How a Reddit forum has become a lifeline to opioid addicts in the US

https://twitter.com/sama/status/656892679817527296

The point of business is to create a customer. For that to happen, there has to be someone out there who has voluntarily decided they want to use (and ideally pay for) your product. The same goes for political movements - to build a mass political movement, you need a critical mass of people who voluntarily decide that this cause is worth investing time and money into.

By definition, addiction means that your voluntary choices are going to serve the furtherance of your addiction. So there's no customer there, and no profit potential, unless you're a drug dealer. Social interventions like drug treatment clinics could perhaps work, relying on the desires of loved ones, but it's very hard to help someone else unless they make choices to help themselves. When your brain chemistry has been altered so all it wants is more of the drug, that's not a given.

It's a hard problem. Unfortunately history hasn't been kind to populations with mass drug abuse; when I think of countries with a societal drug problem [1][2] or even subpopulations within a larger nation with widespread drug abuse [3][4], the cultures involved all basically collapsed. For countries, the general pattern involved top-down reforms -> military defeats -> revolution -> conquest by another power. For subcultures within a larger nation, it's the total marginalization of the group in question, assimilation into the larger population of the remaining productive members, and then long-term decay and blight on the remnants of the subculture.

[1] https://en.wikipedia.org/wiki/Opium_Wars

[2] https://en.wikipedia.org/wiki/Drug_policy_of_Nazi_Germany

[3] https://en.wikipedia.org/wiki/Crack_epidemic

[4] https://en.wikipedia.org/wiki/Alcohol_and_Native_Americans

The opioid crisis seems like a symptom of our social problems (hopelessness in the rust belt, unscrupulous over-prescribing of pain meds) that has fatal consequences.

Short of a drug that provided a permanent cure for opioid addiction itself, I'm not sure what sort of solutions can be pursued by scientific/tech research, as opposed to addressing the root social causes.

I'm interested in what ideas others might have though.

This. The AIDS epidemic in the 1980's was the same. Tens of thousands of people dying every year, with more than forty thousand per year at jts peak, and more than 600,000 dead to date. Because of homophobia, the public at large didn't care about the victims - most people, if they took notice at all, only expressed groundless fear in catching HIV just going about their business.

Opiate addiction isn't a disease in the sense that there's a biological virus or bacteria that can be transmitted from person to person, so "normal" people think they can't "catch" it. And so without public sympathy for the victims, no wonder there isn't some mass political movement trying to get Congress to fund a proper response.

Methadone clinics, rehabs and other places like that, however, do profit off of addicts' recovery and may even have genuine intentions of helping (it seems to vary from place to place). Those profits are minor compared to the profit off of addicts' misery and death, however, and their efforts are not usually talked about much in the press. Laws also hold back such institutions from providing good treatment and dehumanize the addicts trying to stay clean. In many places, addicts are treated horribly and made to suffer intentionally by the staff, often having to wait around sick for hours just to see a doctor before getting a dose of methadone even though they've been on the program for years. They are made to line up daily or weekly for a dose when a regular prescription would do just fine, even after they've been on methadone for years. At many of these clinics, it's a wonder that anyone stays clean. There is no professionalism. Doses are messed up when addicts travel and they are left without their methadone. Staff end up stealing either money or methadone. There is no accountability. Not all clinics lack compassion and treat addicts badly, but many do. It's no wonder these places try to fly under the radar while the good clinics and rehabs are too busy helping addicts to be in the press or make much noise. If cancer or heart patients were treated this way, you can bet your ass there'd be a national backlash, but our society has been conditioned to have no compassion for addicts. This is the result. It's ugly and nasty.

On the matter of self-driving car investment, vs opiate addiction treatment - car makers need to turn a profit, so they need something new to sell. A lot of people also commute daily, and don't enjoy doing so. So in the (distant) shiny future where your car drives you to work, they are building something that I think a lot of people will be willing to pay for, or use as a service.

[0] Addendum - it also avoided the public eye because of where addiction was happening, and who to. A lot of it started in smaller towns, often those struggling economically. The kind of places that don't get a lot of attention.

So while the public at large may be ignorant of this crisis (and honestly, on how many issues is even the most educated of us truly knowledgeable about?) the States' representatives that have these problems back home appear to be taking it very seriously.

1. The opioid crisis is getting a lot of airtime in the media outlets that I read.

3. The opioid crisis is one of the biggest reasons why the Senate's Trumpcare bill is now dead, and was also a major topic of discussion in the weeks leading up to its unexpected loss this week. In short, its drastic cuts to Medicaid would have decimated opioid treatment in some of the states hit hardest, and Senator Capito of West Virginia, at least, would have voted against it because the $40-odd billion dollars that Mitch McConnell would've specifically allocated to opioid treatment would have been a 'drop in the bucket.' Here's some earlier discussion of this point: http://talkingpointsmemo.com/dc/capito-says-opiod-treatment-...

So, all said, maybe find some new sources of news and discussion?

edit: here's a new wire article from the AP that just crossed my RSS reader: http://talkingpointsmemo.com/news/democrats-trump-action-opi...

Actually, it is the opposite. Gun violence, opioid crisis, etc are given too much attention.

The deaths of opioid crisis and gun deaths are minuscule compared to the deaths cause by obesity, sedentary lifestyle, cancer, heart disease, etc.

Take the top two killers in america - heart disease and cancer ( about 600K deaths each ) vs gun violence + opioid crisis ( about 30K each ).

Heart disease by itself kill 10X more people than gun violence and opioid crisis combined.

From your own link:

"According to the Center for Disease Control, in 2015 52,404 people died from drug overdoses in the United States. 33,091 of those deaths involved opioids. In comparison, 35,092 people died in auto accidents in 2015 (Department of Transportation), and 12,195 people died from non-suicide firearm-related injuries in 2014 (CDC, 2015 data not yet available)."

I'm not surprised at all, and the only emotion I feel is complete disgust, directed at politicians that refuse to work together. It started the second Obama was elected POTUS and the opposing party declared they would not work with him, and that lasted the full 8 years.

Even neglecting that, crash victims are more worthy (on average) than overdose victims, as they come into their fate largely on accident, while overdose victims largely make an informed choice to roll the dice. I don't like saying this; it sounds judgmental and it certainly won't be popular, but this is the logical conclusion. Fortunately, the choice between self-driving cars and combatting the opioid epidemic doesn't remotely hinge on this point.

What do you want to see? What would you consider an ideal world here?

I know how you feel. It's utterly ridiculous that a society should so heartlessly abandon the most vulnerable among us who struggle so needlessly. We should do better! We can do better! We MUST do better! It's a moral imperative.

Yet, for all that, it's possible that resources are limited. And when resources are limited, questions of sustainability, achievability, returns, and cost-effectiveness become relevant. This is particularly true when there multiple goals to be chased - would you be happy if all Medicare funding for the elderly was stripped away in favor of treating opioid addiction?

It's the same for basically every issue. Humans can be altruistic, but organizations rarely are.

Simply: change happens when expending power leads to a greater expected increase in (relative) power than doing nothing for a sufficient amount of power-brokers to overcome costs of change and opponents(those who expect to lose from the change). This is a structural issue, not human nature.

Blaming the addicts helps to reduce the cost of doing nothing. The good(?) news is that this is tending to hit wealthier people than past epidemics and so is getting correspondingly greater attention.

Rejoice! The problem is far worse than these sad, bullshit excuses.

I think you're right but the reasoning is one step removed from the conclusion.

Drug addition is a poor people problem (in part because it takes resources and support to break the cycle).

Opiod (and meth for that matter) addiction skews rural and therefore white.

A lot of people take the attitude that poor rural white trash are poor white trash because they live in a dying town with no industry and refuse to relocate to somewhere they can more easily scrape by. The catch is that the people making these judgements generally have a very different set of values than the people they're judging.

When you take the attitude that the situation that leads one to easily become an addict is the fault of the addict then it's hard to have sympathy for addicts.

There's also a lot of (well meaning) "optimism to the point of stupidity" in assessing how effective firearms legislation is as an avenue to reduce violent crime and how easy it is to make a driver-less car that can effectively share the roads with vehicles operated by people

One of our biggest blockers has been the existing recovery industry. Addiction is so stigmatized that getting people to use an app on their phone, even after treatment, is problematic because they feel like the data could get out that they're an addict. This is another reason more research isn't done. These existing facilities literally don't collect data - much less use it in any relevant way.

Value-based payments and growing oversight from insurance companies is changing that somewhat. These facilities are starting to be required to report outcomes data - so from a business perspective we're good. But man this industry and it's privacy/secrecy are something else.

Self-driving cars actually would have a benefit for society in terms of higher durability for vehicle and optimal road selection leading to lower carbon emissions, lower traffic accidents, and less use of natural resources.

I am more annoyed by all the time and effort going into Google's and Facebook's ad-tech optimizations.

Wait, what? This is a "lobby"?

I thought the NRA with their even larger resources, backed by industrial interests, is the actual lobby. You know, the one who pushed forward those laws into insane directions, which you'll find almost nowhere else in the world.

[1]http://nautil.us/issue/49/the-absurd/why-your-brain-hates-ot...

Assuming that might have been misspeech, it's easy to see why autonomous vehicles have so much more interest. The interest isn't in preventing human death, the interest is there because not only is it a more fascinating problem to solve, but it saves everybody time and hassle. Lowering the number of deaths is just a great effect.

Focus on a problem isn't always about sheer concern, sometimes the focus is so much higher just because it's a problem more people feel they can contribute to solving. Parkinson's law of triviality...

They already are being profited from politically via the War on Drugs.

Addicts don't make good customers.

EDIT: Looks like it was a place to connect opiate buyers and sellers

The US prescribes far more opioids than any other developed nation.

These two combine and there are a bunch of people without addiction, but with spare pills. Those pills have a market value, and so they get sold. Or relatives of the patient find the pills and take them.

When drugs can be used to change how you feel people often will to escape negative feelings. Replace boredom with depression, anxiety, pain, it's all similar.

It's all about escapism.

http://www.npr.org/sections/thetwo-way/2017/05/31/530929307/...

Here's something... curious. Poppy production was virtually wiped out in Afghanistan: http://www.nytimes.com/2001/05/20/world/taliban-s-ban-on-pop...

Then we invaded. Now it's high: https://upload.wikimedia.org/wikipedia/commons/5/5c/Afghanis...

The jobs are gone. Now it's time to stop marginalizing and treating jobless people like parasites. This would help more.

I know people who use kratom and they have good things to say, but I've known people who say the same thing about x, y, and z supplement/nootropic whatever.

The problem with this is that human beings will reject ideas that don't agree with what they want to hear, like the populations of coal towns in Appalachia that want to blame "Liberals" for their lot in life because they've hitched their wagon to the (dying) coal industry and don't want to change.

It's like the Simpsons Principal Skinner meme. "Could I be wrong about something? No! It's definitely everyone else that is wrong!"

Also, ideas don't woo people in and of themselves. Why do you think that charismatic leaders can swap entire populations to follow horrible ideologies that offer simple and easy solutions to their problems by throwing other people under the bus to pave the way to a better future for a select few?

I think it's dangerous to conflate government sanctioned censorship with moderation on a privately owned website.

Lol okay dude hop onto stormfront and engage in some civic discourse, offer some arguments, see how that goes.

You seem to be suggesting that one can't simultaneously have a job and dreams and be an alcoholic/drug addict/gangster. This is sloppy logic

Edit: Your perspective also explains why society hasn't addressed alcoholism and drug addiction for so long: to you, the alcoholics and addicts are an entirely separate group from upright, hardworking, motivated, dream-pursuing "normal" people.

You are completely right that it sucks to not have a job, but its possible that's a reflection of how social life is structured and not some biological Protestant work ethic. Right now "I work at X company" is shorthand for "I am a a productive member of society". That certainly benefits companies and certain types of people. But it's not the only imaginable value system. And I suspect that people who feel valuable are a lot less likely to find solace in bottle of pills.

Now I tread carefully because you never know what kind of propaganda is being spread around.

People say stick to the subreddit. But I think that's silly. If the core of Reddit is rotten, then the subreddit themselves will be affected. It has happened to places I visit like /r/environment. There is a constant barrage of non-environmentally friendly comments. Not enough to change the overall makeup of the subreddit, but enough to make you wonder who is on the other side of the screen voting or down voting on stories.

Then there are places like /r/technology, which is almost intolerable to me at times.

People say I am paranoid, but like with anything, if you know a place well and visit it for years, you can sense when things change.

And yes my opinion is subjective, but this is a subjective topic.

In the good old days with forums, people were recognizable with avatars and signatures. People chatted about everything, not just the topic at hand, so the personality of each person had a large spectrum. The communities were small enough where people formed an identity and reputation. Many times they even connected their real life identity in "post your picture" threads.

Reddit has effectively killed many forums without replacing that human community aspect and it's kind of sad.

However I'd like to point out the admin policy towards hate groups and speech on reddit is in my opinion incredibly dangerous and damaging to our society. They will take action against subreddits like FPH (fat people hate) because of "real life" actions, meawhile there are thousands of highly upvoted calls to violence daily. Is this just a reflection of our society? Probably but I'm always interested to see which sites allow what. Here's what Jack Dorsey had to say about it regarding twitters ban on hate speech "Abuse is not part of civil discourse. It shuts down conversation and prevents us from understanding each other. Freedom of expression means little if we allow voices to be silenced because of fear of harassment if they speak up"

As a minority I've stopped using reddit and know many others like me, the ones that stay stick around to drop in "As a [insert minority group]...it's totally OK that this racist meme is highly upvoted with racist comments - because its a joke ha ha" posts

The obvious counter-argument is silencing them strengthens their argument and makes them a martyr. I don't buy that argument at all, it's far more dangerous to allow them to indoctrinate and appeal to all the fringe disenfranchised youth which they've become frighteningly effective at. In any case it's clear reddit can be used for good like in this article, I'm just not so sure it's a net positive to society as another poster argued.

Is it fair to say it's their responsibility to police society when they just run the platform? Probably not, but I do know there's a big problem here and it's causing immense damage daily, racism and xenophobia are on the rise.

Your comments have been breaking the HN guidelines by being uncivil and/or unsubstantive. Would you please fix this?

We detached this subthread from https://news.ycombinator.com/item?id=14805715 and marked it off-topic.

But, of course, you're not thinking of addition as a medical issue. You're treating it like a moral failure.

So while there certainly will be people undeserving or who cannot be saved, a majority of "addicts" are more likely people who could be better with the right kind of therapy and social support.