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Justice is such a poor way to describe what is happening here. I have full empathy with those who have struggled with opioid addiction or lost loved ones to the

Justice is such a poor way to describe what is happening here. I have full empathy with those who have struggled with opioid addiction or lost loved ones to the disease. But the fact is that opioid prescriptions are still being written with too little oversight, too few safeguards, and not enough support for patients. Withstanding such contradiction in treatment of opioid suppliers, the federal government cannot keep treating opioid abuse on the supply side. We need solutions that focus on patient health and wellness. An opioid on its own does not result in overdoses or abuse, and even moderate use can be balanced with a healthy lifestyle. The DOJ does not have the tools, skills, or experience necessary to address the public health crisis that is opioid abuse.

toomuchtodo 6y ago
The DOJ has a hammer. They’re using that hammer in the only way they can (supply side). If you want the demand side fixed, fix it locally (and lobby the federal government for more funds if necessary). The St Petersburg police department (Florida) recently announced they’d hire 25 social workers instead of 25 police officers to address social needs that would’ve previously been handled suboptimally as a police dispatch. There is evidence local efforts can be made when the appetite and will is present. Having seen opioid addiction up close, I have a hard time not condoning DOJ actions. It’s not perfect, but nothing is.
- njovin 6y ago
  As long as the US federal government and the DEA continue their ridiculous war on drugs and refuse to reclassify certain substances despite overwhelming popular and scientific support I fear that any action by regular folks is wasted. It’s clear that higher powers prevail and as long as big pharma keeps funneling money into our “Democratic System” logic and reason will lose out to money and influence.
263943736 6y ago
Opioids are among the best medications for treating severe pain. If we're focusing on patients I'd much rather focus on rehabilitative strategies since the current degree of increased scrutiny is already making accessing adequate medication more difficult for groups like the elderly or people with chronic pain. Even more increased oversight is just going to escalate hesitation among doctors.
- solinent 6y ago
  Opioids don't aid in recovery though--they're not a band-aid, they're simply a veneer. They can prevent recovery since they delays][ physical rehabilitation. I honestly think cannabis is a much better solution long-term, but good luck transitioning an opiate user to cannabis.
  - 263943736 6y ago
    Not being in crippling pain is usually considered a good thing. Sure, some things like a broken arm can probably get by with weed and yes some people respond exceptionally well to weed but there is a night and day difference between the two when it comes to treating most forms of severe pain such as what people with significant spinal trauma experience or what the elderly often (for any number of reasons ultimately relating to age) experience.
    - solinent 6y ago
      I agree (it's meaningless though, I'm just pointing out the obvious above, I'm not an expert here) for acute injury it makes sense to use opioids in severe cases like you mention, however, I think we still need to find the best strains and cultivate them for pain use, we've only scratched the surface with cannabis, it's a big genus. Weed ain't what it used to be. For chronic cases, I think chronic makes a lot of sense. Pain helps you get moving. Opioid's don't. Too much pain is debilitating. Surely we can find a formula here (a very very large one). Cannabis never removes all the pain. I think that's the main feature here.
- nipponese 6y ago
  Check out therapies targeting sodium channels. I found out through my wife that her company (a major pharma corp) is working on therapeutics that can block voltage to certain sodium channels in the brain to suppress pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350027/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350027/
- Aerroon 6y ago
  I wonder where most of the harm is coming from with opioids. Do the opioids themselves cause more harm than society does by making them illegal? The cases I've mostly heard about seemed to be that people hot addicted to opioids and the only way to keep it going was to break the law. That eventually got them in trouble. For some drugs it does seem like the government trying to protect you from the drugs do more harm than what the drugs themselves do. Are opioids among them?
jimkleiber 6y ago
Your comment reminds me of an episode of Joe Rogan with Johann Hari [1], talking about what really causes addiction and the failures of the "war on drugs." He states, "The opposite of addiction is not sobriety, the opposite of addiction is connection." (18:08) The former U.S. surgeon general, Vivek Murthy, declared loneliness an epidemic, and just wrote a book on it [2]. I believe the biggest challenge we face in the United States centers on emotional health. How do we feel? Whom do we trust? Who do we think loves us? How do we rebuild trust? How do we apologize and forgive? How do we grieve? I watched a 60 Minutes episode talking about some of the pharma reps trying to convince doctors to prescribe more opioids [3]. One rep, Alec Burlakoff, had this interchange with the interviewer: > Bill Whitaker: You're preying on these people-- > Alec Burlakoff: Yeah, because they're desperate. They'll try anything. And they may get relief from Subsys initially, But we all know what's gonna happen. We know. We've been doin' this long enough. We know how it ends. > Bill Whitaker: And that is? > Alec Burlakoff: It ends in addiction, withdrawal, pain, suffering, and even death. > Bill Whitaker: And you didn't care about that? > Alec Burlakoff: Back then, I was numb to that. This reminds me that while I often think that the people who feel disconnected are the ones using the opioids, very often the ones selling them also feel disconnected. How did this man get so numb to selling products that he knew were causing so much pain and suffering to others? How did he get so numb in life in general? More importantly, how do we help him feel more alive? I agree, I don't think the Department of Justice, especially with a focus on punishment rather than rehabilitation, can lift us out of this hole. I believe it will require a focus on emotional health, on repairing relationships, on helping us feel less distant, more close, to our friends, family, neighbors, and fellow Americans. [1]: https://www.youtube.com/watch?v=CDpjvFn4wgM https://www.youtube.com/watch?v=CDpjvFn4wgM [2]: https://www.amazon.com/Together-Connection-Performance-Greater-Happiness/dp/0062913298 https://www.amazon.com/Together-Connection-Performance-Great... [3]: https://www.cbsnews.com/news/opioid-epidemic-pharmaceutical-executives-60-minutes-2020-06-21/ https://www.cbsnews.com/news/opioid-epidemic-pharmaceutical-...
- peteretep 6y ago
  > Johann Hari A man whose professional experience is journalist and has no science, medical, public health, or psychotherapy background... and he’s trying to sell a book. Is this too harsh a take? Is there a reason I should be taking his opinion seriously?
KerrickStaley 6y ago
> even moderate use can be balanced with a healthy lifestyle Genuinely curious: this doesn't really mesh with my understanding. I think opioids are extremely addictive (more so than tobacco or even cocaine or amphetamine) and as a result it's nearly impossible to be a "casual" user (and therefore I don't ever intend to try any opioids). Is there evidence that opioids can be "moderately" used?
- GordonS 6y ago
  > as a result it's nearly impossible to be a "casual" user I wonder about the truth of this. I've done a lot of reading at places like Bluelight (for research and curiosity), and it seems there really are a lot of people who set strict guidelines for their drug use and are able to use opioids periodically without addiction.
- TylerE 6y ago
  They are extremely addictive. No one disputes that. The actual drugs here - I’m talking pure, regulated pharmaceutical versions - are pretty benign physiologically. Constipation is about the worst of it. The combination products (opioid plus something else) are a bit worse - but in those cases it’s the other thing (usually Tylenol) that’s actually hard on your body, especially the liver. Although it’s much less common these days due to all the regulation, many doctors kept a up successful practices for decades while self medicating heavily. What gets people killed are either things sold as other things (e.g. heroin laced with fentanyl, which is much stronger) or propel who quit for a while and then go right back to their old dose and OF because their tolerance is gone.
- deleted 6y ago
  [deleted]
- CerebralCerb 6y ago
  > Set against a background of assumptions that heroin use is inevitably problematic, there is significant evidence of its controlled use. This paper attempts to draw together the literature on patterns of heroin use which avoid physical and psychological dependence. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1988.tb03035.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.... This paper is a great read on the topic. Some suggest more than 50% of heroin users are casual users.
arcticbull 6y ago
This is your regular reminder that Portugal decriminalized all drugs in 2001 and usage did not go up but the health effects and negative societal effects of drug use all but vanished [1]. They went from worst in the EU to among the best in the EU in the decade that followed on pretty much every metric. Addiction has a huge situational component. 20% of US GIs in Vietnam were addicted to heroin. When they returned home 90% of them stopped using heroin overnight, indefinitely [2]. We're doing this all wrong. [1] https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it https://www.theguardian.com/news/2017/dec/05/portugals-radic... [2] https://jamesclear.com/heroin-habits https://jamesclear.com/heroin-habits
- remarkEon 6y ago
  This is your regular reminder that extrapolating an outcome from a country like Portugal (an outcome we should all be happy about, by the way) to a country like the United States is unwise. I've never been to Portugal, but have friends that live in both Spain and Portugal and I'm pretty envious of the kind of community and shared identity they describe. I image that probably has something to do with the outcome seen there. So, while I think it's possible to decriminalize all drug use in certain contexts, we've tried this experiment in some US cities and it's not resulted in anything anyone could describe as a success. >Addiction has a huge situational component. Yes, this is exactly what I'm getting at. >20% of US GIs in Vietnam were addicted to heroin. When they returned home 90% of them stopped using heroin overnight, indefinitely [2]. This seems to contradict your previous point, no? In Vietnam there was of course zero enforcement, outside of the military (I'm being charitable here for reasons that should be obvious), and they returned home to a country where the drug was illegal. Edit: very interesting, the negative reaction to this comment. What I said is true, so I can only assume that people who are reacting negatively are doing so because they are projecting a view on me that I do not hold.
  - Implicated 6y ago
    > we've tried this experiment in some US cities and it's not resulted in anything anyone could describe as a success. We have? Can we get a citation on that?

toomuchtodo 6y ago

The DOJ has a hammer. They’re using that hammer in the only way they can (supply side). If you want the demand side fixed, fix it locally (and lobby the federal government for more funds if necessary). The St Petersburg police department (Florida) recently announced they’d hire 25 social workers instead of 25 police officers to address social needs that would’ve previously been handled suboptimally as a police dispatch. There is evidence local efforts can be made when the appetite and will is present. Having seen opioid addiction up close, I have a hard time not condoning DOJ actions. It’s not perfect, but nothing is.

njovin 6y ago
As long as the US federal government and the DEA continue their ridiculous war on drugs and refuse to reclassify certain substances despite overwhelming popular and scientific support I fear that any action by regular folks is wasted. It’s clear that higher powers prevail and as long as big pharma keeps funneling money into our “Democratic System” logic and reason will lose out to money and influence.

263943736 6y ago

Opioids are among the best medications for treating severe pain. If we're focusing on patients I'd much rather focus on rehabilitative strategies since the current degree of increased scrutiny is already making accessing adequate medication more difficult for groups like the elderly or people with chronic pain. Even more increased oversight is just going to escalate hesitation among doctors.

solinent 6y ago
Opioids don't aid in recovery though--they're not a band-aid, they're simply a veneer. They can prevent recovery since they delays][ physical rehabilitation. I honestly think cannabis is a much better solution long-term, but good luck transitioning an opiate user to cannabis.
- 263943736 6y ago
  Not being in crippling pain is usually considered a good thing. Sure, some things like a broken arm can probably get by with weed and yes some people respond exceptionally well to weed but there is a night and day difference between the two when it comes to treating most forms of severe pain such as what people with significant spinal trauma experience or what the elderly often (for any number of reasons ultimately relating to age) experience.
  - solinent 6y ago
    I agree (it's meaningless though, I'm just pointing out the obvious above, I'm not an expert here) for acute injury it makes sense to use opioids in severe cases like you mention, however, I think we still need to find the best strains and cultivate them for pain use, we've only scratched the surface with cannabis, it's a big genus. Weed ain't what it used to be. For chronic cases, I think chronic makes a lot of sense. Pain helps you get moving. Opioid's don't. Too much pain is debilitating. Surely we can find a formula here (a very very large one). Cannabis never removes all the pain. I think that's the main feature here.
nipponese 6y ago
Check out therapies targeting sodium channels. I found out through my wife that her company (a major pharma corp) is working on therapeutics that can block voltage to certain sodium channels in the brain to suppress pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350027/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350027/
Aerroon 6y ago
I wonder where most of the harm is coming from with opioids. Do the opioids themselves cause more harm than society does by making them illegal? The cases I've mostly heard about seemed to be that people hot addicted to opioids and the only way to keep it going was to break the law. That eventually got them in trouble. For some drugs it does seem like the government trying to protect you from the drugs do more harm than what the drugs themselves do. Are opioids among them?

jimkleiber 6y ago

Your comment reminds me of an episode of Joe Rogan with Johann Hari [1], talking about what really causes addiction and the failures of the "war on drugs." He states, "The opposite of addiction is not sobriety, the opposite of addiction is connection." (18:08) The former U.S. surgeon general, Vivek Murthy, declared loneliness an epidemic, and just wrote a book on it [2]. I believe the biggest challenge we face in the United States centers on emotional health. How do we feel? Whom do we trust? Who do we think loves us? How do we rebuild trust? How do we apologize and forgive? How do we grieve? I watched a 60 Minutes episode talking about some of the pharma reps trying to convince doctors to prescribe more opioids [3]. One rep, Alec Burlakoff, had this interchange with the interviewer: > Bill Whitaker: You're preying on these people-- > Alec Burlakoff: Yeah, because they're desperate. They'll try anything. And they may get relief from Subsys initially, But we all know what's gonna happen. We know. We've been doin' this long enough. We know how it ends. > Bill Whitaker: And that is? > Alec Burlakoff: It ends in addiction, withdrawal, pain, suffering, and even death. > Bill Whitaker: And you didn't care about that? > Alec Burlakoff: Back then, I was numb to that. This reminds me that while I often think that the people who feel disconnected are the ones using the opioids, very often the ones selling them also feel disconnected. How did this man get so numb to selling products that he knew were causing so much pain and suffering to others? How did he get so numb in life in general? More importantly, how do we help him feel more alive? I agree, I don't think the Department of Justice, especially with a focus on punishment rather than rehabilitation, can lift us out of this hole. I believe it will require a focus on emotional health, on repairing relationships, on helping us feel less distant, more close, to our friends, family, neighbors, and fellow Americans. [1]: https://www.youtube.com/watch?v=CDpjvFn4wgM https://www.youtube.com/watch?v=CDpjvFn4wgM [2]: https://www.amazon.com/Together-Connection-Performance-Greater-Happiness/dp/0062913298 https://www.amazon.com/Together-Connection-Performance-Great... [3]: https://www.cbsnews.com/news/opioid-epidemic-pharmaceutical-executives-60-minutes-2020-06-21/ https://www.cbsnews.com/news/opioid-epidemic-pharmaceutical-...

peteretep 6y ago
> Johann Hari A man whose professional experience is journalist and has no science, medical, public health, or psychotherapy background... and he’s trying to sell a book. Is this too harsh a take? Is there a reason I should be taking his opinion seriously?

KerrickStaley 6y ago

> even moderate use can be balanced with a healthy lifestyle Genuinely curious: this doesn't really mesh with my understanding. I think opioids are extremely addictive (more so than tobacco or even cocaine or amphetamine) and as a result it's nearly impossible to be a "casual" user (and therefore I don't ever intend to try any opioids). Is there evidence that opioids can be "moderately" used?

GordonS 6y ago
> as a result it's nearly impossible to be a "casual" user I wonder about the truth of this. I've done a lot of reading at places like Bluelight (for research and curiosity), and it seems there really are a lot of people who set strict guidelines for their drug use and are able to use opioids periodically without addiction.
TylerE 6y ago
They are extremely addictive. No one disputes that. The actual drugs here - I’m talking pure, regulated pharmaceutical versions - are pretty benign physiologically. Constipation is about the worst of it. The combination products (opioid plus something else) are a bit worse - but in those cases it’s the other thing (usually Tylenol) that’s actually hard on your body, especially the liver. Although it’s much less common these days due to all the regulation, many doctors kept a up successful practices for decades while self medicating heavily. What gets people killed are either things sold as other things (e.g. heroin laced with fentanyl, which is much stronger) or propel who quit for a while and then go right back to their old dose and OF because their tolerance is gone.
deleted 6y ago
[deleted]
CerebralCerb 6y ago
> Set against a background of assumptions that heroin use is inevitably problematic, there is significant evidence of its controlled use. This paper attempts to draw together the literature on patterns of heroin use which avoid physical and psychological dependence. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1988.tb03035.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.... This paper is a great read on the topic. Some suggest more than 50% of heroin users are casual users.

arcticbull 6y ago

This is your regular reminder that Portugal decriminalized all drugs in 2001 and usage did not go up but the health effects and negative societal effects of drug use all but vanished [1]. They went from worst in the EU to among the best in the EU in the decade that followed on pretty much every metric. Addiction has a huge situational component. 20% of US GIs in Vietnam were addicted to heroin. When they returned home 90% of them stopped using heroin overnight, indefinitely [2]. We're doing this all wrong. [1] https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it https://www.theguardian.com/news/2017/dec/05/portugals-radic... [2] https://jamesclear.com/heroin-habits https://jamesclear.com/heroin-habits

remarkEon 6y ago
This is your regular reminder that extrapolating an outcome from a country like Portugal (an outcome we should all be happy about, by the way) to a country like the United States is unwise. I've never been to Portugal, but have friends that live in both Spain and Portugal and I'm pretty envious of the kind of community and shared identity they describe. I image that probably has something to do with the outcome seen there. So, while I think it's possible to decriminalize all drug use in certain contexts, we've tried this experiment in some US cities and it's not resulted in anything anyone could describe as a success. >Addiction has a huge situational component. Yes, this is exactly what I'm getting at. >20% of US GIs in Vietnam were addicted to heroin. When they returned home 90% of them stopped using heroin overnight, indefinitely [2]. This seems to contradict your previous point, no? In Vietnam there was of course zero enforcement, outside of the military (I'm being charitable here for reasons that should be obvious), and they returned home to a country where the drug was illegal. Edit: very interesting, the negative reaction to this comment. What I said is true, so I can only assume that people who are reacting negatively are doing so because they are projecting a view on me that I do not hold.
- Implicated 6y ago
  > we've tried this experiment in some US cities and it's not resulted in anything anyone could describe as a success. We have? Can we get a citation on that?