4 ms·

It's been widely understood since the 1970s, if not longer, that opioids have a high potential for addiction and that long term use tends to be harmful. Sure, h

It's been widely understood since the 1970s, if not longer, that opioids have a high potential for addiction and that long term use tends to be harmful. Sure, he seems to have been quite a junior employee, but I knew opioids were a high risk category of drugs when I was in high school. I don't think he's the worst guy in the world, but I do think McKinsey style consulting and this experience in particular is a net negative.

asdff 2y ago
Potential for addiction yes but we are looking at it from the lens of a post Purdue media bias. People abuse plenty of drugs that aren't opioids and we aren't say seeing a big push against Xanax for example because that wasn't in any crosshairs of media spectacle. People die on Xanax but it doesn't seem to matter because people write them off as combining with alcohol or that they were addicts. And indeed most drugs of this sort are not particularly harmful if they are used within recommendations. At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it.
- sepositus 2y ago
  > At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it I'd like to think that most of those decisions are coming from datasets that suggest, on average, certain medications tend to lead to abuse, including from people with no prior history of abuse. I'm quite libertarian in a lot of my views, but this particular one on lax drug controls I've never really been able to buy into.
  - skippyboxedhero 2y ago
    I can't remember the exact stats but something like 5% of doctors were writing 75% of the sales for these products. It isn't that they lead to abuse, it is that people who are using heroin will abuse them, and will go to doctors who facilitate that.
    - wlesieutre 2y ago
      Dentists were handing opioid prescriptions out like candy to teenagers getting their wisdom teeth out. How many of those kids were previously on heroin and were picking dentists who would hook them up? It's a massively common procedure and defaulting to "here's some addictive painkillers just in case you want them" was an insane thing to do, even if only 1% of cases turn out badly.
      - zoklet-enjoyer 2y ago
        I got my wisdom teeth out at 16 or 17 and was given a prescription for oxycodone. I was really excited because I had read about oxy online and wanted to try it. But also I knew it was referred to as hillbilly heroin because of how addictive it was, so I had to be careful. I didn't take any of the oxy after the surgery and just took ibuprofen, so I could save the oxy for later on. I got high off it a few times and loved it. Later on I got a chance to try some hydrocodone and I thought that was even better, because the oxycodone was a little too much for me. I didn't nod off on the hydros. Anyway, opiates are great, that's why I haven't used them since high school.
      - nielsbot 2y ago
        Exact same thing happened to me. I got my wisdom teeth pulled and the guy prescribed me Percocet. Interesting experience was signing a form in triplicate (white copy me, yellow copy walgreens, pink copy DEA) to pick it up. Never took any.
        nradov 2y ago
        Same thing happened to me in 2007. In retrospect it seems crazy.
        confidantlake 2y ago
        Same thing, same year. Got an entire bottle of strong painkillers and didn't need/take any of them.
    - 2y ago
  - throwing_away 2y ago
    > I'm quite libertarian in a lot of my views, but this particular one on lax drug controls I've never really been able to buy into. Ok, I'll bite ;) Let's agree that the "liberal" approach is harm-reduction -- safe injection sites, needle exchanges, free filters, test sites, community disease screening, etc. In places where this has been tried (see: SF), it seems to provide some relief to people on the ground, but it's done nothing to address in the inflow of addicts against ever more dangerous supply. What if the correct liberal position was actually "free pain pills for anyone that needs them, with compassion for all users", and what we think of as "liberal" policies even in SF are actually appeasement of a puritanical system? That would make the libertarian position "you can't be giving out free pills with government money, make them buy them when they need them like the rest of us" and the world would return to order. The right-wing position would remain "the government should use force to prevent people from doing immoral things". As for the addicts, they will now be using a safer route of administration with controlled dosing and not be economically hindered. As for the cartels, they will no longer find money in the drug trade. For a while I thought I understood the dynamics of how things got the way they are, but it seems like everyone else has forgotten, so maybe we could try a new approach soon.
    - sepositus 2y ago
      I spend a good portion of my time in community service, mostly in areas where drug abuse is rampant. During this time, I've talked with a fair number of addicts, and I'd say over 90% of them stem from either being introduced to drugs by a friend (peer pressure) or following after the drug addiction of an existing family member. Generally, within a year or two, they were on the streets resorting to crime to fuel their addiction. Now, my experience is not representative as a whole, but it's generally what fuels my thoughts on this subject. If this is the story I hear quite frequently, why would I want these drugs to be introduced legally into people's lives? That's why I've always had issues understanding people pushing for legalization. I understand how it can come across as puritanical ("I know what's best for you"). However, when all data suggests that engaging in drug use almost universally results in poverty, why would we as a society want to unleash such a thing upon people? It's for the betterment of humanity that life-ruining drugs are illegal. At least those are my thoughts.
- zoklet-enjoyer 2y ago
  Benzos are hard to overdose and die off of. You're more likely to die from withdrawals, or yeah, mixing with alcohol. That's user error.
  - dimal 2y ago
    I have first hand experience of being addicted to benzos and drinking at the same time. I could have died. This was the Heath Ledger era, so I knew what could happen, but benzo addiction is so horrible that I didn’t care. I would go to bed some nights not knowing if I’d wake up. Fuck it. At least I could sleep. Would that be user error, or would it be the doctor’s fault for not telling me how addictive the benzos were? I was mentally ill. He told me to take them every day. I didn’t take them excessively. I took them as prescribed. It was only after the addiction got out of control that I started drinking again. Mentally ill people make bad decisions. The doctor made no effort to ensure I was safe. He kept upping my dose. It’s worth watching the documentary “As Prescribed”[0], which is about benzo addiction. A lot of people go through what I went through. Some don’t survive. We blame drug dealers for ODs but not psychiatrists. Why? [0] https://youtu.be/bDPPdWsN0mk?si=ckAiPvawFVAB4xEE https://youtu.be/bDPPdWsN0mk?si=ckAiPvawFVAB4xEE
    - zoklet-enjoyer 2y ago
      I'm surprised your doctor didn't warn you about that. Growing up, I knew about benzos not from anyone taking it as prescribed, but as a recreational drug
  - meowfly 2y ago
    Also the opioid epidemic actually did make benzos much harder to get. Atleast where I live, your primary doctor is very unlikely to prescribe them and instead will refer you to a psychiatrist. The people I know who were on Ambien or Atvian have been cut off. I think the ADHD drugs are probably next. My conspiracy theory is too much of the professional class (including doctors) is using them regularly, so it's much hard to crack down on.
- anigbrowl 2y ago
  we are looking at it from the lens of a post Purdue media bias include me out of your of your assumptions, please. I knew the Purdue pharma stuff was bad from the get-go, and it's not because I'm prudish about drugs or a huge believer in regulating everything to the point of paralysis. It was because the combination of high physical potential for abuse + strong economic incentives to monetize that leads to bad results. Wars have literally been fought over this in the past. https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars You might be familiar with Adam Smith's famous economic example of the pin factory. Here's Rudyard Kipling's description of an opium factory operated by the British colonial power in 19th century India, an equally brilliant illustration of commercial logic but applied in service of perverse incentives. https://ota.bodleian.ox.ac.uk/repository/xmlui/handle/20.500.12024/3289 https://ota.bodleian.ox.ac.uk/repository/xmlui/handle/20.500...
SmellTheGlove 2y ago
When I was in my mid to late 20s I was at a consulting firm and later in government directly. I wasn’t assigned to anything particularly objectionable or anything, but I’ve looked back on it a lot and it’s heavily influenced how I operate in the tech industry now, 20 years later. In government and in consulting I saw a lot of misaligned incentives that led to empire building, duplicative efforts, and treatment of individuals that I didn’t really find to be effective. And today, I’m really good at spotting that and stopping it quickly, because I think much of that was not the best way to operate. But I didn’t immediately get into it and realize it wasn’t how I would run things - and experiencing being part of the machine for a bit first taught me lessons that I would not have learned as an outside observer. If you made the same assumptions about me based on what I did in my 20s, you’d actually be assuming the direct opposite of what I believe in and how I work today. We’re all shaped by our experiences, but that shaping doesn’t always mean we grow into the behaviors that we experienced during our formative early career. Maybe this guy looks on that experience and knows exactly what he doesn’t want to see happen.
Mistletoe 2y ago
I’d say it goes back considerably further than the 1970s. https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars I’m still struck by how deeply immoral it is to start a war and say “You WILL allow us to sell you opium!”
khana 2y ago
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asdff 2y ago

Potential for addiction yes but we are looking at it from the lens of a post Purdue media bias. People abuse plenty of drugs that aren't opioids and we aren't say seeing a big push against Xanax for example because that wasn't in any crosshairs of media spectacle. People die on Xanax but it doesn't seem to matter because people write them off as combining with alcohol or that they were addicts. And indeed most drugs of this sort are not particularly harmful if they are used within recommendations. At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it.

sepositus 2y ago
> At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it I'd like to think that most of those decisions are coming from datasets that suggest, on average, certain medications tend to lead to abuse, including from people with no prior history of abuse. I'm quite libertarian in a lot of my views, but this particular one on lax drug controls I've never really been able to buy into.
- skippyboxedhero 2y ago
  I can't remember the exact stats but something like 5% of doctors were writing 75% of the sales for these products. It isn't that they lead to abuse, it is that people who are using heroin will abuse them, and will go to doctors who facilitate that.
  - wlesieutre 2y ago
    Dentists were handing opioid prescriptions out like candy to teenagers getting their wisdom teeth out. How many of those kids were previously on heroin and were picking dentists who would hook them up? It's a massively common procedure and defaulting to "here's some addictive painkillers just in case you want them" was an insane thing to do, even if only 1% of cases turn out badly.
    - zoklet-enjoyer 2y ago
      I got my wisdom teeth out at 16 or 17 and was given a prescription for oxycodone. I was really excited because I had read about oxy online and wanted to try it. But also I knew it was referred to as hillbilly heroin because of how addictive it was, so I had to be careful. I didn't take any of the oxy after the surgery and just took ibuprofen, so I could save the oxy for later on. I got high off it a few times and loved it. Later on I got a chance to try some hydrocodone and I thought that was even better, because the oxycodone was a little too much for me. I didn't nod off on the hydros. Anyway, opiates are great, that's why I haven't used them since high school.
    - nielsbot 2y ago
      Exact same thing happened to me. I got my wisdom teeth pulled and the guy prescribed me Percocet. Interesting experience was signing a form in triplicate (white copy me, yellow copy walgreens, pink copy DEA) to pick it up. Never took any.
      - nradov 2y ago
        Same thing happened to me in 2007. In retrospect it seems crazy.
        confidantlake 2y ago
        Same thing, same year. Got an entire bottle of strong painkillers and didn't need/take any of them.
  - 2y ago
- throwing_away 2y ago
  > I'm quite libertarian in a lot of my views, but this particular one on lax drug controls I've never really been able to buy into. Ok, I'll bite ;) Let's agree that the "liberal" approach is harm-reduction -- safe injection sites, needle exchanges, free filters, test sites, community disease screening, etc. In places where this has been tried (see: SF), it seems to provide some relief to people on the ground, but it's done nothing to address in the inflow of addicts against ever more dangerous supply. What if the correct liberal position was actually "free pain pills for anyone that needs them, with compassion for all users", and what we think of as "liberal" policies even in SF are actually appeasement of a puritanical system? That would make the libertarian position "you can't be giving out free pills with government money, make them buy them when they need them like the rest of us" and the world would return to order. The right-wing position would remain "the government should use force to prevent people from doing immoral things". As for the addicts, they will now be using a safer route of administration with controlled dosing and not be economically hindered. As for the cartels, they will no longer find money in the drug trade. For a while I thought I understood the dynamics of how things got the way they are, but it seems like everyone else has forgotten, so maybe we could try a new approach soon.
  - sepositus 2y ago
    I spend a good portion of my time in community service, mostly in areas where drug abuse is rampant. During this time, I've talked with a fair number of addicts, and I'd say over 90% of them stem from either being introduced to drugs by a friend (peer pressure) or following after the drug addiction of an existing family member. Generally, within a year or two, they were on the streets resorting to crime to fuel their addiction. Now, my experience is not representative as a whole, but it's generally what fuels my thoughts on this subject. If this is the story I hear quite frequently, why would I want these drugs to be introduced legally into people's lives? That's why I've always had issues understanding people pushing for legalization. I understand how it can come across as puritanical ("I know what's best for you"). However, when all data suggests that engaging in drug use almost universally results in poverty, why would we as a society want to unleash such a thing upon people? It's for the betterment of humanity that life-ruining drugs are illegal. At least those are my thoughts.
zoklet-enjoyer 2y ago
Benzos are hard to overdose and die off of. You're more likely to die from withdrawals, or yeah, mixing with alcohol. That's user error.
- dimal 2y ago
  I have first hand experience of being addicted to benzos and drinking at the same time. I could have died. This was the Heath Ledger era, so I knew what could happen, but benzo addiction is so horrible that I didn’t care. I would go to bed some nights not knowing if I’d wake up. Fuck it. At least I could sleep. Would that be user error, or would it be the doctor’s fault for not telling me how addictive the benzos were? I was mentally ill. He told me to take them every day. I didn’t take them excessively. I took them as prescribed. It was only after the addiction got out of control that I started drinking again. Mentally ill people make bad decisions. The doctor made no effort to ensure I was safe. He kept upping my dose. It’s worth watching the documentary “As Prescribed”[0], which is about benzo addiction. A lot of people go through what I went through. Some don’t survive. We blame drug dealers for ODs but not psychiatrists. Why? [0] https://youtu.be/bDPPdWsN0mk?si=ckAiPvawFVAB4xEE https://youtu.be/bDPPdWsN0mk?si=ckAiPvawFVAB4xEE
  - zoklet-enjoyer 2y ago
    I'm surprised your doctor didn't warn you about that. Growing up, I knew about benzos not from anyone taking it as prescribed, but as a recreational drug
- meowfly 2y ago
  Also the opioid epidemic actually did make benzos much harder to get. Atleast where I live, your primary doctor is very unlikely to prescribe them and instead will refer you to a psychiatrist. The people I know who were on Ambien or Atvian have been cut off. I think the ADHD drugs are probably next. My conspiracy theory is too much of the professional class (including doctors) is using them regularly, so it's much hard to crack down on.
anigbrowl 2y ago
we are looking at it from the lens of a post Purdue media bias include me out of your of your assumptions, please. I knew the Purdue pharma stuff was bad from the get-go, and it's not because I'm prudish about drugs or a huge believer in regulating everything to the point of paralysis. It was because the combination of high physical potential for abuse + strong economic incentives to monetize that leads to bad results. Wars have literally been fought over this in the past. https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars You might be familiar with Adam Smith's famous economic example of the pin factory. Here's Rudyard Kipling's description of an opium factory operated by the British colonial power in 19th century India, an equally brilliant illustration of commercial logic but applied in service of perverse incentives. https://ota.bodleian.ox.ac.uk/repository/xmlui/handle/20.500.12024/3289 https://ota.bodleian.ox.ac.uk/repository/xmlui/handle/20.500...

SmellTheGlove 2y ago

When I was in my mid to late 20s I was at a consulting firm and later in government directly. I wasn’t assigned to anything particularly objectionable or anything, but I’ve looked back on it a lot and it’s heavily influenced how I operate in the tech industry now, 20 years later. In government and in consulting I saw a lot of misaligned incentives that led to empire building, duplicative efforts, and treatment of individuals that I didn’t really find to be effective. And today, I’m really good at spotting that and stopping it quickly, because I think much of that was not the best way to operate. But I didn’t immediately get into it and realize it wasn’t how I would run things - and experiencing being part of the machine for a bit first taught me lessons that I would not have learned as an outside observer. If you made the same assumptions about me based on what I did in my 20s, you’d actually be assuming the direct opposite of what I believe in and how I work today. We’re all shaped by our experiences, but that shaping doesn’t always mean we grow into the behaviors that we experienced during our formative early career. Maybe this guy looks on that experience and knows exactly what he doesn’t want to see happen.

Mistletoe 2y ago

I’d say it goes back considerably further than the 1970s. https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars I’m still struck by how deeply immoral it is to start a war and say “You WILL allow us to sell you opium!”

khana 2y ago

[dead]