18 ms·

The Poison We Pick

309 points by matt4077 9y ago

ilackarms 9y ago
all this talk about opioids and no mention of ibogaine
- kylek 9y ago
  Wanted to say this too. Unfortunate. It’s awful that it is illegal (and for the most part unknown) in the states.
gt_ 9y ago
At least we are moving past the scape goats and taking a thoughtful, considerate look at what is actually happening. I regularly have long conversations about this with my mother, a nurse in Louisville, KY and steadfast American patriot. She is at a loss of any explanation these days. I am torn when we talk about it because I know her pride in our country is a big part of her, but it doesn’t rest with what she is seeing. Watching her spirit shift into curiosity then skepticism has been difficult to witness. She wants to blame someone but she no longer believes that someone is out there.
- jacobush 9y ago
  This sounds like a good development?
  - dmreedy 9y ago
    The loss of a source of meaning in life is a dangerous thing, especially if it isn't replaced by something else. That way lies nihilism, and, if the thesis of the article is to be believed, opiod addiction.
    - the-dude 9y ago
      > That way lies nihilism Sounds exhausting.
      - onychomys 9y ago
        How long have you waited with that username to make that reference? <3
        the-dude 9y ago
        1598 days.
    - m_fayer 9y ago
      Nihilism is a high-brow thing for high-brow people. You're right that it is a dangerous thing, but I think before nihilism, for most it leads to depression, anxiety, anomie, and then all sorts of destructive self-medication.
  - gt_ 9y ago
    Well, it depends on what you believe is the culprit, but the easy scape goats are long debunked at this point. We will some day realize that the psychological situation of income inequality (or other socioeconomic equivalences) is the root of drug epidemics. The sooner that happens, the better, because neither incarceration or isolated treatment can address this. Everyone grows up with different experiences and I think being raised different would have delayed where I’m at with this but I have worried for a long time that particular increases of drug use cannot happen purely due to availability of the substance. It doesn’t make sense in the narratives I’ve witnessed, mainly referring to what motivates mass drug use, accounting for lushes and party behavior as constants. I have never been a drug user but have observed my friends use and have lost a few of them when I was younger. It simply doesn’t happen in healthy social environments. I am a motivated and passionate person. My life always has goals and ideas floating around. When I was younger, sometimes my friends didn’t keep up, or something like that. Every time I have lost a friend to drugs(death or otherwise), it was preceded by me acknowledging they no longer felt the hope and excitement for the future we had once shared. In retrospect, it usually correlated with something in their life they were ashamed of, a harsh reality or realization that they didn’t have certain opportunities. It could be small but still have big repercussions. I have felt shame for thinking I may have overwhelmed them with my dreaming, higher-than-average curiosity or motivation for constructive activities. Although I am that weirdo, it doesn’t usually send people to drug use. What does is usually private and disguised in shame. The monster here is loss of hope. I have learned this argument usually comes across as either fleeting or ideological. It’s very hard to put into words to someone with another comprehension of the problem, and witnessing one or two people face substance abuse doesn’t bring it home either. I developed this view from watching how crowds of people use drugs. When you isolate the party people and the lushes, you are left with people who simply feel like they don’t count.
    - gnode 9y ago
      You argue that the drug epidemic is the result of income inequality, but then go on to say it's loss of hope that's the problem. Are you arguing that income inequality is the cause of this loss of hope, thus drug addiction?
mmjaa 9y ago
The way to treat the opioid crisis is that it is a battlefield, and America is losing. Drugs have long been seen as a way of usurping the will of ones' enemies; it is no different now. America has been under pharmacological attack for decades; its people are too addicted to see that this is by design. Drugs have weakened America, and that is by design of its enemies.
- the-dude 9y ago
  From the article : "The drug was ubiquitous among both the British and American forces in the War of Independence as an indispensable medicine for the pain of battlefield injuries." What is your point exactly?
  - mmjaa 9y ago
    The point is that there is a war being fought against American society, and the weapon is: drugs. Its one of those weapons where the willingness of the intended recipient to apply it to themselves is key to its effectiveness. Its not a 'popular' opinion, but it has to be pointed out that the use of drugs to devolve society is as old as the political hills, yet its not something that is taught in schools, nor do generations grow up with an awareness that widespread drug adoption is a consequence of someone wanting to destroy civil society, by design. Its as much a battle of identity as it is pharmaceutical in nature. Too many Americans feel their identity is challenged if you question their use of drugs - legal, and illegal. This is why its such an effective weapon in creating devolved society: the targets willingly apply it to themselves. All you have to do is get it to them.
    - the-dude 9y ago
      So in this particular case, who are the perceived enemies?
      - mmjaa 9y ago
        Functioning civil society is the target; America cannot be defeated by conventional warfare. Covert, alternative warfare is waged instead - this is why you have entire neighbourhoods destroyed by opioids. America is filled with lost battlefields in this regard. Who stands to benefit from the destruction of civil American society? Its enemies. And if you're asking me who would be Americas' enemies, well .. the list is too long to consider.
Angostura 9y ago
Well written and insightful, thank you. Useful fodder as I answer my kids' questions about drugs.
- shaki-dora 9y ago
  This article, especially the end, is actually more about the fundamental ills of American society, rather than just drugs. It’s about the breakdown of the social glue in the face of relentless market pressure and individualism, and the diminish end of trust and solidarity, along with institutions like organized religion, unions,families, or even sports clubs.
thecheops 9y ago
I was the first to blame the drug companies (they certainly warrant blame) but there are other factors to consider that are addressed in this article that I failed to previous realize. Worth the 15-20 minutes to read.
- KarenSatantsby 9y ago
  Yes this is a great civics lesson article. Very good stuff. Has History and does not really blame but just lays out the conditions like cards on a table. The last three paragraphs were amazing.
dmreedy 9y ago
I've been talking with my brother a lot about this recently, especially as a function of the overall decrease of 'meaning' in the world. I think it goes back even further, to the advent of postmodernism in the throes of World War I. They were the first lost generation, but I don't think they were the last. The death of modernism and the accompanying assault on the bastions of objective meaning (as discussed in the article, Religion, Jingoism, and Community by way of Tribalism) is in some sense a healthy thing, as 'objective' meaning is too often used as false justification to do battle with other, contradicting 'objective' meaning. But it hasn't been replaced with anything. And the intervening years have only weakened it further. Maybe we had a brief sputter of national identity again with World War II, but the atomic bomb saw to that, and Vietnam finished the job (in America, at any rate). And now we're drifting in a world without objectivity. And what do you work for when the only objective truth is death, and the end of your accomplishments? Some people seem to be able to answer this question for themselves, some cannot. We thought as well that this may be why there are so many people engaged rabidly in the consumption of fiction these days; it seems to me just as much a symptom of a broader crisis of meaning as opiods may be. A fictional world is readily graspable; you can wrap your whole head around the whole thing. And meaning is easily found in the simplified moral space that these simulations are often constructed under. It seems to me just as much a salve for the meta-crisis of meaninglessness as a drug, in some sense. I don't mean to ascribe any moral right or wrong to any of this; in fact, that's the whole thrust of it. It's harder and harder to know what moral right and wrong are. --- EDIT: it's been pointed out that I should probably be less careless throwing a word like "objective" around: I mean it only in the sense of mass perceived objectivity. If a society agrees on it, it's as close to objectivity as we seem to be able to get. Substitute it for "Societal Consensus", if it pleases you, but I think the brain treats them as one and the same.
- thomzi12 9y ago
  Um, people have been “rabidly” consuming fiction since the Greeks created theater?
  - cornholio 9y ago
    They were also busy surviving, most of the time. First world problems.
meri_dian 9y ago
There is sadness in every corner of the world, but that only overlaps with opiate availability in certain places. In America, like every nation, there is sadness. However in America, unlike many other nations, we have widespread opiate availability. This combinations leads to opiate deaths on the scale we see. It's not complex. What is the answer? China knows the evils of opiate addiction, perhaps in the future, after enough of our own society is ravaged by it we will adopt the Chinese attitude towards opiates and look back at the naive past as our future selves tend to do.
- gt_ 9y ago
  I think this conclusion is premature. Obviously it’s a hard question but I will share a few reasons why I hesitate here: - The last 2 major drug-use epidemics in the US erupted in communities afflicted by major financial hardship and growing socioeconomic disparities. Both were victims of the poppy. I hesitate to discard the correlation. -I have taken hydrocodone. Personally, I hate it. I can’t think or function, but yeah other than that nothing seems like it matters. For me, it feels deadening, like suicide, the other epidemic that happens to be afflicting the same communities as the opioid epidemic. There is no recorded rise in suicide availability. I hesitate to discard the correlation. -Although much of the world has been outlawing opioid availability, opioids are available and prescribed throughout. We do not/cannot know how many people would be using opioids if they lacked availability to them but this drug has a nature worth considering, which I think the article gets at very well. -Let’s say the pharmaceutical cowboys’ are privy to ‘supply and demand’. No we aren’t talking about a fluid market but let’s also say, hypothetically, that not every society in the world is feening to collapse itself for opioid highs. And let’s assume US pharmaceutical suppliers have ways of identifying and responding to demands with supply despite being a regulated industry. I personally find none of these to be even a stretch, and to conclude, I have no problem imagining how it would play out exactly like we have observed.
- vzcx 9y ago
  Um... The Chinese like opiates, too. The majority of heroin produced in the golden triangle region finds its way into China. Why all of the moralizing about the "evils" of opiate addiction? Addiction is complicated, and while substance abuse can be harmful to the user, widespread social intolerance and the subsequent prohibitions on addictive substances only serve to amplify that harm. The opioid deaths we see are a direct result of the prohibition of opioids. Shipping into different jurisdictions carries the largest risk in the black economy. Thus, the transition from opium to morphine to heroin to the various fentanyls. There can be no quality control or FDA-enforced purity standards, hence the overdoses. If you want to reduce deaths, opioids need to become more available, not less. If you want to talk about morality, my question for you is: why do you want to restrict access to the chemicals that make these poor souls feel normal, pushing them into the black market?
pwaivers 9y ago
> "And so we wait to see what amount of death will be tolerable in America as the price of retaining prohibition. Is it 100,000 deaths a year? More? At what point does a medical emergency actually provoke a government response that takes mass death seriously? Imagine a terror attack that killed over 40,000 people. Imagine a new virus that threatened to kill 52,000 Americans this year. Wouldn’t any government make it the top priority before any other?" This is a very good point and really puts it into perspective. Overall this is an excellent essay. I also really like how he addresses the physical affects of opioids, rather than just saying it gets you "high".
- meri_dian 9y ago
  It's actually a foolish quote. What can the government do in the face of tens of thousands of people essentially choosing to kill themselves? It could jail them, but our culture is moving towards one where doing that to drug users is frowned upon. So what option does it have? Putting the onus on the government to solve this problem goes against the very essence of this piece. If social fragmentation is truly the cause of the opioid crisis, then government intervention will by like putting a mud wall in front of a raging river.
  - Arnt 9y ago
    Do you intend to say that the Scandinavian countries' deliberate policies against social fragmentation since about 1950 haven't had any effect? Or that they wouldn't have any effect elsewhere? Or that they don't exist?
    - meri_dian 9y ago
      Scandinavian countries don't have social fragmentation on the scale of the US because they are not the US. Not nearly as diverse, or large. They have much more history and common ancestry and culture and community. There is very little of use that can be gained from comparing Scandinavian countries to the US.
      - 9y ago
dkural 9y ago
The article keeps repeating how America is the "most highly evolved liberal democracy", most advanced / modern country etc. This is simply not true. Many European countries have free / low cost education, including higher education, free healthcare where it is rationed by need as opposed to $, maternal and paternal leave, paid vacations, some have free childcare, access to mental healthcare, decriminalization of drug addiction accompanied with treatment, higher gender and social equality, and more importantly, higher social mobility (since access to education and healthcare is more equal); affordable and high quality public transportation, and walkable cities. Property tax %s are lower in most of Europe as well. Their effective tax rate is lower too, since once you don't need to pay as much for education and healthcare, your take-home pay is higher. You have extra time to sleep, spend with your family and friends, or go out for a walk / read. Your mind doesn't constantly worry about the future of your children or healthcare access due to the social net. This means you're more productive at work and in society. What's described above is the most evolved liberal democracy. Not the white collar rat race we got here, where we worship billionaires and tax cuts for corporations, where it is still a debate if weapons of mass carnage can be sold to children, where the police force murders its own citizens every day on the streets, where politicians are bought and sold to the highest bidder, in the country with the highest incarceration rate in the world.
- tomp 9y ago
  on the other hand, US has been a democracy for by far the longest. Other European countries pale in comparision, with the possible exception of the UK.
  - dkural 9y ago
    If black people don't count, sure. I would argue that the US has not been a full democracy until Civil Rights. Jim Crow laws were in effect until 1965. Also, black people could not exercise their vote, were not allowed to attend university, eat in the same restaurants, or even sit on the same section of the bus. As far as black people were concerned, the US was not a democracy.
    - 9y ago
noahdesu 9y ago
The first thing I did when I opened this article was search for "rat", and was happy to see it there. From the comments I saw I had a hunch it might be: I recently finished a really powerful chapter in the book "Chasing the Scream: The First and Last Days of the War on Drugs" which describes an experiment involving rats that ostensibly shows that addiction isn't about the chemical, but rather it's about the environment and feeling alone. But that chapter also discussed the broader challenge of escaping the view point entrenched in a generation that has only known addiction as a direct result of chemical action. And a huge part of this article, at least the first half or so I got through, painted this chemical action picture: "The molecules derived from it have effectively conquered contemporary America." and it kept going on and on, to describe all the effects in wondrous terms, which seems to just reinforce what the book I've been reading claims are already a societal level view points. I'm by no means qualified to speak about addiction from a public health stand point, nor do I really understand the pharmacological action of any drugs. But this book highlights many experiments or studies that indicate our current thinking is ass backwards, only to have the work squashed and funding ripped away. Now, I cannot stop but seeing these threads in most content produced regarding the drug war or opioid crisis. It'd be nice to know for sure, but it has become very difficult to even entertain the bullshit that politicians are still peddling w.r.t. to the drug war and realistic solutions.
- lamename 9y ago
  Environment and social setting is known to be important for addiction (along with basically everything else in perception and behavior, e.g. compensatory responses [1]), I think it's just a matter of how long it takes for scientific nuance to go mainstream. The simplified picture is still often the chemical picture, imo, for 2 reasons: 1) the public forgets that the brain is an organ that obeys physical laws, and that behavior and perception depend entirely on the brain. 2) Ok, yes, environment is important, but how is that represented in the brain? It's still physiological, which inevitably includes chemicals. [1] http://nobaproject.com/modules/conditioning-and-learning http://nobaproject.com/modules/conditioning-and-learning
- foxbarrington 9y ago
  In addition to rat park[0], there's also been an amazing study wrt to Viet Nam vets[1]. Only 5% of soldiers relapsed to heroin use in the first year of returning home. Compared to a traditional 90% relapse rate when addicts treated in the US return to their homes. [0] https://en.wikipedia.org/wiki/Rat_Park https://en.wikipedia.org/wiki/Rat_Park [1] https://www.npr.org/sections/health-shots/2015/01/05/371894919/what-heroin-addiction-tells-us-about-changing-bad-habits https://www.npr.org/sections/health-shots/2015/01/05/3718949...
chrisgd 9y ago
I think almost all problems we discuss every day: political divide, millennial job prospects, student loan debt, drug crises can be traced to wealth inequality. At it's core, all these problems evolve from unfettered capitalistic pursuits. The middle man taking their cut of student loans and having no means to resolve that debt through bakruptcy. No growth jobs that offer no safety net. For profit schools, prisons and healthcare allowing those at the top to accumulate wealth by depriving more people of what was once considered a community benefit. We yell that the other side has it wrong while owners of gun manufacturers escape any civil liability and providers of medicare admin routinely overbill, then pay fines less than the wealth accumulated. Opiates provide an opportunity to escape what seems unescapable. I am not sure the answer but the framing is continually wrong.
- arca_vorago 9y ago
  I agree with just about all of what you said. So many bad things are tied to this. Crime rate. Horrible educational results and environments (I worked in Baltimore schools as a contractor and it's one of the saddest experiences I ever had and I'm a combat vet). One thing to remember though about the war on drugs and especially the opiate crisis is that it was also largely a creation of the CIA who learned it from the Brits who had been doing it as far back as the opium wars. Black markets provide black money budgets not overseen by Congress, and the CIA really hates oversight (they prefer overlook committees). The main opiate crisis in particular stems from Vietnam, where generals would play along for a cut while the CIA had drug operations all over including Laos, etc. They'd then ship it back and sell it specifically in the inner (mostly black and other minority) city. The same thing is true of this opiate crisis. The war in Afghanistan has massively increased poppy production (which the taliban had outlawed) while US forces would eradicate weed crops they allowed poppy fields, and low and behold, the vast majority of the heroin, etc now in America can be traced (Chem analysis) right back to Afghanistan. I promise you it's Vietnam on repeat, and the CIA has their hands all over it. Of course south America is the same. Behind every top cartel member is a CIA man pulling their strings, and look at the destruction they are wreaking on the border towns. The death toll of civilians is higher than allied casualties in OIF! It's just like Iran contra. Since lots of the time they don't want to pay full price, the Intel agencies will ship arms to them as well. It's high time for a new church committee! The problem is the surveillance engine is so pervasive, which enables the blackmail and extortion system, just about every senator or congressman who pushed back would be quickly compromised. This is the real deep state, in the Peter Dale Scott sense of the term, and it must be addressed if we are going to strike at the root of many of our problems, instead of hacking at the branches.
ArcticUnicorn 9y ago
"It’s been several decades since Daniel Bell wrote The Cultural Contradictions of Capitalism, but his insights have proven prescient. Ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations, destroying what conservatives value the most. They create a less human world. They make us less happy. They generate pain." This articulates the feelings/observations I've been mulling over recently. Also the idea of opiate abusers being a self-selecting group of the "failed" areas of society was something I hadn't thoroughly considered. Very interesting. If opiates caused a more distinct rise in violet crime, would public policy be forced to respond similar to the other drug epidemics? (Though I might argue that those epidemics were just replaced with this one, yielding quieter and more easily ignored victims.)
- maratd 9y ago
  > ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations Is there an actual example of this? I can't think of a single one.
  - mistermann 9y ago
    Society splitting into haves and have nots due to technology, globalization, and a myriad of other things most definitely changes social cohesion. That's just one example, when (if?)people finally start paying attention there will be many more obvious effects.
    - deleted 9y ago
      [deleted]
  - api 9y ago
    The escalating offensiveness of media due to the fact that offensive speech gets attention and therefore makes money?
    - 9y ago
scottlegrand2 9y ago
This is bad, really bad, but just wait til our roads are filled with self-driving trucks and the remaining factories with robots then the fentanyl party will really begin unfortunately. It is fantastic that OpenAI is attempting to address the more dire threats of a rogue AI, but there's a big near term threat already staring us in the face and seemingly zero leadership here in the United States aware of the crisis that will arrive in the next decade or so. And what passes for leadership has absolutely no concrete plan to get us past it.
tcj_phx 9y ago
When I met the friend who taught me about heroin, I figured she was "high as a kite" because she chattered from topic to topic like a butterfly. She called back a few days later, and started to invite me into her world. I didn't know anything about the street pharmacy, except that cannabis had been helpful for another friend to get her alcohol use under control. She said she'd relapsed on cocaine because of severe depression, then shortly later on heroin -- supposedly to treat her high blood pressure (from smoking cocaine). I think really she was just lonely. A chapter in Gabor Maté's book is titled Through a Needle, a Soft, Warm Hug [0]. She was going to the methadone clinic daily when we met. If she couldn't get to the clinic by the 11am closing, she'd have to order heroin from her street pharmacist. It was almost as if the clinic had contempt for its clients -- their business was to be their clients' legal dealer. Four months after she'd begun to teach me about her world, I decided she didn't actually like it that much, and began to express disapproval at her self-medication strategies. She tried sticking with her old drug world, but she liked me more than the drugs. At about six months we had a nice time frying donuts (coconut oil is a treatment for compulsive alcohol use, and makes for tasty donuts). Two days later she called to say that she "wished [she] wasn't a drug addict". The next day, "I SHOULD ONLY USE SUBSTANCES WHICH ARE LEGAL! Alcohol is legal, [tcj_phx]..." (me: doh! progress, I'll take it), the following day, "I hate methadone, I hate everything about it..." Essentially what I did was a months-long pace... then lead (hypnotic technique). The most important interventions to end the present "opioid epidemic" (artificial) is to provide a legal supply of clean heroin, safe injection sites, and protecting addicts from the criminal justice system. [0] https://news.ycombinator.com/item?id=16023802 https://news.ycombinator.com/item?id=16023802 (Yesterday's post about adoption-trauma is relevant too: https://news.ycombinator.com/item?id=16443667 https://news.ycombinator.com/item?id=16443667 )
jatsign 9y ago
Loved the way the article was written. I read a lot of long-form articles and have a few favorite writers. Is anyone aware of a service that will track individual writers and give an alert when they post something new? Sort of like an RSS feed for an individual writer, regardless of where their new article is posted.
- maxerickson 9y ago
  Twitter. No, I'm serious. If you don't want the tweets, just filter links out of tweets. But the part where writers promote themselves on Twitter is true enough.
  - jatsign 9y ago
    Not a bad idea, but the first writer I checked, Dexter Filkins, doesn't seem to use it. :\ The most reliable method might be to grab RSS feeds from a lot of online magazines like the New Yorker and parse the Author field. But that'd be a lot of manual work since the feeds change format sometimes...
DyslexicAtheist 9y ago
> We consume 99 percent of the world’s hydrocodone and 81 percent of its oxycodone. this is quite a mouthful and horrid if true. would like to see some sources for this claim
- paganel 9y ago
  Don't have any sources available, but as an European it's strange how prevalent opioids are in the States for what are seen as "regular" medical interventions. I remember having a discussion with a US redditor, telling him/her that even though I had 3 or 4 teeth extracted during the last 10 or so years I've never been prescribed opioids (the extractions were done by different doctors, in different clinics), I've always managed the post-extraction pains with Nurofen-like drugs and I was quite ok (and I don't think of myself as a particular "pain-resistant" guy, quite the contrary). There were other redditors in the same thread (I remember one from Germany) who had had the same experiences as me. So, all things considered, these numbers don't surprise me at all.
  - PuffinBlue 9y ago
    The NYT actually ran another story on exactly this topic - difference in European/US approach to pain management, but more from the patients perspective, it's really good reading too: https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge... Title was: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea It made the top spot on HackerNews too: https://news.ycombinator.com/item?id=16252372 https://news.ycombinator.com/item?id=16252372
lewis500 9y ago
This whole piece is a good example of how fine writing can hoodwink you. Garbage analysis from start to finish. "Unlike in Europe, where cities and towns existed long before industrialization, much of America’s heartland has no remaining preindustrial history, given the destruction of Native American societies. The gutting of that industrial backbone — especially as globalization intensified in a country where market forces are least restrained — has been not just an economic fact but a cultural, even spiritual devastation." From time immemorial, people---especially cultural critics and journalists---have blamed social phenomena on culture, the era's degradation, political changes or something else they are interested in anyway. It flatters you for your command of politics and history: turns out all that stuff you read about because it interests you is actually solidly causative in explaining something important. What a nice coincidence. I am pretty sure that when the history of this era is written by real social scientists, what they will decide is much more technical and boring...having little to do with the topics that capture our attention for other reasons (manufacturing jobs and trump's election in this case). For example: a bunch of new opioids had been invented, which insurance paid for and doctors prescribed. Large amounts of heroin were available at low prices from increasingly competent and seamless sellers. In what world would these phenomena take place and the amount of addiction not increase? I used to live in England. There is not as much of a crisis there although there is plenty of economic hardship, loss of manufacturing jobs, etc. The difference is that the NHS won't pay for everybody to load up on a thousand pills, and England is an island where you can't easily smuggle in tons of heroin. Sometimes the article really veers into the absurd. Consider this passage: "A huge boom was kick-started by the Civil War, when many states cultivated poppies in order to treat not only the excruciating pain of horrific injuries but endemic dysentery. Booth notes that 10 million opium pills and 2 million ounces of opiates in powder or tinctures were distributed by Union forces. Subsequently, vast numbers of veterans became addicted — the condition became known as “Soldier’s Disease” — and their high became more intense with the developments of morphine and the hypodermic needle. They were joined by millions of wives, sisters, and mothers who, consumed by postwar grief, sought refuge in the obliviating joy that opiates offered." Right here Sullivan offers a total explanation for why everyone got addicted to painkillers: the government was literally manufacturing them and giving them in massive quantities. But that's not literary enough, so he turns around and fabricates something out of whole cloth: "the epidemic of the late 1860s and 1870s was probably more widespread, if far less intense, than today’s — a response to the way in which the war tore up settled ways of life, as industrialization transformed the landscape, and as huge social change generated acute emotional distress. This aspect of the epidemic — as a response to mass social and cultural dislocation — was also clear among the working classes in the earlier part of the 19th century in Britain. As small armies of human beings were lured from their accustomed rural environments, with traditions and seasons and community, and thrown into vast new industrialized cities, the psychic stress gave opium an allure not even alcohol could match." Ah so it was the "psychic stress" of industrialization. So losing manufacturing jobs causes addiction, but also so does gaining them. Interesting that manufacturing jobs are such a powerful explanation in an era when our president is constantly banging on about manufacturing jobs. Suppose we hadn't industrialized at that time; I'm pretty sure people still would have gotten addicted given how many free opiates they were getting. In that case Sullivan probably would have said, "The rural isolation of Americans...the soul-crushing vicissitudes of farming born alone...caused Amercians to take refuge in opiates." Also worth remembering Andrew Sullivan is serially wrong.
filipsch 9y ago
> It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Pretty strong statement
deleted 9y ago
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sgentle 9y ago
Rather than place the blame on a lack of structure, community or spirituality, I see this as just a natural consequence of a system optimised at every turn for economic output. I've heard a lot about a singularity doomsday scenario where a paperclip-maximising AI realises people are much less useful as paperclip constructors than they are as paperclip ingredients. Surely it can't be so hard to see that the productivity-maximising AI that we've cobbled together out of economic rather than electromechanical components is slowly realising it doesn't need us anymore either? The truth is the economy soon won't have any use for poor whites other than consuming the output of rich whites. The last bastions of unskilled and semi-skilled labour are being automated or sent overseas (to be automated there). I'm really curious to see what America's 3.5 million truck drivers do when they lose their jobs over the next ten years. I guess we'll teach them to code? But don't feel too sorry for them; the rising tide of productivity caught poor blacks before that, and all the hamster-wheeling busywork of the middle class is up next. Managers and decision-makers will stay above it right up until they realise abstraction cuts both ways. It'll just be the quants at the end, tweaking the last few parameters and getting the lights on the way out. I think most of the world at least tries to keep the economic AI from being in charge of everything. It's hard because it keeps buying our politicians, but even so there's a sense that it should be serving our values, not the other way around. We might work with it, respect it even, but we don't trust it. The USA is pretty strange in this sense, because somewhere along the line a huge chunk of the population got convinced that if they just leave everything to the paperclip AI it'll take care of them. And, for a time, it will, and the people who work hard to make paperclips get rewarded, and the people who start paperclip factories get rewarded more still. But, inevitably, you're not a paperclip, and your value is incidental in this system. Faced with that, then, your only options are to find a system where people have value independent of their productivity, make being valueless palatable, or just go die quietly somewhere. It's probably not so surprising that, in the absence of the former option, the latter two are becoming increasingly popular. And, I guess, not so surprising that the paperclip worshippers are particularly unconcerned with mental health and sensible drug policy. Still pretty gross though.
- DenisM 9y ago
  The third option is protests of various forms. The most polite one is throwing a brick trough the window of society by electing some loose-cannon politician. The brick went obviously unheeded, and I’m worried of what will follow. Capitalism has succeeded in its primary goal - amassing resources for capital-intensive projects. We’re done, we have so much capital companies sits on hundreds of billions of dollars. Something new will be needed for the next step.
platz 9y ago
This is why folks like JBP are flourishing, for better or worse (He recognizes the problem).
- Jesus_Jones 9y ago
  who is jbp?
  - grzm 9y ago
    Jordan B Peterson
    - platz 9y ago
      downvoters; i am not endorsing his views, just explaining why he someone like him is resonating at this point in time.
      - grzm 9y ago
        FWIW, your comment is nearly content free: I suspect people may be down voting because there's little substance there pointing out the similarities and reasoning, particularly as a top-level comment.
        platz 9y ago
        thats a good point.
philipkglass 9y ago
Sullivan starts out highlighting how America is exceptionally afflicted by opioid abuse, but goes on to unconvincingly weave a bunch of unexceptional factors into his explanation. Smartphones, TV, video games, online porn: they're in every developed country. They can't be the explanation for what's different about America. Decline of religiously-derived meaning? Most developed countries' populations place less importance on religion than Americans. Factory jobs squeezed by automation and cheap offshore labor? Canadian manufacturers have access to the same robots as American firms, and Canada has been a member of the World Trade Organization as long as the US has. Inter-temporal comparisons also show that it doesn't make sense to blame the American opioid crisis on the decline of manufacturing jobs. The number of American manufacturing jobs peaked in the 1970s. "Rust belt" became a common term in the 1980s. But the opioid crisis is much more recent.
- arprocter 9y ago
  Sullivan is a conservative, gay, catholic, British expat; so his conclusions come through that lens
rl3 9y ago
As an aside, the cover illustration would serve as perfect art for a proper Cannon Fodder remake.
microcolonel 9y ago
I read this article the other day, and it presents a convincing possible avenue for explaining the current uptick in opioid abuse. https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-you-screw-next-meth-back-12574 https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-you-...
jdtang13 9y ago
Really brilliant and well-written article. The analysis of the uniqueness of American society is really well-done as well. American hyper-individualism, work ethic, and atomic self-oriented lifestyle leads people to seek their own meanings, which leads to tremendous suffering when community network is destroyed and when there's no available work to do.
JudasGoat 9y ago
As a Heroin addict that hasn't used in over 5 years, I believe the emptiness of Materialism was as instrumental in my addiction as the richness of spirituality has been in my recovery.
mikevp 9y ago
Personally, I just don't "get" the high of opiods. My experience has been entirely medical -- morphine after surgery, and the usual vicodin/percocet/whatever pills after injury or tooth extraction. Different people react to them differently. Some people, like me, they make physical pain recede, but nothing else. Some people, they make feel groggy or sick, and they don't like them. (My grandmother was like this -- she disliked the grogginess from the Brompton's Mixture more than she disliked the pain of her terminal cancer. She only took it once or twice.) And some people, one dose and it's "Where have you BEEN all my life!!!!" An interesting line of research might be -- why the difference in reaction to opiods? Why do some people get the "WOW! I LIKE that!!" reaction, while others don't?
- deleted 9y ago
  [deleted]
bandrami 9y ago
Unfortunately Sullivan ignores one huge factor: the deliberate and deceitful marketing of opioids to doctors by pharma companies as effective and safe for chronic pain management despite the fact that studies have repeatedly failed to show it is either.
diogenescynic 9y ago
Considering how overpopulated the planet is, this is probably a necessary evil.

The Poison We Pick

309 points by matt4077 9y ago

ilackarms 9y ago

all this talk about opioids and no mention of ibogaine

kylek 9y ago
Wanted to say this too. Unfortunate. It’s awful that it is illegal (and for the most part unknown) in the states.

gt_ 9y ago

At least we are moving past the scape goats and taking a thoughtful, considerate look at what is actually happening. I regularly have long conversations about this with my mother, a nurse in Louisville, KY and steadfast American patriot. She is at a loss of any explanation these days. I am torn when we talk about it because I know her pride in our country is a big part of her, but it doesn’t rest with what she is seeing. Watching her spirit shift into curiosity then skepticism has been difficult to witness. She wants to blame someone but she no longer believes that someone is out there.

jacobush 9y ago
This sounds like a good development?
- dmreedy 9y ago
  The loss of a source of meaning in life is a dangerous thing, especially if it isn't replaced by something else. That way lies nihilism, and, if the thesis of the article is to be believed, opiod addiction.
  - the-dude 9y ago
    > That way lies nihilism Sounds exhausting.
    - onychomys 9y ago
      How long have you waited with that username to make that reference? <3
      - the-dude 9y ago
        1598 days.
  - m_fayer 9y ago
    Nihilism is a high-brow thing for high-brow people. You're right that it is a dangerous thing, but I think before nihilism, for most it leads to depression, anxiety, anomie, and then all sorts of destructive self-medication.
- gt_ 9y ago
  Well, it depends on what you believe is the culprit, but the easy scape goats are long debunked at this point. We will some day realize that the psychological situation of income inequality (or other socioeconomic equivalences) is the root of drug epidemics. The sooner that happens, the better, because neither incarceration or isolated treatment can address this. Everyone grows up with different experiences and I think being raised different would have delayed where I’m at with this but I have worried for a long time that particular increases of drug use cannot happen purely due to availability of the substance. It doesn’t make sense in the narratives I’ve witnessed, mainly referring to what motivates mass drug use, accounting for lushes and party behavior as constants. I have never been a drug user but have observed my friends use and have lost a few of them when I was younger. It simply doesn’t happen in healthy social environments. I am a motivated and passionate person. My life always has goals and ideas floating around. When I was younger, sometimes my friends didn’t keep up, or something like that. Every time I have lost a friend to drugs(death or otherwise), it was preceded by me acknowledging they no longer felt the hope and excitement for the future we had once shared. In retrospect, it usually correlated with something in their life they were ashamed of, a harsh reality or realization that they didn’t have certain opportunities. It could be small but still have big repercussions. I have felt shame for thinking I may have overwhelmed them with my dreaming, higher-than-average curiosity or motivation for constructive activities. Although I am that weirdo, it doesn’t usually send people to drug use. What does is usually private and disguised in shame. The monster here is loss of hope. I have learned this argument usually comes across as either fleeting or ideological. It’s very hard to put into words to someone with another comprehension of the problem, and witnessing one or two people face substance abuse doesn’t bring it home either. I developed this view from watching how crowds of people use drugs. When you isolate the party people and the lushes, you are left with people who simply feel like they don’t count.
  - gnode 9y ago
    You argue that the drug epidemic is the result of income inequality, but then go on to say it's loss of hope that's the problem. Are you arguing that income inequality is the cause of this loss of hope, thus drug addiction?

mmjaa 9y ago

The way to treat the opioid crisis is that it is a battlefield, and America is losing. Drugs have long been seen as a way of usurping the will of ones' enemies; it is no different now. America has been under pharmacological attack for decades; its people are too addicted to see that this is by design. Drugs have weakened America, and that is by design of its enemies.

the-dude 9y ago
From the article : "The drug was ubiquitous among both the British and American forces in the War of Independence as an indispensable medicine for the pain of battlefield injuries." What is your point exactly?
- mmjaa 9y ago
  The point is that there is a war being fought against American society, and the weapon is: drugs. Its one of those weapons where the willingness of the intended recipient to apply it to themselves is key to its effectiveness. Its not a 'popular' opinion, but it has to be pointed out that the use of drugs to devolve society is as old as the political hills, yet its not something that is taught in schools, nor do generations grow up with an awareness that widespread drug adoption is a consequence of someone wanting to destroy civil society, by design. Its as much a battle of identity as it is pharmaceutical in nature. Too many Americans feel their identity is challenged if you question their use of drugs - legal, and illegal. This is why its such an effective weapon in creating devolved society: the targets willingly apply it to themselves. All you have to do is get it to them.
  - the-dude 9y ago
    So in this particular case, who are the perceived enemies?
    - mmjaa 9y ago
      Functioning civil society is the target; America cannot be defeated by conventional warfare. Covert, alternative warfare is waged instead - this is why you have entire neighbourhoods destroyed by opioids. America is filled with lost battlefields in this regard. Who stands to benefit from the destruction of civil American society? Its enemies. And if you're asking me who would be Americas' enemies, well .. the list is too long to consider.

Angostura 9y ago

Well written and insightful, thank you. Useful fodder as I answer my kids' questions about drugs.

shaki-dora 9y ago
This article, especially the end, is actually more about the fundamental ills of American society, rather than just drugs. It’s about the breakdown of the social glue in the face of relentless market pressure and individualism, and the diminish end of trust and solidarity, along with institutions like organized religion, unions,families, or even sports clubs.

thecheops 9y ago

I was the first to blame the drug companies (they certainly warrant blame) but there are other factors to consider that are addressed in this article that I failed to previous realize. Worth the 15-20 minutes to read.

KarenSatantsby 9y ago
Yes this is a great civics lesson article. Very good stuff. Has History and does not really blame but just lays out the conditions like cards on a table. The last three paragraphs were amazing.

dmreedy 9y ago

I've been talking with my brother a lot about this recently, especially as a function of the overall decrease of 'meaning' in the world. I think it goes back even further, to the advent of postmodernism in the throes of World War I. They were the first lost generation, but I don't think they were the last. The death of modernism and the accompanying assault on the bastions of objective meaning (as discussed in the article, Religion, Jingoism, and Community by way of Tribalism) is in some sense a healthy thing, as 'objective' meaning is too often used as false justification to do battle with other, contradicting 'objective' meaning. But it hasn't been replaced with anything. And the intervening years have only weakened it further. Maybe we had a brief sputter of national identity again with World War II, but the atomic bomb saw to that, and Vietnam finished the job (in America, at any rate). And now we're drifting in a world without objectivity. And what do you work for when the only objective truth is death, and the end of your accomplishments? Some people seem to be able to answer this question for themselves, some cannot. We thought as well that this may be why there are so many people engaged rabidly in the consumption of fiction these days; it seems to me just as much a symptom of a broader crisis of meaning as opiods may be. A fictional world is readily graspable; you can wrap your whole head around the whole thing. And meaning is easily found in the simplified moral space that these simulations are often constructed under. It seems to me just as much a salve for the meta-crisis of meaninglessness as a drug, in some sense. I don't mean to ascribe any moral right or wrong to any of this; in fact, that's the whole thrust of it. It's harder and harder to know what moral right and wrong are. --- EDIT: it's been pointed out that I should probably be less careless throwing a word like "objective" around: I mean it only in the sense of mass perceived objectivity. If a society agrees on it, it's as close to objectivity as we seem to be able to get. Substitute it for "Societal Consensus", if it pleases you, but I think the brain treats them as one and the same.

thomzi12 9y ago
Um, people have been “rabidly” consuming fiction since the Greeks created theater?
- cornholio 9y ago
  They were also busy surviving, most of the time. First world problems.

meri_dian 9y ago

There is sadness in every corner of the world, but that only overlaps with opiate availability in certain places. In America, like every nation, there is sadness. However in America, unlike many other nations, we have widespread opiate availability. This combinations leads to opiate deaths on the scale we see. It's not complex. What is the answer? China knows the evils of opiate addiction, perhaps in the future, after enough of our own society is ravaged by it we will adopt the Chinese attitude towards opiates and look back at the naive past as our future selves tend to do.

gt_ 9y ago
I think this conclusion is premature. Obviously it’s a hard question but I will share a few reasons why I hesitate here: - The last 2 major drug-use epidemics in the US erupted in communities afflicted by major financial hardship and growing socioeconomic disparities. Both were victims of the poppy. I hesitate to discard the correlation. -I have taken hydrocodone. Personally, I hate it. I can’t think or function, but yeah other than that nothing seems like it matters. For me, it feels deadening, like suicide, the other epidemic that happens to be afflicting the same communities as the opioid epidemic. There is no recorded rise in suicide availability. I hesitate to discard the correlation. -Although much of the world has been outlawing opioid availability, opioids are available and prescribed throughout. We do not/cannot know how many people would be using opioids if they lacked availability to them but this drug has a nature worth considering, which I think the article gets at very well. -Let’s say the pharmaceutical cowboys’ are privy to ‘supply and demand’. No we aren’t talking about a fluid market but let’s also say, hypothetically, that not every society in the world is feening to collapse itself for opioid highs. And let’s assume US pharmaceutical suppliers have ways of identifying and responding to demands with supply despite being a regulated industry. I personally find none of these to be even a stretch, and to conclude, I have no problem imagining how it would play out exactly like we have observed.
vzcx 9y ago
Um... The Chinese like opiates, too. The majority of heroin produced in the golden triangle region finds its way into China. Why all of the moralizing about the "evils" of opiate addiction? Addiction is complicated, and while substance abuse can be harmful to the user, widespread social intolerance and the subsequent prohibitions on addictive substances only serve to amplify that harm. The opioid deaths we see are a direct result of the prohibition of opioids. Shipping into different jurisdictions carries the largest risk in the black economy. Thus, the transition from opium to morphine to heroin to the various fentanyls. There can be no quality control or FDA-enforced purity standards, hence the overdoses. If you want to reduce deaths, opioids need to become more available, not less. If you want to talk about morality, my question for you is: why do you want to restrict access to the chemicals that make these poor souls feel normal, pushing them into the black market?

pwaivers 9y ago

> "And so we wait to see what amount of death will be tolerable in America as the price of retaining prohibition. Is it 100,000 deaths a year? More? At what point does a medical emergency actually provoke a government response that takes mass death seriously? Imagine a terror attack that killed over 40,000 people. Imagine a new virus that threatened to kill 52,000 Americans this year. Wouldn’t any government make it the top priority before any other?" This is a very good point and really puts it into perspective. Overall this is an excellent essay. I also really like how he addresses the physical affects of opioids, rather than just saying it gets you "high".

meri_dian 9y ago
It's actually a foolish quote. What can the government do in the face of tens of thousands of people essentially choosing to kill themselves? It could jail them, but our culture is moving towards one where doing that to drug users is frowned upon. So what option does it have? Putting the onus on the government to solve this problem goes against the very essence of this piece. If social fragmentation is truly the cause of the opioid crisis, then government intervention will by like putting a mud wall in front of a raging river.
- Arnt 9y ago
  Do you intend to say that the Scandinavian countries' deliberate policies against social fragmentation since about 1950 haven't had any effect? Or that they wouldn't have any effect elsewhere? Or that they don't exist?
  - meri_dian 9y ago
    Scandinavian countries don't have social fragmentation on the scale of the US because they are not the US. Not nearly as diverse, or large. They have much more history and common ancestry and culture and community. There is very little of use that can be gained from comparing Scandinavian countries to the US.
    - 9y ago

dkural 9y ago

The article keeps repeating how America is the "most highly evolved liberal democracy", most advanced / modern country etc. This is simply not true. Many European countries have free / low cost education, including higher education, free healthcare where it is rationed by need as opposed to $, maternal and paternal leave, paid vacations, some have free childcare, access to mental healthcare, decriminalization of drug addiction accompanied with treatment, higher gender and social equality, and more importantly, higher social mobility (since access to education and healthcare is more equal); affordable and high quality public transportation, and walkable cities. Property tax %s are lower in most of Europe as well. Their effective tax rate is lower too, since once you don't need to pay as much for education and healthcare, your take-home pay is higher. You have extra time to sleep, spend with your family and friends, or go out for a walk / read. Your mind doesn't constantly worry about the future of your children or healthcare access due to the social net. This means you're more productive at work and in society. What's described above is the most evolved liberal democracy. Not the white collar rat race we got here, where we worship billionaires and tax cuts for corporations, where it is still a debate if weapons of mass carnage can be sold to children, where the police force murders its own citizens every day on the streets, where politicians are bought and sold to the highest bidder, in the country with the highest incarceration rate in the world.

tomp 9y ago
on the other hand, US has been a democracy for by far the longest. Other European countries pale in comparision, with the possible exception of the UK.
- dkural 9y ago
  If black people don't count, sure. I would argue that the US has not been a full democracy until Civil Rights. Jim Crow laws were in effect until 1965. Also, black people could not exercise their vote, were not allowed to attend university, eat in the same restaurants, or even sit on the same section of the bus. As far as black people were concerned, the US was not a democracy.
  - 9y ago

noahdesu 9y ago

The first thing I did when I opened this article was search for "rat", and was happy to see it there. From the comments I saw I had a hunch it might be: I recently finished a really powerful chapter in the book "Chasing the Scream: The First and Last Days of the War on Drugs" which describes an experiment involving rats that ostensibly shows that addiction isn't about the chemical, but rather it's about the environment and feeling alone. But that chapter also discussed the broader challenge of escaping the view point entrenched in a generation that has only known addiction as a direct result of chemical action. And a huge part of this article, at least the first half or so I got through, painted this chemical action picture: "The molecules derived from it have effectively conquered contemporary America." and it kept going on and on, to describe all the effects in wondrous terms, which seems to just reinforce what the book I've been reading claims are already a societal level view points. I'm by no means qualified to speak about addiction from a public health stand point, nor do I really understand the pharmacological action of any drugs. But this book highlights many experiments or studies that indicate our current thinking is ass backwards, only to have the work squashed and funding ripped away. Now, I cannot stop but seeing these threads in most content produced regarding the drug war or opioid crisis. It'd be nice to know for sure, but it has become very difficult to even entertain the bullshit that politicians are still peddling w.r.t. to the drug war and realistic solutions.

lamename 9y ago
Environment and social setting is known to be important for addiction (along with basically everything else in perception and behavior, e.g. compensatory responses [1]), I think it's just a matter of how long it takes for scientific nuance to go mainstream. The simplified picture is still often the chemical picture, imo, for 2 reasons: 1) the public forgets that the brain is an organ that obeys physical laws, and that behavior and perception depend entirely on the brain. 2) Ok, yes, environment is important, but how is that represented in the brain? It's still physiological, which inevitably includes chemicals. [1] http://nobaproject.com/modules/conditioning-and-learning http://nobaproject.com/modules/conditioning-and-learning
foxbarrington 9y ago
In addition to rat park[0], there's also been an amazing study wrt to Viet Nam vets[1]. Only 5% of soldiers relapsed to heroin use in the first year of returning home. Compared to a traditional 90% relapse rate when addicts treated in the US return to their homes. [0] https://en.wikipedia.org/wiki/Rat_Park https://en.wikipedia.org/wiki/Rat_Park [1] https://www.npr.org/sections/health-shots/2015/01/05/371894919/what-heroin-addiction-tells-us-about-changing-bad-habits https://www.npr.org/sections/health-shots/2015/01/05/3718949...

chrisgd 9y ago

I think almost all problems we discuss every day: political divide, millennial job prospects, student loan debt, drug crises can be traced to wealth inequality. At it's core, all these problems evolve from unfettered capitalistic pursuits. The middle man taking their cut of student loans and having no means to resolve that debt through bakruptcy. No growth jobs that offer no safety net. For profit schools, prisons and healthcare allowing those at the top to accumulate wealth by depriving more people of what was once considered a community benefit. We yell that the other side has it wrong while owners of gun manufacturers escape any civil liability and providers of medicare admin routinely overbill, then pay fines less than the wealth accumulated. Opiates provide an opportunity to escape what seems unescapable. I am not sure the answer but the framing is continually wrong.

arca_vorago 9y ago
I agree with just about all of what you said. So many bad things are tied to this. Crime rate. Horrible educational results and environments (I worked in Baltimore schools as a contractor and it's one of the saddest experiences I ever had and I'm a combat vet). One thing to remember though about the war on drugs and especially the opiate crisis is that it was also largely a creation of the CIA who learned it from the Brits who had been doing it as far back as the opium wars. Black markets provide black money budgets not overseen by Congress, and the CIA really hates oversight (they prefer overlook committees). The main opiate crisis in particular stems from Vietnam, where generals would play along for a cut while the CIA had drug operations all over including Laos, etc. They'd then ship it back and sell it specifically in the inner (mostly black and other minority) city. The same thing is true of this opiate crisis. The war in Afghanistan has massively increased poppy production (which the taliban had outlawed) while US forces would eradicate weed crops they allowed poppy fields, and low and behold, the vast majority of the heroin, etc now in America can be traced (Chem analysis) right back to Afghanistan. I promise you it's Vietnam on repeat, and the CIA has their hands all over it. Of course south America is the same. Behind every top cartel member is a CIA man pulling their strings, and look at the destruction they are wreaking on the border towns. The death toll of civilians is higher than allied casualties in OIF! It's just like Iran contra. Since lots of the time they don't want to pay full price, the Intel agencies will ship arms to them as well. It's high time for a new church committee! The problem is the surveillance engine is so pervasive, which enables the blackmail and extortion system, just about every senator or congressman who pushed back would be quickly compromised. This is the real deep state, in the Peter Dale Scott sense of the term, and it must be addressed if we are going to strike at the root of many of our problems, instead of hacking at the branches.

ArcticUnicorn 9y ago

"It’s been several decades since Daniel Bell wrote The Cultural Contradictions of Capitalism, but his insights have proven prescient. Ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations, destroying what conservatives value the most. They create a less human world. They make us less happy. They generate pain." This articulates the feelings/observations I've been mulling over recently. Also the idea of opiate abusers being a self-selecting group of the "failed" areas of society was something I hadn't thoroughly considered. Very interesting. If opiates caused a more distinct rise in violet crime, would public policy be forced to respond similar to the other drug epidemics? (Though I might argue that those epidemics were just replaced with this one, yielding quieter and more easily ignored victims.)

maratd 9y ago
> ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations Is there an actual example of this? I can't think of a single one.
- mistermann 9y ago
  Society splitting into haves and have nots due to technology, globalization, and a myriad of other things most definitely changes social cohesion. That's just one example, when (if?)people finally start paying attention there will be many more obvious effects.
  - deleted 9y ago
    [deleted]
- api 9y ago
  The escalating offensiveness of media due to the fact that offensive speech gets attention and therefore makes money?
  - 9y ago

scottlegrand2 9y ago

This is bad, really bad, but just wait til our roads are filled with self-driving trucks and the remaining factories with robots then the fentanyl party will really begin unfortunately. It is fantastic that OpenAI is attempting to address the more dire threats of a rogue AI, but there's a big near term threat already staring us in the face and seemingly zero leadership here in the United States aware of the crisis that will arrive in the next decade or so. And what passes for leadership has absolutely no concrete plan to get us past it.

tcj_phx 9y ago

When I met the friend who taught me about heroin, I figured she was "high as a kite" because she chattered from topic to topic like a butterfly. She called back a few days later, and started to invite me into her world. I didn't know anything about the street pharmacy, except that cannabis had been helpful for another friend to get her alcohol use under control. She said she'd relapsed on cocaine because of severe depression, then shortly later on heroin -- supposedly to treat her high blood pressure (from smoking cocaine). I think really she was just lonely. A chapter in Gabor Maté's book is titled Through a Needle, a Soft, Warm Hug [0]. She was going to the methadone clinic daily when we met. If she couldn't get to the clinic by the 11am closing, she'd have to order heroin from her street pharmacist. It was almost as if the clinic had contempt for its clients -- their business was to be their clients' legal dealer. Four months after she'd begun to teach me about her world, I decided she didn't actually like it that much, and began to express disapproval at her self-medication strategies. She tried sticking with her old drug world, but she liked me more than the drugs. At about six months we had a nice time frying donuts (coconut oil is a treatment for compulsive alcohol use, and makes for tasty donuts). Two days later she called to say that she "wished [she] wasn't a drug addict". The next day, "I SHOULD ONLY USE SUBSTANCES WHICH ARE LEGAL! Alcohol is legal, [tcj_phx]..." (me: doh! progress, I'll take it), the following day, "I hate methadone, I hate everything about it..." Essentially what I did was a months-long pace... then lead (hypnotic technique). The most important interventions to end the present "opioid epidemic" (artificial) is to provide a legal supply of clean heroin, safe injection sites, and protecting addicts from the criminal justice system. [0] https://news.ycombinator.com/item?id=16023802 https://news.ycombinator.com/item?id=16023802 (Yesterday's post about adoption-trauma is relevant too: https://news.ycombinator.com/item?id=16443667 https://news.ycombinator.com/item?id=16443667 )

jatsign 9y ago

Loved the way the article was written. I read a lot of long-form articles and have a few favorite writers. Is anyone aware of a service that will track individual writers and give an alert when they post something new? Sort of like an RSS feed for an individual writer, regardless of where their new article is posted.

maxerickson 9y ago
Twitter. No, I'm serious. If you don't want the tweets, just filter links out of tweets. But the part where writers promote themselves on Twitter is true enough.
- jatsign 9y ago
  Not a bad idea, but the first writer I checked, Dexter Filkins, doesn't seem to use it. :\ The most reliable method might be to grab RSS feeds from a lot of online magazines like the New Yorker and parse the Author field. But that'd be a lot of manual work since the feeds change format sometimes...

DyslexicAtheist 9y ago

> We consume 99 percent of the world’s hydrocodone and 81 percent of its oxycodone. this is quite a mouthful and horrid if true. would like to see some sources for this claim

paganel 9y ago
Don't have any sources available, but as an European it's strange how prevalent opioids are in the States for what are seen as "regular" medical interventions. I remember having a discussion with a US redditor, telling him/her that even though I had 3 or 4 teeth extracted during the last 10 or so years I've never been prescribed opioids (the extractions were done by different doctors, in different clinics), I've always managed the post-extraction pains with Nurofen-like drugs and I was quite ok (and I don't think of myself as a particular "pain-resistant" guy, quite the contrary). There were other redditors in the same thread (I remember one from Germany) who had had the same experiences as me. So, all things considered, these numbers don't surprise me at all.
- PuffinBlue 9y ago
  The NYT actually ran another story on exactly this topic - difference in European/US approach to pain management, but more from the patients perspective, it's really good reading too: https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge... Title was: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea It made the top spot on HackerNews too: https://news.ycombinator.com/item?id=16252372 https://news.ycombinator.com/item?id=16252372

lewis500 9y ago

This whole piece is a good example of how fine writing can hoodwink you. Garbage analysis from start to finish. "Unlike in Europe, where cities and towns existed long before industrialization, much of America’s heartland has no remaining preindustrial history, given the destruction of Native American societies. The gutting of that industrial backbone — especially as globalization intensified in a country where market forces are least restrained — has been not just an economic fact but a cultural, even spiritual devastation." From time immemorial, people---especially cultural critics and journalists---have blamed social phenomena on culture, the era's degradation, political changes or something else they are interested in anyway. It flatters you for your command of politics and history: turns out all that stuff you read about because it interests you is actually solidly causative in explaining something important. What a nice coincidence. I am pretty sure that when the history of this era is written by real social scientists, what they will decide is much more technical and boring...having little to do with the topics that capture our attention for other reasons (manufacturing jobs and trump's election in this case). For example: a bunch of new opioids had been invented, which insurance paid for and doctors prescribed. Large amounts of heroin were available at low prices from increasingly competent and seamless sellers. In what world would these phenomena take place and the amount of addiction not increase? I used to live in England. There is not as much of a crisis there although there is plenty of economic hardship, loss of manufacturing jobs, etc. The difference is that the NHS won't pay for everybody to load up on a thousand pills, and England is an island where you can't easily smuggle in tons of heroin. Sometimes the article really veers into the absurd. Consider this passage: "A huge boom was kick-started by the Civil War, when many states cultivated poppies in order to treat not only the excruciating pain of horrific injuries but endemic dysentery. Booth notes that 10 million opium pills and 2 million ounces of opiates in powder or tinctures were distributed by Union forces. Subsequently, vast numbers of veterans became addicted — the condition became known as “Soldier’s Disease” — and their high became more intense with the developments of morphine and the hypodermic needle. They were joined by millions of wives, sisters, and mothers who, consumed by postwar grief, sought refuge in the obliviating joy that opiates offered." Right here Sullivan offers a total explanation for why everyone got addicted to painkillers: the government was literally manufacturing them and giving them in massive quantities. But that's not literary enough, so he turns around and fabricates something out of whole cloth: "the epidemic of the late 1860s and 1870s was probably more widespread, if far less intense, than today’s — a response to the way in which the war tore up settled ways of life, as industrialization transformed the landscape, and as huge social change generated acute emotional distress. This aspect of the epidemic — as a response to mass social and cultural dislocation — was also clear among the working classes in the earlier part of the 19th century in Britain. As small armies of human beings were lured from their accustomed rural environments, with traditions and seasons and community, and thrown into vast new industrialized cities, the psychic stress gave opium an allure not even alcohol could match." Ah so it was the "psychic stress" of industrialization. So losing manufacturing jobs causes addiction, but also so does gaining them. Interesting that manufacturing jobs are such a powerful explanation in an era when our president is constantly banging on about manufacturing jobs. Suppose we hadn't industrialized at that time; I'm pretty sure people still would have gotten addicted given how many free opiates they were getting. In that case Sullivan probably would have said, "The rural isolation of Americans...the soul-crushing vicissitudes of farming born alone...caused Amercians to take refuge in opiates." Also worth remembering Andrew Sullivan is serially wrong.

filipsch 9y ago

> It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Pretty strong statement

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sgentle 9y ago

Rather than place the blame on a lack of structure, community or spirituality, I see this as just a natural consequence of a system optimised at every turn for economic output. I've heard a lot about a singularity doomsday scenario where a paperclip-maximising AI realises people are much less useful as paperclip constructors than they are as paperclip ingredients. Surely it can't be so hard to see that the productivity-maximising AI that we've cobbled together out of economic rather than electromechanical components is slowly realising it doesn't need us anymore either? The truth is the economy soon won't have any use for poor whites other than consuming the output of rich whites. The last bastions of unskilled and semi-skilled labour are being automated or sent overseas (to be automated there). I'm really curious to see what America's 3.5 million truck drivers do when they lose their jobs over the next ten years. I guess we'll teach them to code? But don't feel too sorry for them; the rising tide of productivity caught poor blacks before that, and all the hamster-wheeling busywork of the middle class is up next. Managers and decision-makers will stay above it right up until they realise abstraction cuts both ways. It'll just be the quants at the end, tweaking the last few parameters and getting the lights on the way out. I think most of the world at least tries to keep the economic AI from being in charge of everything. It's hard because it keeps buying our politicians, but even so there's a sense that it should be serving our values, not the other way around. We might work with it, respect it even, but we don't trust it. The USA is pretty strange in this sense, because somewhere along the line a huge chunk of the population got convinced that if they just leave everything to the paperclip AI it'll take care of them. And, for a time, it will, and the people who work hard to make paperclips get rewarded, and the people who start paperclip factories get rewarded more still. But, inevitably, you're not a paperclip, and your value is incidental in this system. Faced with that, then, your only options are to find a system where people have value independent of their productivity, make being valueless palatable, or just go die quietly somewhere. It's probably not so surprising that, in the absence of the former option, the latter two are becoming increasingly popular. And, I guess, not so surprising that the paperclip worshippers are particularly unconcerned with mental health and sensible drug policy. Still pretty gross though.

DenisM 9y ago
The third option is protests of various forms. The most polite one is throwing a brick trough the window of society by electing some loose-cannon politician. The brick went obviously unheeded, and I’m worried of what will follow. Capitalism has succeeded in its primary goal - amassing resources for capital-intensive projects. We’re done, we have so much capital companies sits on hundreds of billions of dollars. Something new will be needed for the next step.

platz 9y ago

This is why folks like JBP are flourishing, for better or worse (He recognizes the problem).

Jesus_Jones 9y ago
who is jbp?
- grzm 9y ago
  Jordan B Peterson
  - platz 9y ago
    downvoters; i am not endorsing his views, just explaining why he someone like him is resonating at this point in time.
    - grzm 9y ago
      FWIW, your comment is nearly content free: I suspect people may be down voting because there's little substance there pointing out the similarities and reasoning, particularly as a top-level comment.
      - platz 9y ago
        thats a good point.

philipkglass 9y ago

Sullivan starts out highlighting how America is exceptionally afflicted by opioid abuse, but goes on to unconvincingly weave a bunch of unexceptional factors into his explanation. Smartphones, TV, video games, online porn: they're in every developed country. They can't be the explanation for what's different about America. Decline of religiously-derived meaning? Most developed countries' populations place less importance on religion than Americans. Factory jobs squeezed by automation and cheap offshore labor? Canadian manufacturers have access to the same robots as American firms, and Canada has been a member of the World Trade Organization as long as the US has. Inter-temporal comparisons also show that it doesn't make sense to blame the American opioid crisis on the decline of manufacturing jobs. The number of American manufacturing jobs peaked in the 1970s. "Rust belt" became a common term in the 1980s. But the opioid crisis is much more recent.

arprocter 9y ago
Sullivan is a conservative, gay, catholic, British expat; so his conclusions come through that lens

rl3 9y ago

As an aside, the cover illustration would serve as perfect art for a proper Cannon Fodder remake.

microcolonel 9y ago

I read this article the other day, and it presents a convincing possible avenue for explaining the current uptick in opioid abuse. https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-you-screw-next-meth-back-12574 https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-you-...

jdtang13 9y ago

Really brilliant and well-written article. The analysis of the uniqueness of American society is really well-done as well. American hyper-individualism, work ethic, and atomic self-oriented lifestyle leads people to seek their own meanings, which leads to tremendous suffering when community network is destroyed and when there's no available work to do.

JudasGoat 9y ago

As a Heroin addict that hasn't used in over 5 years, I believe the emptiness of Materialism was as instrumental in my addiction as the richness of spirituality has been in my recovery.

mikevp 9y ago

Personally, I just don't "get" the high of opiods. My experience has been entirely medical -- morphine after surgery, and the usual vicodin/percocet/whatever pills after injury or tooth extraction. Different people react to them differently. Some people, like me, they make physical pain recede, but nothing else. Some people, they make feel groggy or sick, and they don't like them. (My grandmother was like this -- she disliked the grogginess from the Brompton's Mixture more than she disliked the pain of her terminal cancer. She only took it once or twice.) And some people, one dose and it's "Where have you BEEN all my life!!!!" An interesting line of research might be -- why the difference in reaction to opiods? Why do some people get the "WOW! I LIKE that!!" reaction, while others don't?

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bandrami 9y ago

Unfortunately Sullivan ignores one huge factor: the deliberate and deceitful marketing of opioids to doctors by pharma companies as effective and safe for chronic pain management despite the fact that studies have repeatedly failed to show it is either.

diogenescynic 9y ago

Considering how overpopulated the planet is, this is probably a necessary evil.