 10y ago
  > Are you claiming that choosing to indulge in drugs that you know are addictive and potentially lethal is without a moral dimension? There is usually very little to the "choice" that addicts once made. My girlfriend was injected with meth amphetamine when she was 11 (by an "angry" 14 year old). That experience solidly messed up her brain chemistry, and no one knew how to help her. Her doctor used Depot Provera to chemically castrate her at around age 19-20. This likely made her suicidal, as is frequently the case [1]. Should my girlfriend be punished for her doctors inability to help her? [1] http://www.sciencefriday.com/segments/looking-beyond-condoms-for-male-contraception/ http://www.sciencefriday.com/segments/looking-beyond-condoms... - caller at 8min30sec was similarly made "manic and suicidal" with Depot Provera. She overdosed on me a year ago, likely because of the benzodiazepines that the mental hospital got her hooked on (she thought heroin would get her through benzo withdrawal, but really each amplifies the other's effect). I called 911, they did their job, and the police decided they didn't need to make the situation worse. Here's the link to my comment from 13 days ago: https://news.ycombinator.com/item?id=13846763 https://news.ycombinator.com/item?id=13846763