Nineteen people a week overdose in Richmond, dozens are dying, hundreds revived | Hacker News Reader

Nineteen people a week overdose in Richmond, dozens are dying, hundreds revived

richmond.com

141 pointsiamjeff231 comments

Just the other morning I got off of bart in downtown Oakland, 12th street and there was a guy just laid out, unresponsive right on the steps outside the station. He had smoked something out of a can. I stuck with the guy while the paramedics came, but the most tragic part was that he had a plastic "No Allergies" bracelet on. When the paramedics took off his shirt he still had adhesive on his skin from the EKG straps or what not. So he had gotten out of the hospital and then immediately ODed (presumably again).

I'm not sure what we need to do, but if you haven't encountered the epidemic first hand, it's only a matter of time until you do.

Yep. My uncle died from an OD earlier this year. Drugs cut with fentanyl. It's truly a terrible epidemic.

Sorry to hear. Partaking in heavy drugs to any degree invites those dark unknowns. The number of hands these drugs pass through to reach the end-user is more than a couple. I recall on average it's 8 different turnovers. Each time, likely being cut down. They operate a margin business without concern for where it ends up. It's likely safe to say that a vast majority of drugs are cut these days.

A friend I grew up with just shot himself to death. He was on a TV show, model and had it all going for him..until the night he tried black tar heroin through a needle, off a spoon. An older friend convinced him and four others to try it one night at a wrap party for the TV show. Grew up affluent but drugs immediately nosedived his life. Ended up in and out of jail, losing it mentally, mental institutions, broke every window at his parents house, just living a really rough existence. The part that got me: the older friend who introduced him to it showed up to his funeral.

The other one of the four is on his third strike for heroin, just got his second DUI trying to "live it up" – drugs i.e. heavy drugs, are a game that you do not win.

> Each time, potentially being cut down.

Drug potency follows something like an S-curve. As enforcement increases a drug will get increasingly stepped on, until the purity is low enough that the drug gets replaced with a more potent analog. Consumer Reports wrote about this in their guide to drugs from the 70s.

> Consumer Reports . . . guide to drugs

Whoa. Care to further elaborate?

It’s free online: The Consumer Union guide to licit and illicit substances.

I will check it out today, thank you!

I can see how people move to something like heroin after being on pain meds and getting addicted, but who really just 'tries' heroin? At this point, the mix danger and addiction danger is well known and publicized. I'm asking, because I cannot mentally put it together, particularly if someone has life going in the right direction.

Alcohol is the biggest gateway drug and it's not really close.

As someone posted below on his usage, his misunderstanding was thinking Heroin fell into same category of drugs "ok to try" .. but, it isn't just one trip. It's a shift chemically unless I'm mistaken.

I think it is, but how quickly it occurs seems to depend on the person. I've known people who tried heroin once or a couple of times and never touched it again - one such person once said she stopped when she did because she knew that after another time she wouldn't be able to stop. With others, it's one and done - instant addiction. I don't really have a metric, but the existence of the variation is interesting in its own right.

Terrifying stuff. I've had a run-in with it myself, when someone slipped me a cut pill of molly, in my younger or dancing-at-parties days lo these many years ago; luckily I had friends there who realized something was up and looked out for me, or almost missing a flight the next morning would no doubt have been far from the worst consequence. I've never had the urge to go back to that particular well, but what I remember of the experience makes it easy to understand why someone would; there is that about it which, while under its influence, makes it impossible for the world to touch one in any meaningful way. Of course, when not under its influence, the opposite is true and very emphatically so, which I think is in large part what keeps people going back even when they're as dedicated as they can be to the goal of kicking.

This is just a specific model of how people act you just conjured up in your head. People in many situations try heroin all the time, whether or not it seems coherent.

Chronic pain escalation, sure, but also: kids.

I've come to realize that the concept of gateway drugs is bullshit. Kids are going to try whatever they have available. If heroin suddenly enters the scene, then heroin is what they're going to try. Same thing for meth.

Also, it's a different sort of high. When you want to get drunk, you drink. When you want to feel stupid, you smoke weed. But when you just want to feel like everything is beautiful and nothing is wrong, you try opiates (or amphetamines).

> But when you just want to feel like everything is beautiful and nothing is wrong, you try opiates (or amphetamines).

Interesting, this is exactly what weed is giving me, without any nasty effects and addictions of hard drugs. If in nature, this effect is super strong. I came up with most important decisions in my life when high, and they are still solid and best choices possible, even when looking back after 10 years. Different perspective on situations, in some cases really proactive thinking and resolving issues before they arise and so on...

I guess it really affects us differently. I've seen few people get weird/aggressive on it, but then again I would never want to drink with them either. Something badly broken deep inside, with no real chance of fix, ever.

It's also worth noting that you can smoke heroin, which probably requires a significantly lower mental barrier to cross.

And once you're in the throes of addiction from smoking it, I'm guessing injection seems less and less objectionable.

There are people that do base jumping that are otherwise well adjusted adults. It’s very dangerous and no level of expertise reduces that danger.

Some people are just attracted to the crazy unknown. Many can’t believe they could become addicts because they’ve never been addicted. Others still don’t care because they’re just one step removed from suicide.

>Some people are just attracted to the crazy unknown

Yes. "Find what you love and let it kill you" somebody said. And most people don't feel safe unless they're living fearfully close to the edge of what is possible for them. In the past men worked till they dropped dead in their 40s to keep their families alive through the winter; women had baby after baby until they died or couldn't otherwise cope.

The strange thing is that, absent those harsh historical conditions, people still want the feeling of an edge, an existential risk. So they gamble, they do drugs, etc.

But these aren't good edges to be on. There are many real, urgent problems the world faces that could benefit from obsessive, risk-seeking commitment to the 'crazy unknown'. Addiction-level commitment. It shouldn't have to be to drugs. How do we funnel ourselves towards these problems?

Drug users often take as a group, so if the group has no money to buy their regular drugs that day and one of them has heroin to snort or inject they will do it. That's how most addicts I met while living in a shitty drug filled area got addicted. Heroin is the cheapest street drug here right now too since it's cut with dirt cheap and easy to import fentanyl. For years it wasn't even illegal to export it from China, so anybody could get it direct off sites like Alibaba and try and smuggle it in.

PLEASE READ AND PUSH TO THE TOP!! this is a direct result of the war on drugs. the fentanyl and carfentanil coming from china are responsible. before these two were being imported at such high rates opioid deaths were 4,000 per year vs 400,000 for alcohol. Which at first was being blamed on fentanyl being prescribed legally, but was incorrect data. Check the numbers yourself at wonder cdc. attached is the screenshot form cdc data. https://imgur.com/a/fFBTe

Please don't use uppercase for emphasis, please don't post the same comment more than once, and please don't ask people to upvote, even when the topic is important.

You know that people made unable to assess risk. This is why children are driven everywhere, and why we have to take our shoes off to board a plane.

Heroin, tried once, is not instantly addictive for most people.

> "but who really just 'tries' heroin"

Natural. Selection.

> Sorry to hear. Partaking in heavy drugs to any degree invites those dark unknowns. The number of hands these drugs pass through to reach the end-user is more than a couple. I recall on average it's 8 different turnovers. Each time, likely being cut down. They operate a margin business without concern for where it ends up. It's likely safe to say that a vast majority of drugs are cut these days.

Drugs have always been cut. Historically it was just cut with OTCs or detritus, which was a problem that could be solved in most cases by simply doing more.

The problem as of late has become when they lace it with things like fentanyl, which is a cheap filler that actually improves the high (thus encouraging repeat business) but can be lethal in large doses.

Unfortunately "larger doses" in terms of Fentanyl is not that much: https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-fa...

> Historically it was just cut with OTCs or detritus, which was a problem that could be solved in most cases by simply doing more.

Well, until you get a more pure batch and you try to do the same amount you do with the dilute batch.

This is how prohibition is killing people: by removing any sort of quality control for the customer. You can die by drinking bad wine or eating contaminated food, but we have processes and laws that make sure wine is done properly and food is not contaminated, so the consumer knows that, when she buys pasta, it's going to be pasta, not a bunch of random chemicals that look like pasta and might taste somewhat like pasta. Can you imagine buying unlabeled pasta from a shady guy in an industrial estate near a plant manufacturing yellow plastic? That's what buying drugs is today, thanks to prohibition.

Yeah, people think they're too good to have a problem with this stuff, but there's a real physical damage going on that is not something that one can shake off.

I lost a relative to drug abuse. I think one of the reasons they got into it was she they were very intolerant to boredom and just scoffed at everything. Nothing was serious, everything got a do over.

I do wonder how fentynl is getting in, or is it being made here?

If a chemist is reading this, I would love your imput. I was under the assumption fentynl complicated to produce.

That said, my wish is the government would provide generic bupenorpine to any person that wants the drug. It needs to be easily available to anyone. No b.s., just give out the drug. Save all the drama. Give them a long half life drug that will get them off the hard stuff. Let them taper off the bupenorpine when they see fit.

Now--they will say the addict needs counseling, nalaxone, and blah, blah, blah.

Just give out generous bupenorpine. It has a long half life, and you have to be determined to overdose on it.

I will be shocked if anything is done for most addicts.

Hell--when my psychiatrist retires, I honestly don't know what I'm going to do. I'm on two very controlled substances, and so tired of hearing the experts opinion, and their outlandish prices.

So yes, we will see commercials, etc., but just give out bupenorpine. Most addicts don't need extensive counseling--I believe. They are just afraid of widhdrawls. Withdrawals that might be less severe than they imagine?

> I do wonder how fentynl is getting in, or is it being made here?

Imported from China. Wasn't regulated at all there until recently, then the producers started messing with the formula.

[removed]

what the fuck are you on about? wrong thread?

Actually, I'm trying to have a nuanced conversation on a sensitive topic with an open mind.

I get the feeling this is one of the things that no one wants to discuss, or at least it's a bad idea to try to discuss it.

Note how violent and immediate the reaction was, right when I tried to point to a segment of people who are the most likely to be in the target segment of the original article. I don't feel like martyring myself, so I won't push it further. But suffice to say, it does not seem like we as a society are ready to have hard conversations about why people turn to drugs.

Just to be clear for those coming to this after the fact: the reaction was not violent and immediate. Your comment was not nuanced. And it was very much not sensitive.

You attempted to claim that such overdoses are in part due to Reddit (and society in general) ostracizing neo-nazis and members of hateful groups. Not only is this just wrong, it implies that many affected by the crisis are members of such groups, which they are not (as someone who has a family member addicted to opioids I'm very annoyed by your comparison).

You just wanted to talk about your Neo-Nazi subreddits getting taken away and people called you out on it. Frankly, a Neo-nazi should be an outcast. A racist, sexist, etc should be excluded. And if they don't like that, then they should stop being a Nazi before turning to drugs.

I claimed no such thing.

My point was solely "A certain subreddit got banned. Those people seem to have very few options, and maybe they were using it as a support group. They might turn to drugs now."

The reaction violent and immediate: within 5 minutes of posting the comment, you're now trying to imply some very strange things about me. You're even going so far as to "clarify" things for readers by posting something I did not say.

I'd like to end this conversation, because HN is optimized for good conversation and this isn't heading anywhere productive. Agreed?

I have a family member affected by a similar crisis, though thankfully not quite as intense. I'm sorry that the comparison annoyed you, but I was just searching for answers.

That is not a violent reaction.

"We need to kick you out of the country" is a violent reaction.

"What are you talking about this is dumb" is not a violent reaction.

You shared your ideas, they obviously weren't taken as good ideas by the group here, and people told you so.

No one called for violence against you, no one called you names (as far as I can tell), just no one agreed with you, and maybe a liiiiittle discourteously.

That's not violence, that's discussion.

It was violent in the sense of a chemical reaction. It also violently curtailed any chance of intellectual conversation. For that, I regret saying anything.

I'm not upset about mere disagreement. I'm upset that I was searching openly and honestly for an answer to this crisis that affects all of us, and in exchange I was labeled a neonazi sympathizer. On HN of all places.

The conversation shouldn't be about me and my ideas. That's selfish and counterproductive to HN's aims. The goal is to gratify intellectual curiosity, and the subthread I started here is the opposite of that.

HN isn't a place for ideological battle. The fact that two members of the community decided to immediately call out my bullshit suggests that HN wasn't the appropriate venue for this conversation.

I think your own post curtailed any chance of intellectual conversation, and you're taking it out on other posters.

And you've posted you figured it would go like this.

Take the hint you are giving yourself: best re-consider what it is you're about to post, given your past experiences.

> I have a family member affected by a similar crisis, though thankfully not quite as intense. I'm sorry that the comparison annoyed you, but I was just searching for answers.

Sorry to read about your family situation. That said...

There is an entire field dedicated to this. In the spirit of DRY, let's not spin our wheels with hackneyed theories, thinking we'll do better than the individuals that dedicate their lives to rigorously testing hypothesis and formulating therapies.

Why did you delete your comment? I'm compelled to hold you in a negative light just based on principle that you don't stand behind your own words.

It may be worth examining that tendency. I elected to take the Kolmogorov option: https://www.scottaaronson.com/blog/?p=3376

The question of whether or not your arguments have merit won’t even get entered upon, nor will the authority ever be able to repeat back your arguments in a form you’d recognize—for even repeating the arguments correctly could invite accusations of secretly agreeing with them. Instead, the sole subject of interest will be you: who you think you are, what your motivations were to utter something so divisive and hateful.

Suffice to say, it wasn't too smart to even broach the topic. It derailed the conversation, for one. For two, it didn't lead anywhere productive.

Personally, I appreciate your efforts at discussing sensitive topics. I encourage you to keep doing so, as honestly but sensitively as you can. While the "Kolmogorov option" might maximize your personal outcome, this doesn't mean it's best for the group to encourage you to take it. You probably already read the recent discussion by another Scott A? https://slatestarcodex.com/2017/10/23/kolmogorov-complicity-...

Probably the wrong thread :)

You're implying the opioid epidemic is in part due to Reddit banning subreddits filled with hateful speech?* Or what? You're also making some odd as hell "both sides"-ish argument somewhere in there that I can't even parse.

I'm sorry, but we don't have to give spaces for people to be hateful - Reddit banning those assholes was the highlight of my week. I'm not trying to claim that these people should just be ignored, but you're conflating very separate problems.

More importantly, the people being affected by the opioid crisis are predominantly not members of these hateful groups, and I'm pretty frustrated you would conflate them in such a way just so you can have an excuse to talk about the loss of a safe space for hateful rhetoric.

*EDIT: After rereading what the poster wrote a few times, I believe they were attempting to claim that the subreddit bans would encourage more people to head to drug use, rather than vice-versa as I originally interpreted it - it's still pretty off-topic though, and again I'm not very sympathetic to people being sad they no longer have a place to be hateful.

I'd appreciate it if you'd remove your comment since I tried to back out immediately from that line of conversation. Would you mind agreeing?

If so, edit your comment to [removed] and I'll delete this one.

Otherwise, I can try to explain my original motives, and what I observed. But it's a tricky conversation to have, and there's a high chance people's tendency to instantly turn to hatred will focus on me. I'd rather pass.

Calling people out on nonsense isn't hatred.

"Black people are stupid, we need a white ethno-state" is hatred.

"You're wrong and your ideas are wrong" isn't hatred.

Calling people out on bad ideas is a necessary part of the discussion, to weed out bad ideas.

> I'd appreciate it if you'd remove your comment since I tried to back out immediately from that line of conversation. Would you mind agreeing?

Two days ago, I saw you post something asinine and I tried to respond. You deleted your comment before I could hit the reply button, and I lost the opportunity to quote and refute you.

If this is a recurring problem (that you change your mind about statements on a public forum), think a bit more before posting.

If I delete my comment and you can't respond, that's a feature, not a bug. This kind of comment is best left to an email.

The reason I backed out of this subthread is very simple: the first few replies were vaguely insinuating I might somehow be sympathetic to neonazis. That was enough for me to hit the "forget this" button.

> the first few replies were vaguely insinuating I might somehow be sympathetic to neonazis.

Please stop being so defensive. People dog-piled on you because they thought you said something dumb. They're not being "hateful" or "violent". Those words have meanings, and their meanings are actually directly related to why Reddit banned those subreddits. If you can't tell the difference between me saying "Yo your opinion is dumb and here's why" and "You're black you need to leave" then just wow, you may need to take a step away from the Internet for awhile.

I brought up Neo-Nazis and the Alt-Right because they were the main ones affected by the Reddit bans and your comment did not do enough to distance whatever you were talking about from them. Also, the Alt-Right had a large overlap with the subreddits you do seem to be talking about.

If you want to have a conversation about such a thing, I'm happy to engage over private message. But you bringing it up was so tangental, so unrelated, and so odd that I could not resist calling you out on it.

But again, it was just so out of place in a discussion where people are talking about the opioid crisis. The argument you're trying to make is horribly tangental and out of place.

To be especially frank: people are reacting to you so negatively because your comments are completely unrelated and showed an intense desire to discuss the subreddit bans. When we called you out on this, you got extraordinarily defensive and realized the conversation wasn't going to go your way. So you backed down. Welcome to intellectual discourse. If you don't feel confident defending your opinions in such a space...well maybe they're not opinions that you can defend very well.

If you don't feel confident defending your opinions in such a space

The point of HN is to be a search for the truth among colleagues, not a verbal barfight. The fact that you wanted to get into one immediately says a lot about both sides of the conversation.

your comment did not do enough to distance whatever you were talking about from them

You didn't even briefly pause to question whether I might be associated with them. Why should I need to distance myself from them when I'm merely talking about them? The causal linkage is backwards here.

Maybe you feel bad about reacting so harshly and are now backpedaling. Either way, you shouldn't get to force the conversation into a private message:

If you want to have a conversation about such a thing, I'm happy to engage over private message. But you bringing it up was so tangental, so unrelated, and so odd that I could not resist calling you out on it.

If I bring up a topic substantively, honestly, and in a way that's a search for the truth, it shouldn't matter whether it's done in public or in private.

I see Silly doing this everywhere. Asking people to remove their comments.

Edit: See what I did there, bud?

If I recall correctly Silly accused me of slandering some app developer because I posted a negative article.

You're posting about an accusation you can't even remember with incomplete information and out of context. That's like a trifecta of incivility.

If you can't remember exactly what I did, maybe don't spin a half-told version of it?

I recently re-read the story about the rat park experiment.

http://www.stuartmcmillen.com/comic/rat-park/

The gist of it is that yes, rats do get addicted to morphine and prefer it to food, but only if kept in cages.

The rats living in a much less confined space with other rats, allowed to play, nest, have sex and do pretty much all the rat fun things not only did not get addicted to morphine but even waned themselves off of it.

Speaks a lot to the causes which this epidemic is a symptom of and makes me think that addressing it will not be an easy or quick process.

Something I often think about is whether having a job - the agency to by one's own hand change one's prospects in life, to "provide for one's family" - is our equivalent of this "less confined space." In a post-automation post-scarcity world, despite boundless entertainment and resources (things that would make rats perfectly happy)... would ennui still drive people towards self-destructive behavior? And in fact, would the optimization of that entertainment (see: usedopamine.com ) actually prime people's brains towards addiction, towards whatever form the next opioid epidemic might take? We understand so little about our own minds and how they might respond to the world we are ushering in.

Post scarcity? Where, when, and for who? Our current economic models don't work for that unfortunately.

Edit: I should add there are a couple post scarcity instances in recent history. Establishment of America, and post WW2. These also coincided with the least income inequality. But those periods don't last.

In what ways were the Establishment of America, and post WW2 post scarcity?

US inflation adjusted per capita GDP is higher today than at either of those times. While I do not think GDP is a great metric, I cannot think of any metric where we, as a society, have less "stuff" to go around then before.

It’s not the amount of stuff, it’s the inequality.

Interesting hypothesis. How does it explain the doctor in the article, or the lawyers, entertainers, and other wealthy people who wind up addicted?

It probably doesn’t and the uptick in the deaths of comparatively advantaged groups doesn’t fit the model well. Addiction and distress have well documented links with things like unemployment rates correlating well with ODs and deaths. However despite wealthy people featuring in the article the vast majority of the deaths, ODs and incarcerations aren’t in the group you describe.

https://www.google.co.nz/amp/s/www.theatlantic.com/amp/artic...

Fair enough. Still, I'd suggest that the wealthy group indicate opiates scratch an itch which is probably unrelated to inequality. Even if we drastically reduced inequality, that itch would likely still exist. I'd also find it interesting if there was a comparison of the per capita ratio of wealthy addicts to poor addicts. It seems entirely plausible that a causal, not simply correlative, link exists between unemployment/poverty and 'bad' addictive behaviors, but something is hooking highly functioning, wealthy humans on opioids, too.

On a tangent, while I've never had chronic pain, I've had friends who have, and I know it can destroy anyone's life. I don't want to see the abuse of effective pain meds by some lead to difficulties in obtaining pain relief for those who really need it. Someone in chronic pain has enough to handle without worrying about maintaining access to appropriate medication.

Thanks for that.

One of the traps with pain is the assumption that medication is the answer. It isn’t unfortunately and chronic pain should not be treated with medication alone - at least thats what I took away from discussion with a pain specialist who I happened to be working with on something unrelated. Source required.

Right, but "post-scarcity" is about stuff, no?

If you look at Maslow’s hierarchy of needs, the need for meaning / meaningful contribution is extremely important.

I’d say that jobs in the context of survival are useful, but we as human beings also need a sense of accomplishment, of being useful to others beyond the value associated with mere profit.

It's not really a well designed study and it's one that hasn't replicated well.

But people still love bringing it up, especially here on HN where people seem to think they know better than the experts on everything to do with medicine.

Some sources on this? I’d love to read more.

http://slatestarcodex.com/2017/10/25/against-rat-park/ has links, e.g.:

http://sci-hub.io/10.2466/pr0.1996.78.2.391

https://www.ncbi.nlm.nih.gov/pubmed/2616610

But there are other studies linked that seem to confirm it.

https://www.ncbi.nlm.nih.gov/pubmed/3696469

https://www.ncbi.nlm.nih.gov/pubmed/18463628

Not sure where that leaves us.

Makes the guy who brought up sources look stupid

Not at all. Seeing what the OP has seen allows a better evaluation. I wish more online groups put more weight on sources.

Says sources discredit his point then provides sources that do neither.

I agree that rat park isn't great.

But there are very different patterns of prescribing of opioids across the US and eg UK.

Why is this?

Reminds me of https://www.theatlantic.com/health/archive/2017/01/teens-dru...

> I'm not sure what we need to do

Fund recovery centers and programs to rehabilitate users and provide them with ongoing assistance so they can get by and stop using. Most addicts who come out of prison say this because they know they will immediately relapse.

Opiate ODs are given naloxone in hospital. It's really effective but they feel like shit. If it's still in their system when they leave, and they try to use, they're more likely to double-dose to get the feeling back.

The problem with opiates (esp in the US) is they ones that are available are too strong and completely unforgiving. Fentanyl is an elephant gun but it's supplanting heroin on streets due to its prevalence (through overuse).

You've got to wonder what a regulated generally-available recreational opiate could do for street safety. It's not just about making sure of the purity, we need help people take the right dose of the right things, so they're not just taking however much of whatever is available.

That, and weaning. I'm sure a lot of these people would prefer not to feel like they do. Quitting opiates cold turkey is not easy.

That sounds like a really complicated issue without a clear solution and no benefit to whoever solves it.

By comparison I think it would be easier to make a self driving car or automated robot that does most of what a heroin addict does.

Sounds terrible don’t care I’m out of sympathy for addicts in society.

I think what is becoming clear now is that not all opiate addicts are recreational users. Many are victims of inappropriate prescriptions and lack of follow-up and supervision.

For how long though? Having watched it first hand you can make whatever excuse you want for the first use, bad boyfriend, pharma industry, etc.

My sister has been on heroin for probably 8 years now. She will call and ask for money and if anyone says no she spouts this same bullshit about it's not her fault etc. and she's an addict. We send her to rehab, she runs away, can't even tell you how many times I've seen it.

Her 4 kids are taken away from her she doesn't even attempt to visit them in any capacity.

Look close enough at a heroin addict you'll find a regular shitty person underneath it.

And that stinks. For everybody involved. You can only do your best.

But it sounds like you're writing them all off, writing the problem off, as something that's just unavoidable, untreatable. It can be both avoided and treated, it just doesn't always work.

Why didn't you notice the dirtiness before heroin?

The main point of my post was that them being shitty "because of heroine" is a false premise.

Like I said in my post, it's only a matter of time until you encounter it first hand, especially if you take a short stroll through select neighborhoods in most large cities. Its obvious you've thought about the issue but I urge you to engage with it by witnessing it first hand. Addicts are people too - they deserve compassion from society just as much as you or I do.

My sister is a heroin addict I've encountered enough =)

Also I have lived in Salem, Oregon look up it's statistics.

Just because my heart doesn't bleed for people who wouldn't do shit to help you doesn't mean I don't understand the problem.

Fair enough - sounds like we may irreconcilable ethical differences. Maybe I'll get more exposed to the issue and more jaded over time. Thanks for explaining your perspective.

I got up to get something to eat and the restaurant I wanted to eat at couldn't open because a group of heroin addicts outside sleeping on the steps refused to move until they were given food.

That was about 40 minutes ago.

seems like a power play the restaurant could win by grabbing some taco bell.

This was at 6AM - Taco Bell near it doesn't open until 7AM silly!

The police don't care about that?

The local Walgreens is now closed between the hours of 12AM - 6AM because the police won't respond to any theft calls during this time.

You're going to have to teach that automated robot to rob cars, prostitute, shoplift, neglect children, and beg for money on the streets too, if you want it to be realistic.

Even if you gave up on sympathy for addicts (and I understand, I was in Portland and have been along that hellish amtrak line) - the problem affects all of us, whether we like it or not.

You can actually purchase the naloxone spray and carry it as a regular person. I've been thinking about getting some but I've heard gnarly stories about people reacting pretty intensely/dangerously after receiving the drug (eg attacking the person administering the drug)

Yeah the nasal spray should work within a couple of minutes. But even IM (5 minutes) is going to be pretty brutal.

You imagine going from a numb high... to feeling everything you were blocking out with opiates. Many of these people have legitimate pain. You'd probably not be too happy.

I'd certainly be wary about administering it to a stranger, without their consent and without knowing what their reaction would likely be. It's legally sketchy, especially if the drug is —as it is— not generally available (it's prescription-only in many places). Still, don't let me put you off saving somebody's life from an accidental overdose.

> Many of these people have legitimate pain.

I think you meant "physical pain"

> the most tragic part was that he had a plastic "No Allergies" bracelet on.

Oh my god. I bet you had to stifle tears at this point. It sounds like something you would see in a movie, with the last cut of the scene slowly bringing the bracelet into focus just long enough for you to realize why he was wearing it.

It is all relative I suppose, but I think it's a reflection on a serious issue plaguing society, if you don't care about the guy, as a technical person you have to say it's a tragic waste of public resources to repeatedly admit someone to ER when they should in a treatment program.

The greatest argument against the death penalty is that it's not applied to the people that deserve it the most. Not only did the pharmaceutical industry earn billions by pushing addictive opioids to people but they also charge people up the nose for the injections they need after they OD'ed because they got addicted. People are still getting filthy rich literally over other people's deaths. In the name of health.

I know a lot of people love capitalism here and I think it works pretty great if you apply it to a lot of markets. But health isn't something that can be regulated by capitalism.

You can buy the new iPhone or you don't. It's a decision. You can make a stupid decision and buy it while you really should feed your kids instead but it's still a decision.

Health issues are not. Nobody decides to have cancer next year because this year things look a bit uncertain at work right now. It just hits you.

Free markets only work when somebody is free to decide.

Can chose to not use heroin and other drugs - like most of society had informed you - and there is infinite amount of data available to anyone looking.

Now, now. Are you implying everyone is always making decisions purely intellectually with no other inputs? People make stupid decisions for stupid reasons all the time. In fact most of the time. That doesn't make it any less of a choice.

It's as much of your choice to use a heroin needle as it is to buy an iPhone is my point.

I've been a teenager and I've known a lot of teenagers. I can totes see a teenager get into heroin for all sorts of stupid reasons. Because teenagers are idiots [1].

I prefer a society where a stupid decision at that age can be corrected for at a later time. I prefer it over a society that oversimplifies all this to 'choice', going against so much of what we've learned about human nature over the past decades.

[1]: Adults are also idiots. People are idiots. Rationality is our weapon against it, but it's so effective precisely because we're so irrational by 'default'. I'm baffled how people can still hold a worldview where 'choice' is somehow a simple concept.

My bad you're forced to use heroine then I guess

The addiction initially wasn't fed by illegal opioids with a bad reputation like heroin but by prescribed medication by a trusted authority. Perhaps some people might go directly to heroin now because there's so much of it going around but the initial wave of addicts was created by companies.

You know this problem is not really prevalent in places with legit healthcare systems, Europe amongst all ? And that we don't pop opiods to all suffering patients, ie we can allow things to hurt a bit sometimes it's not that big a deal, and it's surely better than getting hooked to stuff.

Why blame the pharmaceutical industry. Your practitionners and your patients have a problem.

There's plenty of opiate addicts in Canada. Although some would argue about whether our healthcare system is legit.

Its not a Jewish conspiracy.

People take drugs because they are unhappy. Show me a drug addict and I'll show you someone with a mental illness, trauma or severe life problems.

Apparently in the US right now there are lots of people who feel pretty bad about life. I can relate.

But Jewish conspiracy is easier to grasp and deal with.

It's pharma who let this happen, on purpose.

Our healthcare is commically not a capitalist one. You make a blanket claim that healthcare can't be regulated by capitalism.

I'd argue if the U.S. had a health care market closer to Iran or something it would actually be better. Like, I should be able to sell my organs if I want. I should be able to buy weed instead of opiods. And so on... Then look at all the medical doctors graduating. Their numbers haven't changed since the 90s, because then they make more money due to scarcity.

You argument that nobody decides to have cancer is true but it applies to tons of stuff. You don't decide that your car breaks down. You don't decide that a storm is coming. You don't decide the change in import controls for goods from China. There are literally millions of things that you don't decide.

The very reason we have capitalism is that we have dynamic system that reacts to feedback and finds or at least moves the system towards a new optimal point given the new circumstances.

If there is a operation that exists free market would make that operation as cheap as possible and weather it is your decision to need the operation or not, you will still get a very cheap operation. For the market is irrelevant why the demand exists, but it will attempt to satisfy that demand and we are all better for it.

So the problem with opioids is about demand.

People should trust doctors to give sound advice regarding their opioid consumption, as they do with many other things. The majority of people don't want to be addicted and are happy to comply with measures.

There are a couple problems, first, the doctors primary earn money by selling stuff thanks to the perverse system of intensives that the modern american health care system produces.

Second, there was a actual problem where doctors in the US, by themselves started to over-issue these drugs, and they still do. That is as much a cultural problem as it is anything else. This has to change.

Third, I think its pretty clear that the distribution and demographics about this issue tell a story that is hard to explain by a general 'evil capitalist' pushing pills on people. It is clear that some communities are dis-proportionally effected and that is a more deterministic factor then the price of the pills.

Fourth, if there were actually free markets people would buy high quality product that does not kill you. People who take it might be addicts but you can be high functioning and your chances of recovery are much better then with this disgusting stuff people are forced to consume because of government regulation.

A car analogies, the best ones!

If your car breaks down there are other means of transportation like getting a Uber, renting a car, carpooling, riding a bicycle or even walking. This is the typical "infinite" possibilities situation where capitalism really blossoms. I personally don't own a car because exactly all of those reasons, so I chose to never have a car that I need to repair. I hate things to maintain.

Now imagine a situation where you are only allowed to go to your work in a car, nothing else. If you don't go to your work you will be fired and you will never find another job again (i.e. dead). And the spare part you need for it to get it working again is only available through one source that for some reason charges about 100 times more than it takes to manufacture the part itself. You are not allowed to have any other car than the one you currently own, not even the same one new.

Now that's how having cancer works in the field of choice.

People choose to live near volcanoes, mountains, oceans. Places where tornadoes are frequent. There's a good reason most people on Earth never saw one.

Though I agree somewhat on most of your points. Actually one of the biggest problems is that nor the legal opioids nor heroin are freely available towards consumers. A lot of people are killed because impurities or more unhealthy alternatives. Again, mixing pure capitalism without the real choice makes things really ugly.

But there's a huge incentive to make money not on the best solution for the patient but based on the largest kickback for the doctor and the biggest profit margins for the industry.

I’d encourage you to read a book called Drug Dealer, MD. It details how pain was made “the fifth vital sign” and doctors could lose their board certification and license if patients filed complaints alleging that their pain was not adequately treated by their provider. Even today, surveys that are sent out following hospital encounters ask people if their pain was addressed to their satisfaction. It’s difficult to withhold opioids when your livelihood is on the line.

Yes. That is very much a problem.

But its not a problem with capitalism, it just depends on what your legal rights are. Any institutional setup could have the same problem.

'Dreamlands' addressed the same problem.

Except this is an actual known "evil capitalist" scenario, where pharma execs literally bribed doctors to over-prescribe opioids. RICO conspiracy charges are generally reserved for the likes of the mafia, and even then are rare due to the overwhelming burden of proof required. I'm honestly not sure who I consider worse in this case: the pharma execs handing out bribes, or the doctors who accepted them.

Reference: https://www.justice.gov/usao-ma/pr/pharmaceutical-executives...

I believe this exists, but I don't think that is the majority of cases.

There was genuine movement among doctors in the US, with serious people writing about how pain was not necessary. It is also the case that legally in the US you can be accessed of not addressing peoples pain enough.

Also again, if doctors had an intensive to care for their patient they would have to be more careful about what they give to them.

My experience originates in South Africa. All my friends did coke - it took, in some cases, years to get them off of it. One thing I learned is the barrier of "it's a problem." A few quit entirely (citing biological/logical reasons), almost the rest now use it on occasion - I don't give them hell for that. If someone goes on a drug-filled festival for 5 days (think Burning Man), it's a legitimate experience (that I am entirely unfamiliar with).

I think that's the key: shades of grey. At one point I was very seriously alcoholic but pulled myself out of it; I still concede to social situations. It's not a problem, it's a momentary span of blissful negligence followed by a day of sorrow (that I'm fully dreadful of while drunk).

I'm not special in any regard. I was absolutely lucky enough to realize these things internally. Here's the scary thing:

I spent every living weekend at my friends' digs in South Africa, years and years. It took me a long time to learn about their drug habits. The very first friend candidate that I have met in Seattle has guaranteed that he will get me on coke in no time.

It's an epidemic for absolute certainty. I failed to resolve a single friend's addiction and it still haunts me - what am I going to do with thousands of people who are convinced that there is no problem?

Seattle has a big problem. We are telling addicts to come get their fix safely (which I deeply applaud), but are not attempting to understand their motivation.

Is there any charity making an actual difference that I can volunteer at?

Serious questions...if you’ve used an opioid more than once for recreational purposes, I’d like to hear (1) what prompted you to try it (2) how old you were (3) cost (4) where did you get them (5) why did you stop

Treat me like an idiot, I don’t understand this stuff and I’d like to know more.

* obviously feel free to use a burner account if you’d rather not speak publicly.

It's mostly people that started medicating for chronic pain.

That's not recreational use.

That's just the problem isn't it? People are prescribed a drug for medicinal purposes that is so addictive and so readily distributed for minor ailments that medicinal use inevitably turns to recreational use after the prescription runs out.

Louis Theroux's "Dark States: Heroin Town" is a good account of how these addictions progress in the US, and some of the reasons for the growing numbers we are seeing.

Opioid prescription has tripled from 1999 to 2015. Meanwhile, deaths only started to skyrocket very recently (starting in 2010-2011), probably mostly due to cheap heroin being adulterated with fentanyl.

Opioid abuse is mostly flat or (among youth) decreasing:

https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2...

http://www.monitoringthefuture.org/pubs/monographs/mtf-overv...

There is no actual link between opioid prescription and subsequent heroin use shown by any research.

https://grokinfullness.blogspot.com/2017/09/debunking-standa...

You're right, I learned something here. Thank you for correcting me. Fentanyl seems like the culprit.

No I get that but I get the impression those aren't the circumstances the parent was interested in hearing about.

1) Because they're fun and I was bored 2) Most of my pill days were when I was in high school. I haven't sought out pills since but have been prescribed them when I've had surgery 3) It was just recreational (a hydro or oxy here or there) so the cost was low ~$1/mg for oxy. Obviously if you're addicted then $30+/day is crazy, but once in a blue moon it's no different than going to the movies or grabbing a cheap dinner 4) My friends/neighbors who sold drugs or from the good ole medicine cabinet 5) I'm not really a big fan of the feeling.

1) I'll try any drug once, all my friends in highschool experimented with a lot of drugs and I enjoyed the shared experiences.

2) It was either senior year of highschool or right after, so around 18

3) Varied, but usually it was $30 for an 8mg dilaudid

4) Everyone I knew had at least one dealer for some drug or other, it was possible to get anything just by asking around

5) Got bored of it

I can only speak to Heroin, not prescription painkillers.

1) I had tried just about every other drug, and I felt at that point like they had been unfairly demonized. A high school friend was doing heroin, and so I wrongfully assumed Heroin would fall into the same category. I was pretty young.

2) 14

3) My usual habit for the ten years of my addiction was around 100-150 a day. I simply couldn't find a way to reliably get more money than that.

4) Drug dealers that I knew or in downtown areas. (West Coast)

5) Life was untenable. I was thrown into a detox for one last time and then six months of rehab. It stuck this time, it's difficult to say why.

I was not, as seems to be the common case these days, drawn to opiates after a major surgery or chronic pain. Nor was Fentanyl / overdose rates nearly as bad as they are today.

Hope this helps?

1) is an important insight. The fable of the Boy Who Cried Wolf works for everyone, not just children. Unfounded alarmism will destroy one's credibility, ultimately to the detriment of both sides.

Glad you kicked the habit. A friend of mine did so too, but was left with some very real permanent damage. Hope you got off easier.

Thanks for writing this...

Agree with @icebraining on #1...it’s not fair to group all substances into one category.

hope the best for you...

1. novelty, why not?

2. early 20s

3. de minimis. $12-20 total for dozens of doses of kratom, shipped usps.

4. internet sellers.

5. define "stop?" i continue to use them irregularly. opioids have a very nasty side effect of bad constipation (silver lining: it's a strong encouragement to eat lots of vegetables), so it's not really something you can just use every day. at least for me, that kind of makes use self-limiting.

also, opioids just aren't that great. they're very effective at killing pain, but if you aren't in pain, you don't notice that. beyond that, the high is imo really subtle and easy to forget about. in contrast, with weed, alcohol, lsd, shrooms, mdma, adderall, whatever, you know you're high during the experience.

1) In college, I discovered I loved recreational substances. My best friend was a closet heroin addict and convinced me to try it. 2) 19 or 20 3) 90 to 200 USD per gram. Towards the end, I was spending upwards of 3000 a month. 4) Through my friend at first, but I quickly developed a network of dealers. 5) My entire life had been reduced to obtaining and consuming heroin. I didn't stop when my best friend died, I didn't stop after three overdoses throughout the years. It took an indescribable amount of self-loathing, loneliness, financial insecurity, and general misery for me to realize I couldn't go on like this. I sold almost everything I owned and moved a thousand miles away to live with my parents and try to get my shit together (still a work in progress)

Thanks for writing this...really appreciate it.

Hope the best for you...

1. Sounded like a laugh

2. 23 to 25

3. $8 for a packet of paracetamol/codiene plus a few dollars for coffee filters, $10 for 10 tramadols

4. Pharmacy for the codiene, friend gets the tramadol online from India

5. I didn't really get what the whole fuss is about, it wasn't that fun, and I know anything harder than those is a dark dark path that I have no interest in travelling down.

> I didn't really get what the whole fuss is about

Having taken Tramadols and Oxy for pain (back and separate knee surgery), I can't imagine taking it for fun. The pain stops because they put me to sleep and then I feel like an idiot for 12 hours. At least with the Tramadols I can still sort of function, but I fight the doctor if they want to give me Oxy.

1: I had a severe burn on my crotch (FML) and was prescribed. Funny thing is I KNEW I would become dependent. I'm an addict. sober from cocaine and alcohol (was sober from coke for a couple years before pills, ironically opiates helped me quit drinking which was a big struggle for half of my 20s). No hyperbole, every relative on my fathers side of the family is an addict, going back generations. My dad is an alcoholic, my mom has some mental issues which when combined together are a recipe for addiction (I have bipolar 2 and my mom has depression among other things). I purposefully avoided opiate meds because I know my addiction struggles and knew I wouldn't be able to just take a few pills I would end up taking them for a long time. But, god damn that burn fucking hurt and it's hard for an addict to say no especially when I couldn't fucking walk or sleep. I kind of question why my doc prescribed, even though I know she was just trying to help. We literally just got finished talking about cocaine and struggle to get sober and then she prescribed Oxy... I don't blame her and I also think there is nothing to gain by blaming myself, even though yes it was my choice to take that first pill I don't think it was my choice to be an addict if it were that simple I wouldn't be an addict. blame doesn't serve a point, just like blaming oneself for getting cancer or having bipolar disorder. However I do think Docs still need to improve more and just help patients get through pain without take home pills. Weed helps, fuck Tylenol can be very very effective and being in pain for a week is much better than being dependent on a pill for the rest of your life imho.

2) 24 I tink

3) free prescription no co-pay! Then off the street about $1 per mg of oxy, online and in bulk I can get it for about $.66 per mg

4) originally from a doctor. Then from my coke dealer. Then from the dark net.

5) I haven't been able to stop for more than a couple days

Really appreciate you taking the time to write this.

I agree that blame misses the point and also that doctors need to bear some weight of responsibility when dishing out opioids.

Hope the best for you...

I’d go further - what the hell was the OP’s doctor doing?

Tylonel accounts for a large number of deaths. Chronic pain patients have to take medications for the rest of their lives, it is safer to consume opiates than acetaminophen long term. Best would be nothing, but as long as there is a slow increase opiates can go on up and up. Where the acenimphen will destroy your liver and kill you fast. Furthermore, this is a direct result of the war on drugs. the fentanyl and carfentanil coming from china are responsible. before these two were being imported at such high rates opioid deaths were 4,000 per year vs 400,000 for alcohol. Which at first was being blamed on fentanyl being prescribed legally, but was incorrect data. Check the numbers yourself at wonder cdc. attached is the screenshot form cdc data. https://imgur.com/a/fFBTe

My point was that over prescription is a problem. Just a couple days ago this study showed the power of apap/ibuprofen equal to opiate in extremity pain: https://jamanetwork.com/journals/jama/article-abstract/26615... Yeah apap is dangerous in really high doses but it isn't super fatal w NAC intervention.

But more people die from opiates than apap nih: https://www.ncbi.nlm.nih.gov/pubmed/16294364

Took a few at once of my hydrocodone prescription from a wisdom tooth removal (only two of them at once) at 18 to 20 or so, then did the same thing next time when I had the other two removed. No idea what their real cost is besides the copay. Just wanted to see what it was like. I don't think I really got anything out of it besides a bit of a placebo effect. Didn't seem very appealing.

1) Technically my first exposure was oxycodone from wisdom tooth surgery. I didn't really appreciate what a lucky windfall it was at the time, but thoroughly enjoyed it all. Afterwords I occasionally bought or traded for synthetics, heroin and opium when it was convenient. Having sampled pretty much the entire family, I would have to say that hydromorphone/oxymorphone are my favorites, and codiene is not worth taking at any dose, unless for diarrhea relief. The heaviest period of use in my life (w/ physical dependence and a mind prone to "addiction logic") was in grad school, and I haven't used any opiates at all for probably 5 years, but I would happily consume opiates if it was something I felt like doing (much like I feel about doing acid, going camping, playing a videogame etc). I occasionally used IV but the risk of systemic infection and the ugly needle tracks are not so nice.

2) 16-18, mid thirties now

3) Rarely too much, but when I did lots of heroin I ate less and paid for less other entertainment so I guess it evens out

4) Wherever convenient, usually through my social network

5) I just don't care enough to go to the effort. Nice high, excellent for doing work and being social if I dose reasonably. But other things are nice too. Regarding being social, I can take e.g. oxycodone for multiple days/events in a day, but I cannot take MDMA several times to any useful effect. Regarding work, it's good for long sustained bouts of work as it is easy to gently daydream about problems for any amount of time and it's easy to work for hours because I feel great and free of distractions. The side effects of constipation (I LOVE pooping), appetite loss (I like eating), bad sleep (it's really good for you) and apathy towards sex (bad, except for those unfortunate periods in life where it's good) are all worth considering. Generally, it's difficult to maintain ones quality of life and also do boatloads of opiates, just like anything else. It is very easy to find out oneself doing boatloads, though. Regarding addiction-- Tolerance and withdrawal are not currently considered necessary and sufficient for "addiction." It's considered a behavioral phenomenon. A bad case of the flu is much much worse than a bad period of withdrawal. Regarding the behavioral stuff and desire-- Dealing with unwanted desires is a good skill to have, I guess, and I'm lucky I don't want it very much. It is more effort to do more than it is to do less. But every step into "addiction" is infinitesimal and reversible, and every step out of "addiction" is equally infinitesimal and reversible, though you might notice it more.

I didn't "work my way up" from prescription drugs. I have debilitating depression, to the point where I can't get out of bed most days. I can't say I have much to live for, honestly. I am just functional enough to realize that I am deeply unsatisfied with my life.

I've tried many different antidepressants. My psychiatrist told me that if the next few medications didn't work, he mentioned that I might want to consider electroshock therapy.

I tried heroin with my brother a few years ago, and I got high of course (so my opinion is admittedly skewed,) but it just gave me a couple precious hours of what I imagine it life could be. I work in fintech, so I have to take drug tests, but I've used it off and on since.

I don't want to be high. I just want a life where I actually want to live, an "aspiration" I've had for years.

Maybe my desires are even more skewed due to having gotten high, and knowing that I will forever have a "high bar" for however good it made me feel, but in general it just feels like the quote says, "It gives you a taste of heaven and drags you down to hell." But I was in hell already.

I have similar experience with mental illness (bipolar 2) and that's what I thought for the first couple years. a literal wonder drug! I could be social, I had energy to get up and work, I got a boyfriend. But gradually it loses the magic - or you have to keep increasing dose and eventually if you run out of money you're fucked. I'm guessing that if you're here, like me, you're probably fairly well off.

Have you tried tramadol? Or some SNRIs+low dose opiate or tramadol? Ask your psych for a tramadol script I've found my therapist to be receptive to that as med. I find that effexor helps with withdrawals and tramadol and effexor both helped a lot more than SSRIs for me - the problem is with bipolar it causes cycling

Interesting read for you.

https://www.theguardian.com/commentisfree/2008/aug/19/psycho...

1. Typical prescription route. Thought I'd "never" do heroin. Tolerance grew and grew, and after realizing it was basically morphine (which, I had had prescribed before), it seemed less scary. I didn't seek it out, but literally found a gram on the ground and immediately realized that this was the best ROI for releasing pain (both the physical pain and the pain of living.)

2. 22

3. Currently can get a really good quality (lab tested) gram for $50; this is cartel type pricing

4. Doctor, darknet, in person

5. I haven't. I should, most likely. I should let my tolerance go down but I'm so, so scared to be stuck in bed with pain off the charts combined with the temporary depression.

OK, I'll bite.

I take milder prescription opiates just for fun on rare occasion. That's percocet these days, codeine back in the day.

Only opportunistically though, if I have some left over from a medical reason or someone offers me some. Even then, it's very infrequently. I currently have around 12 percocets that have been sitting around, untouched, for a couple of months now.

I usually don't feel like just lying around and staring at the TV with my mouth open, hence I don't take them. One day though I'm sure I will feel exactly like doing that, at which point might as well add some opiates to make it quite a bit more enjoyable. I usually like to take 2 or 3 with a moderate amount of alcohol, they have a synergistic effect together.

I first tried it around 17, and that was almost 20 years ago. We're talking relatively few occasions over all that time: 0-2 occasions most years, some years more like 4-6, and rarely if ever 6+. I've never seeked it out on the black market or anything; the cost would not be close to worth it, I think. I don't know how much exactly, but surely several times more than medical, where I paid $10 for 20 pills.

I didn't stop, I just don't feel like doing them, most of the time. I have had issues with addiction to other things in the past, but not with these.

That being said, they are quite mild compared to OxyContin, which I think is what most addicts are taking. (Same substance, oxycodone, but much lower dose.) Never tried that stuff but I bet it is a LOT easier to get into trouble with those.

I took opiates and other drugs to mask emotional pain. No doctor prescribed my first dose. No peer pressure was needed. My life had been absent of happiness, the first time I took a drug, it was as though the world rendered itself in colors other than black and gray. I haven't done any drugs other than weed for at least 5 years now. But there was a good 40 plus year period in which I did opiates daily. My biggest mistake was getting on a methadone program, that was a twenty year addiction that made heroin withdrawal look easy. It took 2 years of incarceration to end my methadone addiction.

I first used heroin when I was seventeen in 1972. It was the first time I had tried an opiate. At the time Heroin was pricey at $30 a bag/dose in the Boston area. Around 3 years later, I went to Phoenix where Heroin was $10 a bag. Taking a ride across the border to Nogales lowered the cost to $5. Making approx. $100 a week back then, a habit wasn't possible until I found lower cost drugs. These days I feel happier than I could have imagined. While opiates never really made me happy, They decreased my misery at times. As bad as all this sounds, I thank drug addiction for allowing me to survive until I learned how to live.

There was a very good Louis Theroux doco (Dark States) set in Huntington, West Virginia a couple of weeks ago about the opiod epidemic.

It really hit hard with me for some reason, despite never having first hand contact with anyone with this sort of addiction. In particular, a man who was apparently a pentester before having some sort of accident and becoming addicted to prescribed opoids before transitioning onto illegal drugs. It just felt like something that could hit anyone, and not just the standard "junkie" problem.

"It just felt like something that could hit anyone"

That's why addiction is a problem. Once the central nervous system is compromised by addictive substances, it's no longer only a matter of personal life choices. It does not matter whether the addiction was started by a leisurely experimentation or by a medicine prescribed by a doctor.

> Local jails have been overrun with people locked up and in need of treatment

Why. Do. People. End. Up. In. Jail. Seriously this one is beyond my comprehension - they need treatment, not jails filled with hardened criminals, rapists and probably more (and nastier) drugs than on the street.

War on drugs & big government.

Realistically it starts with the race to the bottom WRT being "tough on crime".

Being tough on real crimes with victims is just fine.

Being tough on victimless crimes is absurd.

It's truly very black and white.

Being tough on real crimes and the outcome of competing in toughness on crime have surprisingly little in common.

In a game of "tough on crime"-oneupmanship, when you can't get any tougher you make up new crimes to beat the other guy.

It's a long story. https://en.wikipedia.org/wiki/Deinstitutionalisation#Consequ...

Like my uncle says, a cop, "what would we do then". Drug & alcohol related arrests are 99% of their work.

We really need to get rid of cops. That experiment is over.

Put them in treatment centers?

Against their will?

As opposed to putting them in jail against their will?

Whom? The cops?

Adding cops is pretty low on the list of reasonable jobs programs

Its not a cop's job. Its a social worker's job.

I do recognize that cops are just "trying to help", and that no one cares about social workers. Cops are in an advantaged position in the USA because they are relatively well respected by most mainstream members of the population. So the fact that they want to help is good.

But Cops aren't given the right training to deal with medical problems or other problems (ie: Fire hazards. In theory, cops could be the ones to inspect Fire Hazards in buildings, but realistically, its better for Firemen to do it).

There are lots of social work jobs in America. A big problem, a seriously big one... is that we expect Cops to do any job. Erm... no. Have drug specialists deal with the drug problem. Cops really shouldn't shoulder the burden of everything in the country.

-------

Cops should focus on the distribution of drugs. Not on the users of the drugs. The users need treatment, mental treatment that cops do not have the abilities to give.

These drug abusers need nurses and social workers to check up on them every few hours. Not cops.

Drug users usually turn violent and can be a hazard to themselves or others. Somebody trained to deal with such situations is required. This is, a cop.

As do people who are infected with Rabies. Or rare forms of violent schizophrenia. Indeed, violent offenders are often not users of drugs, but from my understanding: the cutthroat underground distributors.

Which is why cops should continue to focus on the violent distributors of drugs. But social workers and hospital workers should step up their responsibility and start treating drug abusers better.

Or perhaps, more programs need to be made so that hospital workers / social workers are paid to fix this drug problem.

Hint: throwing drug USERS in jail, where they only get more underground connections and better learn to become a criminal, will start a cycle where they have to end up in jail again. Jail is just about the worst place you can put a person.

> Hint: throwing drug USERS in jail, where they only get more underground connections and better learn to become a criminal, will start a cycle where they have to end up in jail again

What is: the most profitable outcome you can hope for when your prison system is privately owned?

The US prison system is not privately owned. Less than 20% of prisoners are in private jails.

> Drug users usually turn violent

Citation needed.

It's well known that drug dependency is a relatively good predictor of violent behaviour. People think severe mental illness predicts violent behaviour, but substance misuse is far better predictor.

Watch the video here: https://twitter.com/ProfLAppleby/status/917838820682489858?s...

Both videos threw errors in playback.

The initial claim was 'usually turn violent', compared to your 'relatively good predictor of violent behaviour'.

I've known quite a few people with drug dependency problems and very, very few of them were violent.

So, citation still needed.

As we have it now law enforcement is just that. And they are also the frontline to anything downstream (e.g., social worker). We're not really set up to respond to this in a way other than a legal one.

We should have figured this out years ago. This won't be the last article we see like this.

People I know went into policehood to help their community. If that's the goal, they could be put to better use instrumenting more effective policy.

These types of policies should be data and analysis questions, not based on politics and world view. Some of them inarguably work better than others.

We need to exit the theater of unfounded opinion when it comes to these things. It's not useful.

Some of them are probably there for crimes like theft prostitution and selling to sustain their habits. Another significant part would be those who violate parole or drug treatment programs.

And if a drug addict doesn't want treatment? The elephant in the room is forced intervention requires a form of imprisonment.

> And if a drug addict doesn't want treatment?

Switzerland gives their most hopeless heroin addicts free heroin, and a safe place to use it. [0]

A friend's son was expelled from his US high school for dealing heroin - this was probably 12 years ago. Addicts have to advertise to their friends to be able to afford their habit.

[0] http://www.citizensopposingprohibition.org/resources/swiss-h...

There will always be the hardcore who will not, or cannot overcome their addictions. But this is few.

Why not give them free medical grade heroin, in a safe environment?

* Keeps them off the streets. * They no longer need to resort to crime to fund their addictions. * Besides their appointed time to get their dose, they can lead relatively normal productive lives.

It will save $$$$ and also keep money out of pockets of organised crime.

win:win in my book

That is not cessation of drug use but a program to sustain drug addiction safely. Clearly that’s great at reducing harm from dirty needles, but not great at cessation of addiction.

I’m suspect of your claim that the majority of addicts seek treatment, since I’ve not seen any data on seeking cessation. Maybe you know of some other data showing that most addicts seek treatment that includes cessation. However, according to surveys by CDC and national survey on drug use and health 23 million Americans have a substance addiction and 3 million seek treatment. Approx 1 in 6 adults has some form of substance abuse problem. There is nowhere near that number seeking treatment.

Give him (free or cheap) drugs, a safe place to use them, good advices and a way out of his habit. Do not force him.

https://www.thecommononline.org/decriminalization-a-love-sto...

Just give them drugs, then. It has to be cheaper than taking them to the ER every few weeks.

Like that one guy weef or weev, the iPad exploits guy, who went to jail and came back as a white supremecist. Was quite surprised to read that, worse thing is he wasn't in prison like 10 hard years or anything extreme, he was in there a minute though. Oddest thing I ever read.

On the other hand... Norway has some of the nicest prisons in the world. Worth checking out prisons in Norway if you never heard of how nice they are.

He was already a scumbag before prison: https://www.quora.com/Did-Andrew-weev-Aurenheimer-contribute...

It's a myth Norway's prisons are the nicest, maybe for low security offenders otherwise they keep you in solitary for years at a time or worse transfer you to other countries to do your time like how they ship inmates off to Netherlands to a rented prison.

The country with the best drug policy is Portugal which quietly decriminalized all personal amounts and they have one of the lowest OD rate now

In SF and some surrounding areas, all those arrested have their case reviewed prior to arraignment by an agency that will try to place them in a program for recovery; an alternative to jail. SF is doing an OK job funding this effort, and it does make a difference both in outcome and burden to taxpayers (less expensive than jail bed days)

I suspect it's a result of "blanket" thinking - if we don't punish $illegal_behaviour, then people won't stop doing it. Unfortunately in this case, the punishment is the same as the punishment for just about every other crime and for this particular issue it's less of a punishment and more of a catalyst.

A middle ground would be a good solution IMO - some kind of jail-esque treatment center or set wings in existing jails just for drug users where they undergo some sort of treatment/detox program. I daresay in a lot of cases, voluntary treatment isn't going to work, and I suspect a lot of treatment centers out there now are nowhere near as secure as a jail.

Right wing idiots pushing a failed war on drugs. Keep electing republicans, keep getting the same garbage. Can anyone point to a republican who is advocating sane drug policy (genuinely curious?)

You have to be an idiot to think voting on party lines is a good way to solve complex social issues.

Some people do need to end up in jail, but their last name is all over charitable foundations and art galleries worldwide. http://www.esquire.com/news-politics/a12775932/sackler-famil...

> Why. Do. People. End. Up. In. Jail.

Ask the politicians that own large stakes in (or have ties to) corporate-operated prisons, and you'll find your answer.

This is just so sad.

It costs less to prescribe drugs than to diagnose and treat underlying problems. So the American profit-driven medical system relies heavily on drugs, especially for poorer patients. And drug companies love addictive drugs. So we get lots of opiate-addicted patients.

And then there's the "drugs are evil" mindset, which justifies criminalization. Even preventing pain is too much like having fun. So it's better for addicts to OD than get safe drugs. Because they deserve it, or whatever. They should just suck it up, walk it off, ...

So it goes.

I honestly don't understand what kind of solution you're proposing. Would you mind briefly expanding on your statements?

1) Properly treat people's medical problems, rather than just prescribing drugs.

2) Give safe drugs to addicts. Anonymously. Offer help, but don't force anything.

Well I think for #1 we need to understand how many got on this path from a medical provider. We cannot just assume the epidemic is the result of bad diagnoses. The numbers are just too high. It is just more likely that the price point reached for this strong of a drug and the ability to get it to users reached critical mass.

with regards to #2, it would good to know death rates and severe medical incident numbers in any localities to see how much of an effect such an approach is having.

#3 should be requiring all police departments having the training and recovery drugs necessary to pull someone out of an overdose along with no charges being filed for any parties involved in such a call.

this problem has been around a long time and only recently was it even addressed at the highest levels. it seemed like the problem everyone wanted to ignore

It has nothing to do with profit driven. The problem is about intensives.

The perverse US health care system with all its regulation has made it so that doctors primary make money by giving away pills.

There were other models where people would basically have subscription to clinics and those would have a intensive to keep you healthy.

The problem is that all alternative models are literally illegal.

Check out this podcast: http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...

They talk about this book: Ensuring America's Health: The Public Creation of the Corporate Health Care System

This explains why countries with more regulation (to the point of state run medicine in England) don't have nearly the same problem with opioid addiction, right?

Well not necessarily. You can also have a stat run system that can have the same intensive problem. I don't know how Britain handles these things.

It really just depends on the individual institutional setup, and it depends on the culture of the doctors.

This reminds me that the lead singer of GWAR died in Richmond from a heroin overdose in 2014: https://en.wikipedia.org/wiki/Dave_Brockie

The "iron law of prohibition" teaches us this: prohibiting a substance drives out all but the most potent forms of that substance. Back during alcohol prohibition in the US, people made, smuggled, and sold "white lightning" not light beer.

In the case of opiods, the most potent forms are stuff like street fentanyl and oxy 80s pulverized. Milligram mistakes in dosages of this stuff are very dangerous.

The iron law leads to a paradox: decriminalizing a substance makes it safer. Obviously it's more complex than that: addicts need access to safe supplies of the substance. But it's still true.

But keeping opiods criminalized is, basically, makework for law enforcement and public safety people, not to mention people with names like El Chapo.

Switzerland and Portugal are having good success with decriminalization and treatment. Juristictions who don't need anything in the way of foreign aid or other cooperation from the USA are in the best position to do this.

Source: Chasing The Scream, a book by Johann Hari.

One of the Pittsburgh papers just ran an excellent, in-depth article about something very similar, happening in one particular neighborhood of the city: https://newsinteractive.post-gazette.com/riding-od-road/

The opioid epidemic is huge. Legal Cannabis is helping in some places, but it's still illegal at the federal level.

My country had a heroine epidemic in the 80s and early 90s. One of the root causes was a shitty economy and chronic unemployment.

All you can do in the end is try to keep things contained. They opened special places were junkies could use their drugs so that they wouldn't have to OD on the streets.

You can't fix someone unless they WANT to be fixed.

Many places that did not have bad economies had heroine epidemics in those times as well. Can you actually show statistically that bad overall economy and heroine epidemics are in any way linked?

Interesting coincidence that Richmond in Melbourne, Australia, has just been announced as a location for a supervised injecting room. This Richmond is also a hot spot for heroin usage, dealing, and overdoses.

Most of this stems from the overprescription of opioids. I remember when I had surgery for a broken leg the amount of drugs I received after the surgery was astounding. It was almost as if the hospital wanted me to become hooked. I didn't need or ask for the opioids, they were just prescribed for pain killing. A regular Tylenol or Advil would have done the job. Not saying hospitals want people on drugs, but at some point we have hold the people initially prescribing the drugs accountable.

What makes you say that? It's trivial to get opioids on the streets and it's common to be introduced to them as a recreational drug, as I know first hand.

In fact, I don't know anyone who got addicted to opioids due to overprescription, but I know several people who didn't get prescribed opioids they needed because of the fears of overprescription, and thus were left in terrible pain. I don't know how you draw the line, but I think it's evil to leave people in pain because you're afraid they'll use the drugs for fun. Most people who take opioids do not get addicted.

People generally say that over-prescription leads to harder opioid usage because it does. I have had co-workers familiar with the neurological effects of the drugs they've been given balk at it. I've also known community members who had injuries slide into the obscurity of addiction.

A very real factor of this crisis is the pain aversion, people working in dentistry have higher rates of depression and suicide due to the psychological effects of inflicting pain on people (unless the dentist is played by steve martin ofc) and it's a problem without clear solutions. Legalization of marijuana would probably help reduce the mild-moderate pain classes in a non-addictive manner, but for extreme pain there isn't a good solution.

Anyways... there are plenty of first-hand accounts and plenty of studies showing the connection here, please do a little research before posting unsupported claims.

It's important to note that the epidemic that people refer to is the overdose epidemic, often labelled the opiate epidemic for whatever reason.

I haven't seen any evidence that actual rates of heroin abuse increasing year over year. Just wealthier people dying from poorly cut drugs at a more alarming rate.

This was the most recent report I could find: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2...

That is not true, first dentist have a higher suicide rate not because of the pain on people but because so many people hate to see them. It is never a pleasant experience. You also should be aware of the suicide rate in pain patients because their pain cannot be under control. this is a direct result of the war on drugs. the fentanyl and carfentanil coming from china are responsible. before these two were being imported at such high rates opioid deaths were 4,000 per year vs 400,000 for alcohol. Which at first was being blamed on fentanyl being prescribed legally, but was incorrect data. Check the numbers yourself at wonder cdc. attached is the screenshot form cdc data. https://imgur.com/a/fFBTe

I went through open heart surgery two years ago April and opioid over-prescription was already a concern. After discharge I received a six day script for the lowest dose of fentanyl and a month of Lyrica. I have a freakishly high pain tolerance so I managed to 'stretch' the fentanyl patches out to nearly one month (each patch lasted roughly three days). Hindsight being what it is - I obviously made it through. Being down in it though, it was far far less than pleasant. Especially that I was supposed to be active and all the usual recovery stuff. It was a bit of no joke as far as pain load goes. I didn't expect to be completely pain free as that isn't life as far as I am concerned, it would have been nice to have taken a little bit more of the edge off. Round the pain off some.

Agreed.

I too have had a major surgery several years ago. I was given morphine and than Oxycodone when discharged, but not at high enough dosage for adequate relief - 3 or 4 days of pure misery. There is no reason, when short-term opiate use is easily available, for patients to suffer like this.

It seems like the medical establishment was really pushing opiates for years, even when they probably weren't needed. Now they're swung too far in the other direction: under-prescribing them for fear of overdosage, addiction, and even punishment by the DEA and government. Wish we could find some middle ground.

What makes him say that is that it is a well documented problem. Many other people recognize it and treat it accordingly.

My father is a Anthologist and they are very careful with how much they give. It is a major issue.

For some reason, the US, including doctors, have developed a anti-pain philosophy where they oversubscribe these drugs and it is know to cause addiction.

It's incredibly easy to get hooked when taking prescription opiates even if you're fully aware of the situation. I had a wisdom tooth extracted last year, and by the time the pain was finally down to the level I could manage with OTC pain relievers I realized I had developed a mild physical addiction to the hydrocodone.

I had no desire to get high off the pain killers, hell, they didn't even do anything for me in that regard - but I could feel the need to take them. I can easily see how someone without the awareness, willpower and a number of other factors could give in and start down the path of self-destruction. It was a terrifying place for me to be in, and as someone who has responsibly taken prescription opiates for multiple other oral surgeries as well as a septoplasty it was one I never thought possible.

There is a difference between dependence and addiction. People who are in pain 24/7 rely on these medications and are being thrown into the streets because of the DEA, when if fact this is a direct result of the war on drugs. the fentanyl and carfentanil coming from china are responsible. before these two were being imported at such high rates opioid deaths were 4,000 per year vs 400,000 for alcohol. Which at first was being blamed on fentanyl being prescribed legally, but was incorrect data. Check the numbers yourself at wonder cdc. attached is the screenshot form cdc data. https://imgur.com/a/fFBTe

Don’t take my anecdote to mean I’m against prescription opiates, there’s no way in hell I would have been able to manage my pain after these procedures without them - in fact I think we’re steering the ship far too hard away from their use in a reactionary move to combat these deaths. But I don’t have any doubt many people have become physically dependent on these drugs and are now turning to the black market - it very well could have been me in another life.

The war on drugs really needs to come to an abrupt end, people who need opioids to manage their pain should have them, people who are hopelessly addicted should have access in a controlled and safe manner, and for crying out loud can we just legalize weed already?

For more background on why we've got a dope problem, check out this LA Times piece on Oxycontin's 12-hour Problem:

http://www.latimes.com/projects/oxycontin-part1/

That article was written by someone not that familiar with the pharma market.

It would be illegal for Purdue to promote on any other than 12 hours. It's called off-label promotion and companies pay multi-billion dollar fines for it.

While it is factually true that it would be illegal for Purdue to promote off-label, they also need to be held accountable for playing fast and loose with the research studies (even altering the definitions used in the trials) in order to be able to claim 12h coverage when nearly half the patients weren't getting 12h coverage. This, combined with the recommendation to push higher doses to achieve 12h coverage, combined with the gap in coverage, drove a lot of people into a cycle of unhealthy and deadly dependency.

At the very least it's a case of consumer product safety liability and negligence fueled by profit motive.

Shouldn't the FDA be held accountable? They approved the trial design and overall application.

I wish regulators could be perfect, and if they were, we'd reduce harm a lot. But since we know they're not, we can, as participants in society, be as Caesar's wife--above suspicion--and avoid these situations entirely.

A lot of capitalism's woes would be overcome should that standard be applied.

If you've been around long enough you'd realize we're come full circle. Prior to the 1990's pain meds were very rarely handed out.

Then a few things happened: (1) more data was collected that suggested when used for severe pain, the addiction potential was low, (2) adequately controlled pain leads to quicker recovery times and (3) there was a lot of untreated pain at the time.

As a result, opioid use when way up. One could argue it went to far with very strong opioids being given for mild or moderate pain.

The sad thing is that we're already seeing doctors get more stingy with opioids. My guess is we'll swing too far in the other direction and in a decade we'll have people with severe, incurable cancer pain being told "you don't need opioids".

Untrue. this is a direct result of the war on drugs. the fentanyl and carfentanil coming from china are responsible. before these two were being imported at such high rates opioid deaths were 4,000 per year vs 400,000 for alcohol. Which at first was being blamed on fentanyl being prescribed legally, but was incorrect data. Check the numbers yourself at wonder cdc. attached is the screenshot form cdc data. https://imgur.com/a/fFBTe

Talk to the leader of any emergency room staff and this is how it works in most cities.

Another reason to charge more for working in a big city, since smaller rural cities don’t have this problem as much - like the middle of nowhere in Montana versus Seattle.

There are many places around the world called Richmond, and even if we assume it's in the US there are still 16 places called Richmond[1].

I wish people were more specific, particularly when reaching an international audience without an innate understanding of places in the US.

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

It appears this is Richmond, VA.

Richmond, VA is the biggest and most important Richmond. Anyone who has heard of Richmond, VA will likely assume that is the Richmond being referenced. Anyone who hasn't heard of Richmond, VA gains no additional understanding from knowing which state it's in.

If you're in the Bay Area, as HN commenters disproportionally are, your mind is likely to jump first to Richmond, CA in the northern East Bay.

Richmond, CA has a similar problem, I assumed VA, but they both work in this context

The one in Canada as well.

And nothing of value was lost...

Maybe all these drugs being dumped in USA is really part of an evil plan from an enemy nation to destroy this country by destroying its people. Check out this book "Red Cocaine" to see how cocaine traffic started in America.

or, maybe some folks just want an escape from stress / real life.

or, maybe they got hooked after being perscribed painkillers for an injury

or, maybe they're suffering from some mental illness

or, literally any number of other reasons besides some evil nation flooding the US with drugs and somehow 'forcing' citizens to take them.

The point is, you can choose to go after the suppliers, but the underlying problem is still there. Until that's addressed (mental healthcare, serious punishment for over-perscription, etc), we'll just see a new drug take the place of the old.

Even if that was true, they're only supplying the match; we built the bonfire.

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