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I've got a friend who recently was hospitalized for fentanyl addiction. Twenty years ago he was my first investor in my first startup. He was the guy that taug

by xrd 3y ago

I've got a friend who recently was hospitalized for fentanyl addiction. Twenty years ago he was my first investor in my first startup. He was the guy that taught me about mediation. He was the first vegetarian I knew. He owned four cab licenses in Portland. Then Uber came in and shredded his retirement plan. The cab company forced him out so he wouldn't even capitalize on the partial ownership of the land they owned. He lost everything. He has nothing left. He discovered some awful things about his father. His brother died in a gruesome car crash at 25. I remember him telling me about oxycotin (edited: I misremembered it as oxycodone), this "miracle drug" without the addiction of morphine. He got on that. Ten years later he was using heroin. Then fentanyl more recently. I'm pretty angry at the Sakler family. I'm mad at the drug cartels. I'm not mad at my friend. He's a generous and loving person. Everyone has a story. I'm sure some are full of awful actions that led them to where they are, but I don't see my friend in that way.

deleted 3y ago
[deleted]
refurb 3y ago
Oxycodone was always known to be addictive. It’s right on the label from day one. “Also at the time of OxyContin’s approval, FDA product labeling warned of the danger of abuse of the drug and that crushing a controlled-release tablet followed by intravenous injection could result in a lethal overdose. There was no evidence to suggest at the time that crushing the controlled-release capsule followed by oral ingestion or snorting would become widespread and lead to a high level of abuse.” https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-substance-use-and-overdose https://www.fda.gov/drugs/information-drug-class/timeline-se...
- xrd 3y ago
  I remember with distinct anger that my friend told me information to the contrary. He probably got that phrasing from that doctor who got a free trip to Barbados to push it. I wasn't there but i remember him telling me that and it makes my blood boil. I do share other people's skepticism of the medical industry as you might be able to tell. He should have done more research, agreed.
  - fires10 3y ago
    We license doctors to do the research for us. We can not be expected to experts in all fields. It's why we license professionals.
    - zdragnar 3y ago
      We license doctors you visit to practice medicine, not to do research. Unless they're working at a dedicated research hospital like the Mayo clinic, doctors don't do research on their own. They'll stay up to date with what is standards of care, but even that is dictated to them by their EHR software or what they expect your insurance will cover. When I've gotten prescribed a new medicine, I don't really recall a doctor ever even telling me what side effects to watch out for. At most, they've told me not to drink alcohol while on someone.
- arcanemachiner 3y ago
  People are often taken in by the Big New Thing. That's why I have a default policy of skepticism towards pretty much everything.
  - SV_BubbleTime 3y ago
    > That's why I have a default policy of skepticism towards pretty much everything. I’m convinced anyone who doesn’t do this is either too young to know better or too dumb to have been paying attention.
  - bufio 3y ago
    The Big New Thing at the moment seems to be a moral panic about oxycodone.
  - salad-tycoon 3y ago
    “Covid” or the constant breathless reporting about every possible little thing over 3 years did this to me. Not rehash any of it but now 3 years later people like Zuck coming out and saying things like “Woops maybe we censored the wrong things and promoted also the wrong things. Woopsies.” I thought I was world worn and tough. Then came AI and I was again on the doom and gloom train. Then I had a moment, realized this just the new thing and dropped it down a few degrees. What’s next?
- daniel-cussen 3y ago
  Yeah that was saying if you crushed n injected it would be addictive. No. It was addictive in literally any form. They knew that too, n it wasn't on the packaging. You kind of have to be a monster to say something that callous.
  - fweimer 3y ago
    As far as I understand it, crushing/injecting it makes it more likely to induce pronounced euphoria and other side effects that encourage abuse. But it was known from the start that it was addictive (causing a physical dependency) even if used as intended, simply because it is an opioid. Here's an older package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020553s060lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/02... Among other things, it says “Physical dependence and tolerance are not unusual during chronic opioid therapy.” I'm no expert, but I think that explains why warnings about dependence weren't more pronounced. The drug was supposed to be distributed in a tightly controlled fashion due to these risks, after all. In retrospect, the warnings at the start, and the information for patients read like recipes for abuse, though.
  - KnobbleMcKnees 3y ago
    Both sides benefit from the average Joe not knowing the facts. This is, in a nutshell, why so much FUD exists about drug addiction. For dealers, it gets people through the gateway. For the anti drugs crowd, it's the equivalent of preventing teenage sex by not telling them how it's done
2-718-281-828 3y ago
of course you shouldn't be mad at your friend. he is suffering and seeking relief. the sacklers and the cartels for sure are despicable. but they aren't responsible for your friend either. they didn't force him to take drugs. it sounds petty but i firmly believe for a number of reasons that it is very important to keep this in mind.
xrd 3y ago
Also, my friend is in the hospital and apparently will be there for a week or two. So he will leave with several hundred thousand dollars of debt, which will probably be shackled around his mom's neck. This is a medical crisis that will never get solved because our medical system doesn't want to handle people with these addictions. No one does of course. But that's the only way to solve it in my opinion.
- ThePhantom 3y ago
  Sorry to hear about your friend. What was he hospitalized for? Several hundred thousand dollars is an exorbitant amount of money even with how high the cost of healthcare is in the US.
  - xrd 3y ago
    From a mutual friend, apparently the withdrawals were severe. He was actually admitted to a recovery place with his mom's help (that was $45k for a month!). Fentanyl is stored in fat cells apparently. It takes a long time to leave the system. So he was hospitalized because his potassium levels dropped to a dangerous place. I'm not sure of the price tag. But i had another friend who was told to go to another hospital when his wife's pregnancy took a bad turn. They spent two weeks and it was several hundred thousand. The insurance said, just beg the hospital to reduce it? It was ridiculous. I'm just sure my friend won't leave with that covered. Not the hospitals responsibility for sure but it's outrageous the cost and prevents people from seeking help.
- daniel-cussen 3y ago
  [dead]
zoklet-enjoyer 3y ago
That sucks about your friend. But how did anyone think there was no abuse potential? I was in highschool in the early to mid 2000s and even I knew there was massive abuse potential. There's a reason it was called hillbilly heroin
- SV_BubbleTime 3y ago
  I was at a party in 2001 and they were getting Oxy delivered and figuring out how much and who wanted it. I knew then it wasn’t harmless recreational. Two party from that party are now dead of overdoses.
- antonvs 3y ago
  Yeah. Oxycodone was always known to be addictive, like any other opiate. The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release. That turned out to be largely BS, but it wasn’t helped by the fact that addicts would crush the tablets, eliminating the slow release aspect.
  - fires10 3y ago
    I had this told to me and had family members told this by doctors. A large number of addicts started from medical prescriptions for legitimate pain. I have been scolded for not taking pain meds.
  - retrac 3y ago
    > The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release. A similar claim is now made about Vyvanse, a pro-drug for amphetamine. Like a slow release formulation, but needs to be metabolized first. The slower onset, less sharp peak, makes it less euphoric for a similar effective dose, which is supposedly one of the mechanisms involved with the reward-feedback addiction cycle. Less likely to experience (intentionally or accidentally) the intense euphoria of a bit too much instant-release amphetamine on an empty stomach, and so less likely to seek out the experience again. It also frustrates injection, since it needs to be metabolized first so injecting it doesn't make it work any faster. I'm not sure the premise is wrong, and it is probably fairly similar with opioids. But slightly less abuse risk is certainly not the same as non-addictive.
throw-4e451c8 3y ago
> He owned four cab licenses in Portland. Then Uber came in and shredded his retirement plan. I am sorry for your friend, but not for him losing out on his rent seeker plans.
- euiq 3y ago
  this exchange is so hacker news
- nick_ 3y ago
  The folks flagging your post would hunt the poor for sport if it was legally and socially acceptable.
  - p0pcult 3y ago
    [dead]
  - jojobas 3y ago
    There's nothing wrong with (and, in fact, it's virtuous) not spending money to consume today in order to have a better life tomorrow.
mobilefriendly 3y ago
My family member died from his addiction and I'm still angry at him. He made several decades of selfish, disastrous choices. He had every advantage in the world and squandered it all. I'm angry we don't do more to fight these drugs. Drug dealing is very much a violent crime, it killed my cousin. The popular culture that celebrates drugs and dealers. Plenty of blame all around but central is the person who decides to use.
- mikub 3y ago
  I mostly agree with you. But when your doctor is telling you to take some 'medicine', and that is what makes you addicted it's not completly in your hands anymore.
  - brightball 3y ago
    After I had surgery on my ankle in college, my dad took away the pain medicine the moment it was no longer necessary (1 day later) and just gave me Advil after that. I didn’t fully appreciate why until I saw somebody go through it. But then I got the entire picture. This man struggled. Hid it from his family. Finally confessed it to his wife who stuck by him and sent him to a rehab program to get clean. He was gone for about 4 months and got clean. Got his life back. Got his family back and got back to work. And then his old dealer came back around. It took another family member telling the dealer he’d shoot him on sight if he ever came around again to get that predator to leave.
  - c22 3y ago
    Of course it is. Doctors work for you and offer advice. They can't force you to take medicine unless you're involuntarily commited. Do your own research. Get a second opinion. Etc. I rarely end up taking medication that's prescribed to me and overall I think I'm the better for it.
- civilitty 3y ago
  > The popular culture that celebrates drugs and dealers. You mean modern medicine? That's what makes this problem so pernicious - so much of it was created by the people fictionalized in shows like House MD and Grey's Anatomy not The Wire and Breaking Bad.
xrd 3y ago
Fifteen years ago there was a guy outside my apartment selling the homeless newspaper. He admitted he was addicted to heroin. So I paid for him to go to a halfway house. That was because my friend told me that even though it was unlikely to work, every chance is an extra chance. That's what I'm hoping for here. I want a story that addiction from these horrible drugs isn't always the end. It would be amazing if he can recover from this. I'm scared but it's all I have for him right now.
lo_zamoyski 3y ago
Indeed, the idea that we shouldn't criminalize drugs because of some ludicrous personal autonomy argument is silly. It rests on a kind of extreme, libertarian view of human beings and human society in which human beings are construed as atomic, self-sufficient beings shouldering the entire burden of responsibility for their actions (we ARE responsible, but those who encourage or enable bad behavior share responsibility) and society is construed as some kind of purely voluntary association of atomic beings for transactional exchanges. Classical liberal view, extremely anti-social and anti-human. Human beings are social animals. Harming oneself harms society, and harming society harms its members. Society exists for the sake of the common good, and it isn't good to enable or allow drug use.
- Nursie 3y ago
  Yes, and we need to ban equasy as well, it harms people, predominantly the young, and provides no tangible benefits. Children are being harmed by this scourge! Society will be much better off without it! https://journals.sagepub.com/doi/abs/10.1177/0269881108099672 https://journals.sagepub.com/doi/abs/10.1177/026988110809967...
_8j50 3y ago
So, here is my problem: if the sakler family or drug cartels deceived regarding the harmful and addictive nature of drugs, sure thing, hang them for murder! But if an adult human makes a conscious decision, being fully aware of the consequences then it that person's responsibility. I think you should instead be angry at the government. Your friend should have been able to go to a facility that administers fentanyl or heroin safely while making available counseling and any other help that could be provided to him. If there is a dosage for any substance where it can be administered without causing near-term death or irreparable physical damage, the government should either ignore it or intervene by implementing safe ways people can can consume these substances. You shouldn't need to go to a street dealer, even if you don't have a medical perscription they should let you get addicted and consume it if you choose to do so against all advice. Millions die in the US every year because... I don't even know why? It sounds not right to treat people?

by xrd 3y ago

deleted 3y ago

[deleted]

refurb 3y ago

Oxycodone was always known to be addictive. It’s right on the label from day one. “Also at the time of OxyContin’s approval, FDA product labeling warned of the danger of abuse of the drug and that crushing a controlled-release tablet followed by intravenous injection could result in a lethal overdose. There was no evidence to suggest at the time that crushing the controlled-release capsule followed by oral ingestion or snorting would become widespread and lead to a high level of abuse.” https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-substance-use-and-overdose https://www.fda.gov/drugs/information-drug-class/timeline-se...

xrd 3y ago
I remember with distinct anger that my friend told me information to the contrary. He probably got that phrasing from that doctor who got a free trip to Barbados to push it. I wasn't there but i remember him telling me that and it makes my blood boil. I do share other people's skepticism of the medical industry as you might be able to tell. He should have done more research, agreed.
- fires10 3y ago
  We license doctors to do the research for us. We can not be expected to experts in all fields. It's why we license professionals.
  - zdragnar 3y ago
    We license doctors you visit to practice medicine, not to do research. Unless they're working at a dedicated research hospital like the Mayo clinic, doctors don't do research on their own. They'll stay up to date with what is standards of care, but even that is dictated to them by their EHR software or what they expect your insurance will cover. When I've gotten prescribed a new medicine, I don't really recall a doctor ever even telling me what side effects to watch out for. At most, they've told me not to drink alcohol while on someone.
arcanemachiner 3y ago
People are often taken in by the Big New Thing. That's why I have a default policy of skepticism towards pretty much everything.
- SV_BubbleTime 3y ago
  > That's why I have a default policy of skepticism towards pretty much everything. I’m convinced anyone who doesn’t do this is either too young to know better or too dumb to have been paying attention.
- bufio 3y ago
  The Big New Thing at the moment seems to be a moral panic about oxycodone.
- salad-tycoon 3y ago
  “Covid” or the constant breathless reporting about every possible little thing over 3 years did this to me. Not rehash any of it but now 3 years later people like Zuck coming out and saying things like “Woops maybe we censored the wrong things and promoted also the wrong things. Woopsies.” I thought I was world worn and tough. Then came AI and I was again on the doom and gloom train. Then I had a moment, realized this just the new thing and dropped it down a few degrees. What’s next?
daniel-cussen 3y ago
Yeah that was saying if you crushed n injected it would be addictive. No. It was addictive in literally any form. They knew that too, n it wasn't on the packaging. You kind of have to be a monster to say something that callous.
- fweimer 3y ago
  As far as I understand it, crushing/injecting it makes it more likely to induce pronounced euphoria and other side effects that encourage abuse. But it was known from the start that it was addictive (causing a physical dependency) even if used as intended, simply because it is an opioid. Here's an older package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020553s060lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/02... Among other things, it says “Physical dependence and tolerance are not unusual during chronic opioid therapy.” I'm no expert, but I think that explains why warnings about dependence weren't more pronounced. The drug was supposed to be distributed in a tightly controlled fashion due to these risks, after all. In retrospect, the warnings at the start, and the information for patients read like recipes for abuse, though.
- KnobbleMcKnees 3y ago
  Both sides benefit from the average Joe not knowing the facts. This is, in a nutshell, why so much FUD exists about drug addiction. For dealers, it gets people through the gateway. For the anti drugs crowd, it's the equivalent of preventing teenage sex by not telling them how it's done

2-718-281-828 3y ago

of course you shouldn't be mad at your friend. he is suffering and seeking relief. the sacklers and the cartels for sure are despicable. but they aren't responsible for your friend either. they didn't force him to take drugs. it sounds petty but i firmly believe for a number of reasons that it is very important to keep this in mind.

xrd 3y ago

Also, my friend is in the hospital and apparently will be there for a week or two. So he will leave with several hundred thousand dollars of debt, which will probably be shackled around his mom's neck. This is a medical crisis that will never get solved because our medical system doesn't want to handle people with these addictions. No one does of course. But that's the only way to solve it in my opinion.

ThePhantom 3y ago
Sorry to hear about your friend. What was he hospitalized for? Several hundred thousand dollars is an exorbitant amount of money even with how high the cost of healthcare is in the US.
- xrd 3y ago
  From a mutual friend, apparently the withdrawals were severe. He was actually admitted to a recovery place with his mom's help (that was $45k for a month!). Fentanyl is stored in fat cells apparently. It takes a long time to leave the system. So he was hospitalized because his potassium levels dropped to a dangerous place. I'm not sure of the price tag. But i had another friend who was told to go to another hospital when his wife's pregnancy took a bad turn. They spent two weeks and it was several hundred thousand. The insurance said, just beg the hospital to reduce it? It was ridiculous. I'm just sure my friend won't leave with that covered. Not the hospitals responsibility for sure but it's outrageous the cost and prevents people from seeking help.
daniel-cussen 3y ago
[dead]

zoklet-enjoyer 3y ago

That sucks about your friend. But how did anyone think there was no abuse potential? I was in highschool in the early to mid 2000s and even I knew there was massive abuse potential. There's a reason it was called hillbilly heroin

SV_BubbleTime 3y ago
I was at a party in 2001 and they were getting Oxy delivered and figuring out how much and who wanted it. I knew then it wasn’t harmless recreational. Two party from that party are now dead of overdoses.
antonvs 3y ago
Yeah. Oxycodone was always known to be addictive, like any other opiate. The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release. That turned out to be largely BS, but it wasn’t helped by the fact that addicts would crush the tablets, eliminating the slow release aspect.
- fires10 3y ago
  I had this told to me and had family members told this by doctors. A large number of addicts started from medical prescriptions for legitimate pain. I have been scolded for not taking pain meds.
- retrac 3y ago
  > The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release. A similar claim is now made about Vyvanse, a pro-drug for amphetamine. Like a slow release formulation, but needs to be metabolized first. The slower onset, less sharp peak, makes it less euphoric for a similar effective dose, which is supposedly one of the mechanisms involved with the reward-feedback addiction cycle. Less likely to experience (intentionally or accidentally) the intense euphoria of a bit too much instant-release amphetamine on an empty stomach, and so less likely to seek out the experience again. It also frustrates injection, since it needs to be metabolized first so injecting it doesn't make it work any faster. I'm not sure the premise is wrong, and it is probably fairly similar with opioids. But slightly less abuse risk is certainly not the same as non-addictive.

throw-4e451c8 3y ago

> He owned four cab licenses in Portland. Then Uber came in and shredded his retirement plan. I am sorry for your friend, but not for him losing out on his rent seeker plans.

euiq 3y ago
this exchange is so hacker news
nick_ 3y ago
The folks flagging your post would hunt the poor for sport if it was legally and socially acceptable.
- p0pcult 3y ago
  [dead]
- jojobas 3y ago
  There's nothing wrong with (and, in fact, it's virtuous) not spending money to consume today in order to have a better life tomorrow.

mobilefriendly 3y ago

My family member died from his addiction and I'm still angry at him. He made several decades of selfish, disastrous choices. He had every advantage in the world and squandered it all. I'm angry we don't do more to fight these drugs. Drug dealing is very much a violent crime, it killed my cousin. The popular culture that celebrates drugs and dealers. Plenty of blame all around but central is the person who decides to use.

mikub 3y ago
I mostly agree with you. But when your doctor is telling you to take some 'medicine', and that is what makes you addicted it's not completly in your hands anymore.
- brightball 3y ago
  After I had surgery on my ankle in college, my dad took away the pain medicine the moment it was no longer necessary (1 day later) and just gave me Advil after that. I didn’t fully appreciate why until I saw somebody go through it. But then I got the entire picture. This man struggled. Hid it from his family. Finally confessed it to his wife who stuck by him and sent him to a rehab program to get clean. He was gone for about 4 months and got clean. Got his life back. Got his family back and got back to work. And then his old dealer came back around. It took another family member telling the dealer he’d shoot him on sight if he ever came around again to get that predator to leave.
- c22 3y ago
  Of course it is. Doctors work for you and offer advice. They can't force you to take medicine unless you're involuntarily commited. Do your own research. Get a second opinion. Etc. I rarely end up taking medication that's prescribed to me and overall I think I'm the better for it.
civilitty 3y ago
> The popular culture that celebrates drugs and dealers. You mean modern medicine? That's what makes this problem so pernicious - so much of it was created by the people fictionalized in shows like House MD and Grey's Anatomy not The Wire and Breaking Bad.

xrd 3y ago

Fifteen years ago there was a guy outside my apartment selling the homeless newspaper. He admitted he was addicted to heroin. So I paid for him to go to a halfway house. That was because my friend told me that even though it was unlikely to work, every chance is an extra chance. That's what I'm hoping for here. I want a story that addiction from these horrible drugs isn't always the end. It would be amazing if he can recover from this. I'm scared but it's all I have for him right now.

lo_zamoyski 3y ago

Indeed, the idea that we shouldn't criminalize drugs because of some ludicrous personal autonomy argument is silly. It rests on a kind of extreme, libertarian view of human beings and human society in which human beings are construed as atomic, self-sufficient beings shouldering the entire burden of responsibility for their actions (we ARE responsible, but those who encourage or enable bad behavior share responsibility) and society is construed as some kind of purely voluntary association of atomic beings for transactional exchanges. Classical liberal view, extremely anti-social and anti-human. Human beings are social animals. Harming oneself harms society, and harming society harms its members. Society exists for the sake of the common good, and it isn't good to enable or allow drug use.

Nursie 3y ago
Yes, and we need to ban equasy as well, it harms people, predominantly the young, and provides no tangible benefits. Children are being harmed by this scourge! Society will be much better off without it! https://journals.sagepub.com/doi/abs/10.1177/0269881108099672 https://journals.sagepub.com/doi/abs/10.1177/026988110809967...

_8j50 3y ago

So, here is my problem: if the sakler family or drug cartels deceived regarding the harmful and addictive nature of drugs, sure thing, hang them for murder! But if an adult human makes a conscious decision, being fully aware of the consequences then it that person's responsibility. I think you should instead be angry at the government. Your friend should have been able to go to a facility that administers fentanyl or heroin safely while making available counseling and any other help that could be provided to him. If there is a dosage for any substance where it can be administered without causing near-term death or irreparable physical damage, the government should either ignore it or intervene by implementing safe ways people can can consume these substances. You shouldn't need to go to a street dealer, even if you don't have a medical perscription they should let you get addicted and consume it if you choose to do so against all advice. Millions die in the US every year because... I don't even know why? It sounds not right to treat people?