Sewage Is Helping Cities Flush Out the Opioid Crisis
scientificamerican.com
scientificamerican.com
The Techcrunch write up: https://techcrunch.com/2018/03/20/these-are-the-64-startups-... mentions "they hope to also measure pharmaceuticals, infectious disease and food consumption".
Infectious disease finding could be really cool. Imagine easily mapping where a zika outbreak was happening an hour after an infected person uses the restroom. That same day you could do mosquito abatement and post flyers to come to the hospital for treatment.
[1] Viruses vs Superbugs https://amzn.to/2IZXZiJ
https://www.rollingstone.com/culture/news/treating-heroin-ad...
https://www.nytimes.com/2017/09/22/opinion/sunday/portugal-d...
https://www.springboardrecovery.com/switzerlands-approach-he...
For-profit prisons, desperate small towns towns and greedy politicians benefiting, plus the revelations of Ehrlichman of the Nixon administration’s intent (WoD targeted the admin’s enemies: hippies and blacks), make it and outlawing of other vices perversely-corrupt in the extreme. Let’s not forget the 13th amendment loophole expressly endorses slavery of prisoners.
https://www.cnn.com/2016/03/23/politics/john-ehrlichman-rich...
http://www.browardpalmbeach.com/news/geo-group-earns-over-60...
http://www.miaminewtimes.com/news/five-reasons-boca-private-...
No, they should be legalised, regulated, and taxed and run as legitimate business.
Decriminalisation is not a good half way step, because it is more of "we tolerate this". It is harder to tax / regulate and manage legitimate businesses. For example, in Holland cannabis is decriminalised, but the coffee shops cannot (couldn't?) buy it legally and still had to get it from criminal networks.
The only way is complete legislation. No pick and choose. Cannabis legal, MDMA legal, heroin no no no. It would still leave a market for the blackmarket to control and those in are perhaps the most in need of legalised services. For example, anyone buying a gram of heroin a day probably needs help / advice / guidance more than someone buying half a gram of coke each Friday night.
I wouldn't even stop at legislation. In some cases, the drugs should be prescribed freely in the most severe cases of addiction to either help them taper off, or just to accept they will need to maintain a drug dependence until death to leave as relatively normal and productive life as possible. Which ends up better and cheaper for all
This may sound harsh but I am inclined to say, instead of sifting shit, cities might consider ways to find to decent jobs, housing and recreation for their citizens.
What else can be said? All this a product of the redistribution of wealth upward in an ostensibly wealthy society? What could possibly go wrong?
So don’t hold your breath.
Don't let health care providers and pharma off the hook.
It's not just the Middle East, you can find a lot of other examples all over the world. So, no: not uniquely American at all.
But the problem with opioids is that they are slightly moreish.
Rats that live in interesting, healthy environments don't get addicted to opiates.
This crisis has not happened in other western countries were money isn’t in full controll of politics.
Some well produced advert, showing happy people leaving full lives "ask your dr about this now", side effects may include <lighting fast and scary long list of nasty side effects.
Combined with a private health care, which I think makes people want to appear to be getting their money's worth. I see this with my wife and her family (from another country). They are visible happier when come back from the Drs with a big bag of drugs. The wife things UK Drs are no good as most of the time when she went she was told, rest, lots of fluid and take a paracetamol (tylenol?)
I've also read that poor labour conditions / welfare / unemployment pay / sick leave / holiday pay means in the US working poor cannot afford to be ill off work, so need strong painkillers to get through the pain and back to work.
The current US opiod disaster is the result of many factors
Life imitates art?
So, welfare recipients may find themselves drug tested not because they use drugs, but because the people around them do. It stinks of collective punishment.
So they can go from a desperate drug user to a very desperate drug user?
Luckily there will be an election in the next year and they are down in the polls.
I just don't get it. I mean I do get it, in the US it's largely wealthy donors pushing policy that is really all about cutting anything to get them short term tax breaks or whatever..... but damn it if you're really fiscally conservative then finding programs that get these people off welfare and paying taxes is a GOOD THING, but no... just cut everything....
Generally the conservative argument is that welfare money should be earned in some way, essentially by doing socially constructive things (ie staying off drugs, applying for jobs, not committing crime). The goal is to direct resources to people who can be helped and are actually putting in effort to take care of themselves, on the assumption that those people can take some assistance and really benefit from it, whereas the addict who is sleeping on the street will just use tax money to buy more drugs.
A common liberal argument (not the only one but a common one), is that it’s more important to help “those in need,” no strings attached, that you can’t expect them to get out of the gutter until their basic needs are met and even if giving them money just enables their habit you have to “do something” and giving them clean needles and cash is better than “doing nothing.”
One of the problems that manifests all over the world in varying degrees is the tension between doing “something” which can easily harm more than it helps (the conservatives tend to point to this), and doing ENOUGH to actually help someone (or robust social services to rehabilitate people). In the US it used to be common for people to be institutionalized, they’d have all their needs met and in most cases get some semblance of help, albeit at a cost to their freedom. Well, nobody really liked that system since it was very expensive and was prone to human rights problems (if someone is too mentally ill to consent and you try and experimental treatment on them, are you helping or using them as a lab rat?). So now those people are on the street.
At the end of the day it’s a very difficult set of economic and moral problems to solve, and demonizing the political party you dislike and labeling them as heartless villains accomplishes exactly nothing.
What arguably would help is sane housing and public health policies so people could afford a roof over their heads and get medical treatment when needed without having to have an upper class job to pay for it.
I believe in effective solutions. Often it seems conservatives will refuse to use an effective and proven solution if they deem it had somebody getting something for nothing.
It seems as if conservatives will stay wide awake at night angry about somebody getting something they didn’t deserve.
As a liberal I don’t care as much about what people deserve as I care about what works as well as human dignity.
1. Most conservatives believe that the government forcibly taking your money via taxes and using it for purposes you do not approve of is undemocratic and immoral. This is the root of the small government argument - that the government should only do the things that are broadly supported by the population and since the population is fragmented the set of things that enjoy near universal support are very small.
2. Most conservatives believe very deeply that human dignity is found in freedom, independence, and meaningful work. Some might say “meaningful life” instead but for many conservatives they believe very literally that doing something that matters is the reason for living and if you aren’t doing anything that matters then you will be miserable and have no dignity. It isn’t even about making money - though that can help make the work meaningful. For many they would say that what matters is being able to contribute to your community and take care of your friends and family, and if you do a job that sucks but it’s what you’ve got and it gives you the money to contribute and take care of the people who rely on you, then THAT is what is meaningful.
So, suppose the proposal is “shall we give this homeless drug addict a home and food and money so their needs are met and put them in additction counseling and treatment and then hope they recover from their addiction, etc.”
Perhaps the liberal argument is “yes that should work for getting most people on their feet, and if it enables some people to just live more comfortably in a drugged stupor then that’s okay because overall everyone will be better off.”
The conservative argument would generally be, (1) it’s immoral to take money from people who work hard and take care of themselves to give it to someone who doesn’t work so they can live comfortably on drugs, and (2) by just giving them everything you are actually taking away the satisfaction and dignity that comes from taking care of yourself and knowing that you are independent and free.
Note also that the conservatives tend to worry a lot about the moral hazard: they fear that any kind of “bailout” whether it’s for homeless people or for Wall Street etc. takes away the consequences of an individuals actions and therefore incentivizes risky, dangerous, or antisocial activity.
Another way to distill it down is to say that liberals tend toward viewing individuals as inherently good and not responsible for bad things that happen to them, and conservatives tend to view people as inherently bad and mostly responsible for both the good and bad that happens to them.
Conservatives tend to see civilization and civil, productive behavior as something very hard earned and fragile, and worry about how social changes like universal social programs and such may undermine civilization - think Brave New World.
What I find most interesting is the economic libertarian argument about such things which is just to do whatever costs the least :)
Anyway, this stuff is all interesting but to boil it all down what I’ve learned over time is that there isn’t really an us or them or right or wrong politically, rather there are mostly rational people who have reasonable justifications for how they think about these problems, and significantly different life experiences that result in significantly different beliefs about what works and what doesn’t, and therefore what politics they subscribe to.
Instead we prefer broad non-means tested rights.
The reason is twofold: a lot of people don’t want to degrade themselves into taking welfare, hence they end up with no help.
Support and quality for means tested programs tend to drop quickly, because only narrow interest groups exist to champion it.
We see this with e.g. schools. It the middle class all send their children to private schools then the quality of public schools tend to be very bad. That is because there is less pressure to improve it.
We saw this phenomenon over night when de-segregation happened. Blacks schools which got white studens received a lot more improvements, upgrades and quality focus.
You are totally right that many of these problems are very difficult to solve. It's scary to put time and resources into things that may not work. We already are throwing so much money away into stopgap solutions though. The reason why I and many people feel frustrated with conservative policy is because it feels like they stall until we are forced into eventually doing "something" instead of implementing the full solution. Instead of saying, "hold on, do we really need this? Is this the best way to go about this?" it feels like conservative policy is to say "we will do everything we can to not spend money even if it is correct to do so." I totally get that this is a biased point of view. It's just an explanation as to why there is so much resentment of modern conservative politics.
In the real world where there's limited funding, it's just not possible to replace every Starbucks with a treatment center, so communities need to find ways to make those limited resources as effective as possible, and what's more effective than using data about where more opioids are being used?
"Offering treatment on demand everywhere is massively cheaper than trying to find out who is addicted to opiates."
1. Why can't you do both?
2. Treatment on demand can be marketed and tailored based on information about users.
3. I'm not sure it's a safe bet that opiate addiction is in every community. Seems like a false assumption. To my knowledge there are geographic differences, economic differences, and medical access differences between cohorts that use and those that don't.
The danger of disparaging an idea before it reaches maturity is that criticism may actually be incorrect, and discourage/dissuade positive developments. You can get the same criticism across without being counterproductive.
If we care so much about sewers, perhaps we should take the money squandered on this and hire laborers to maintain or replace aging sewer infrastructure.
The data is pretty staggering. 1 in 3 Americans have an opiate prescription each year, 1 in 20 had misused or obtained opiates, and 1 in 100 self-reported as an addict:
https://www.cbsnews.com/news/more-than-one-third-americans-p...
That is mind boggling! I had no idea that opioid prescriptions were that common.
So is this a Baby Boomer effect?
"Clever" titles are annoying to me, and more so when they degrade the clarity of the message.
What does "flushing out" even mean, in the context of the opioid crisis?
Fixing it?
Measuring the crisis?
Identifying hot spots?
Focusing resources?
Identifying specific types of narcotics?
The author has decided that "I am clever" is a more important message than whatever the point of the article is.
If you exert editorial control over anything, fight the temptation to be clever; especially when it obscures the real message.
Meanwhile you can't go wrong with looking for disease tracking.
Download has a whole new meaning.
The best you could do is narrow it down to any homes upstream of sample collection, which could be a single neighborhood or an entire city. Or it could be a drifter peeing straight into the sewer grate who doesn't even live in the city.
> https://en.m.wikipedia.org/wiki/Hypochlorous_acid#Reaction_w...
That fact might make any DNA matching inconclusive.
And you wouldn't want that, because then your sample data becomes useless and people start to shit in their back yards, or in public parks.
That said I am still looking for the toilet that does urin analyses ala The Island, I just only want it to tell me, and let me choose to inform my doctor.
I totally agree. It would be wonderful if there was an inexpensive device (it doesn't need to be a toilet) that could perform thorough health analysis, but inform only the user and not any third party. i.e. no Dr or pharmaceutical companies, the producer or manufacturer, the user's insurance broker, ad / marketing companies etc. Absolutely nobody but the user.
I want to trust technology like this because it could perform a profound public good, but untrustworthy companies keep being identified that have ulterior motives (for all sorts of technology, not this specifically).
And speaking of "public good" it would be extremely beneficial to scientists and doctors if that information was made available to them. And beneficial to you, because that device could be improved to give you a better, more informed diagnosis.
The question is what do you care more about, your health? Or your insurance premium?
EDIT: Of course you would want to anonymize it, but you could only go so far while making it still useful. If you unfocused it to a neighbourhood, insurance premiums would go up for bad areas, and the housing market would fluctuate with the health of it's residence.
On the upside, cities and landowners would be incentivized to now care about the health of their residents. So ¯\_(ツ)_/¯
> On the upside, cities and landowners would be incentivized to now care about the health of their residents. So ¯\_(ツ)_/¯
That would be an interesting consequence.
Long answer: Not really. If it is aggregated to a point that you can't tell who it's coming from specifically, it seems like less of a worry. If they installed it at each toilet... different.
Also - I'm okay with it as long as it is not used to issue warrants. I would take another look at it if they did.