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Comment by beginningguava | Hacker News Reader

The opioid epidemic is an amazing example of human psychology and the power of a visual. More people die from it every year than Vietnam, yet there's been no large public outcry to resolve the situation because it isn't right in your face like a 9/11 or pearl harbor. Even ignoring the human impact and just going to economics, those lost lives will cost the US billions in lost productivity over time, yet nobody really cares.

Honestly, somebody should make a Kony2012 style video about it. It was a sham but I can still remember how viral that thing went, because it hit all the buttons of human psychology.

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Someone replied to you with an ignorant comment that was deleted. I'm copy/pasting it here anyway because they are spewing common misconceptions that need to be squashed.

> The US has 330 million people. Do we really care if a bunch self-select out of the gene pool?

While some people do choose to use drugs with their own free will, this epidemic isn't about that. Many people getting addicted have been initially prescribed the pain killers by a doctor for medical reasons and then got addicted. They didn't use recreationally.

It's thanks to these ignorant comments that make them fearful of seeking help with the addiction.

The was on drugs and the stigma it brings continues it's devastation...

> The only way I would care is if I found out that a foreign power was behind this, i.e. getting people addicted to deadly substances in order to undermine our country. If it's just jackass flunkies doing it because they're jackass flunkies, then I'm just glad they aren't on the highways.

It's not a foreign power, it's our own pharmaceutical companies attacking our citizens.

From lobbying against medical marijuana as an alternative pain killer to pushing false information on doctors and patients about the addictive nature of their drugs.

But pharmaceutical companies don't fit your typical stereotype of a villain and they flood our politics with cash, so they are getting away with murder.

Finally, people regurgitating the garbage like "self-select out of the gene pool" are also a major part of the problem. How someone got addicted to drugs shouldn't be important. Whether It was due to recreational use or by a prescription, they need help and should not be ostracized.

Our public funds should go to recovery centers, not law enforcement for victimless drug use.

There are plenty of laws on the books to arrest someone who harms another, whether on drugs or not. We don't need laws specifically for drug use. Those people need medical help, not jail.

edit: typos

Seems their comment is gone too. I’d love to have been given the chance to downvote them.

To me this all boils down to what you’re saying, but I’d like to just add mention that i think the bigger disease in the US that enables situations like this is the acceptance of misinformation. As you pointed out, many many many of these cases are started by a medically issued prescription, and it kills multiple times more people than recent wars or terrorist related acts, yet anyone who drives action here is often labeled as “helping junkies that don’t deserve help”.

In the very near future when climate change has destroyed our way of life, and one of the few nations that was capable of doing something is finally and certifiably recognized as having sat by and done nothing, i hope the world takes note. These are the kinds of acts of neglect that make Nero famous, and while i don’t want their names remember, i do want the world to move on from the US being seen as the worlds police and freedom fighters. If Kama is real, the US should be concerned, and as someone that is a close neighbour, it terrifying to think how that will flow on to impact the rest of us.

>"In the very near future when climate change has destroyed out planet"

Maybe people are killing themselves because they are addicted to the fear porn spread by mainstream/social media regarding "climate change". I don't mean this as a joke, I was addicted to financial/economic fear porn for a bit and it did have a negative effect on my outlook.

While our media does abuse fear as a way of getting attention, the opioid epidemic has direct lines to pharmaceutical companies.

People dying from their addiction aren't killing themselves, they are struggling to survive.

Climate change is on track to cause catastrophic damage in the next few decades AND there is no indication of anything being seriously done about this. In other words, a train is barrelling and, crucially, there are no signs of anyone intending to stop it. Yeah, I think it's justified to be scared.

There was just a recent discussion here about this and every time I asked for sources and then checked that is not what was found in the primary sources. The catastrophic outlook is created by a few people and amplified by the media as clickbait, not any sort of scientific consensus or track record of successful predictions.

You can go through my recent post history to find it.

I believe the parent's point was not about the veracity of climate change, but rather the impact of constant exposure to fear.

Herbert's quip that "Fear is the mind killer" is apt.

Research (has hit the HN front page several times) bears out the fact that constant exposure to stress decreases IQ.

Ergo, the first step to most effectively combating anything is to accept it, but NOT give in to fear and despair.

Climate change is real. We are not doing enough to counteract it. But we can.

Economic collapse and climate change are very different. Climate change news does not evoke the emotion of fear, but rather emotions of disappointment, lament, and anger.

If you think the economic system is scammy, but most people just won't listen, you will experience the exact same emotions you list. So I have to disagree.

The main "fear porn" here that I think relates, and it's more of a tangent than any direct connection, is the propaganda associated with the War On Drugs, just as a comparison to the realities of the opioid epidemic. Some of the issues that were associated with various illegal drug epidemics were legitimate (particularly addictive substances that had the potential to destroy your health like heroin and cocaine), but the propaganda ended up being a moral panic implemented for sometimes questionable (possibly tribalism oriented) reasons, where a few substances (some of them, like cannabis, being relatively harmless) ended up getting demonized, a way-too-high amount of Americans got arrested for trifles as a result, and so forth. Ironically a large portion of the drugs in this epidemic were not in this much demonized category.

Back on topic, the "messaging" here that directly relates, as far as the opioid epidemic goes, is the opposite: the lax regulation of the marketing for prescription drugs. Purdue Pharmaceutical was allowed to engage in a lot of aggressive marketing courting physicians with plenty of symposiums and swag. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/) The marketing hugely downplayed the addiction potential of Oxycontin, over-promoting the use cases and underplaying risk. (Along the way you get some IMHO absurd swag like an Oxycontin-sponsored 50s swing music compilation -- https://www.reddit.com/r/SwingDancing/comments/593xof/til_th... -- I mean, what?) This helped contribute to the opioid over-prescription problem.

Sober, fact based analysis -- present in neither of the above scenarios -- unfortunately is in short supply these days.

Personally, I haven't seen the sort of aggressive marketing you see in America for prescription drugs in any other country -- at least, I don't recall seeing the sort of direct-to-consumer prescription ads anywhere else, (I was able to find articles that said DTCA is quite restricted in Europe --https://www.pharmafield.co.uk/in_depth/pharmaceutical-direct...). I think pharmacy-to-physician marketing is still allowed in most places, but the above shows that work needs to be done to ensure that this marketing also is sober and fact based. Even physicians can be persuaded by "marketing swag". (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623540/)

Not that I consider the "war on drugs" to be valid in any way, but I haven't seen anything involved with it that is in the same category as the genre of "news" I am talking about:

https://www.urbandictionary.com/define.php?term=Fear%20Porn

https://www.urbandictionary.com/define.php?term=doom+porn

> i think the bigger disease in the US that enables situations like this is the acceptance of misinformation.

It's amazing how many Americans are actually proud of their ignorance.

> It's amazing how many Americans are actually proud of their ignorance.

It's also amazing how many Europeans think they're somehow different.

You can still see the comment if you go to your settings and set "showdead" to yes. I'm guessing it was flag-killed for being inflammatory?

But to take it seriously, what fraction of opioid deaths started from a prescription?

I hate pharma companies too, and think they definitely were a part of the gateway to addiction, but you should read more about how the overdoses are occurring.

As another user pointed out below: > "Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time."

> "Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat."

Also: https://www.theguardian.com/society/2016/may/10/fentanyl-dru...

Synthetic opioid overdoses: https://www.drugabuse.gov/related-topics/trends-statistics/i...

People end up ingesting shit they don't even know about that's in their drugs (like chinese fentanyl) and then accidentally OD. It's still bad to overprescribe drugs, and this shows more legalization/regulation of drugs would be better to not have supplies randomly cut with whatever products some dealer has laying around.

You're missing the link. Here's the chain of events for this epidemic.

1. Doctors over prescribe opioids and poorly monitor patient addiction.

2. Eventually, doctor cuts off patient.

3. Addicted patients turn to street drugs, like Chinese fentanyl.

4. Street drugs have unreliable dosage and ingredients, making it easy to accidentally overdose.

> It's thanks to these ignorant comments that make them fearful of seeking help with the addiction.

I'm not sure the comments are made out of ignorance as much as desperation.

Imagine an audience member telling a DJ: "Hey, I liked your stuff. But I kept hearing a bunch of pops and clicks in the music. Was there something wrong with your system?"

And the DJ says, "No, my system was just discarding the samples that self-selected to miss realtime deadlines. Good riddance, I say!"

We need a name for this fallacy: perhaps the "Unsampling Fallacy?" That is, morally attacking samples in an attempt to characterize the very system for which you were supposed to analyze those samples to gain insights into it.

It's glaring with the DSP example but insidious when it's humans being sampled.

Have you been living under a rock or is my definition of large public outcry vastly different? I hear about this more than I hear about climate change issues (but not as much as about gun violence, which causes far fewer deaths in the US).

But what causes far greater deaths than even opioids, is avoidable medical errors. It's quite difficult to stop a highly addictive class of drugs which is backed by big business (legal or illegal). But that many avoidable medical errors in 2018, despite the high barriers to become a doctor?

Maybe we shouldn't be treating this opioid problem so gravely after all. The more serious, more deadly, more costly problem of avoidable medical errors could be even the root cause of the addiction epidemic.

I spent the better part of my adult life as an addict, and yet not one doctor out of the many that I saw acknowledged or noticed. Furthermore, on the occasions I did muster enough courage to ask them if the drugs were causing harm (three different non-opioid drugs at different periods of my life), I was shrugged off, the doctors saying that my symptoms do not match up, or otherwise downplaying the situation. I needed hard evidence that what I was doing was actually harming me or I saw no incentive to quit. By the time one does enough chronic use to be at risk of death, I imagine the addiction and habit is far too strong to easily break. So I'm of the opinion that the root cause is with the medical profession's apparent limitations.

It's often very hard to get medical help in general until something is plain and obvious, highly common, or literally killing you, with the evidence needing to show up on examination or test. This is something that I could be vastly improved with AI doctors and open access to anonymized health data. But given how much of a fight the taxi cab driver union puts up (with self driving cars and even Uber), I won't hold my breath for the AMA to get behind the idea.

People have gone to a lot of effort to convince their fellow Americans that those that die from opioids deserve it. I'm sure some will turn up in this thread.

"Deserve" is going overboard, but there's certainly a moral difference between something that happens due to one's own choices, vs. something that happens because it was compelled.

It's reasonable have more sympathy for a conscripted soldier killed in a foreign war he had no desire to fight in than an opioid addict that died from a result of choosing to do drugs.

It's not going overboard. I've heard more than one person refer to it as Darwin at work or "they deserved it for being weak"

Of course, someone could be both. Veterans have elevated risks of both drug use (often related to injuries) and suicide due to PTSD.

https://centerstone.org/news-events/news/opioid-crisis-impac...

The permanent war has long term casualties.

You're perpetuating a myth that drug use is all about personal choice. Many addicts started with prescription opioids, recommended by their doctor, and only moved to more dangerous options once their doctor's supply was extinguished. Doctors themselves over-prescribed these to attack pain, meanwhile they were being lied to by pharma about the addictiveness of opioids. On top of that, you have fentanyl being added to heroin to increase its potency, and also vastly increase the mortality rate.

Finally, it may be hard for those of us who were never addicted to opioids to understand. It no longer becomes a simple choice when your body is extremely sick if you don't get your dose. This is one reason why a drug addict might steal from those they love, their illness is literally the most important physical sensation at any moment, overcoming familial and societal norms. It's a scourge and illness, not merely a choice.

I actually don't think that those people really have any significant voice at all, let alone the ability to persuade anyone. Sympathy for the victims of the opioid crisis is one of the few things that spans the political divide; the right sees the outsize devastation it has on their rural constintuencies and the left wants to expand healthcare and decriminalize drugs. The only people I can imagine saying "they deserve it!!" are befuddled leftover Cold Warriors who still see Nancy Reagan every time they close their eyes, or else just transparent trolls who get off on inciting others. Sadly, it just so happens that those same people are in control of the government.

> those lost lives will cost the US billions in lost productivity over time

It's so strange how prevalent it has become in the past few years to talk of human beings in terms of productivity. Growing up in the 90s, all the talk was about how we were mindless consumers. Now, all I hear is people talking of others and themselves as producers and productivity. How they feel about themselves and their worth depends on whether they had a 'productive day'. What does that really even mean? It's amazing how quickly the vernacular changes.

Never in a million years would I have ever thought of someone dying and juxtaposing that with productivity. Why even bring it up? Are we here just to produce for society or the wealthy or the government? 20 years ago, would we have been upset at all the consumers or consumption being lost through suicide and death? We are talking of others and ourselves like farmers talk about produce and livestock. Maybe that's what modern society has reduced us to. Livestock that needs to produce.

Reporting on productivity change is a reasonable way to quantify the social impact of a phenomenon, which allows people to compare it in scale to other issues, and prioritize scarce resources accordingly. Of course it's imperfect, and data is lost compared to a qualitative assessment of individual lives. But can you think of a consistently better quantitative measurement? Longevity?

We've recently seen a lot of coverage of the forecast that climate change could cause a 10% reduction in GDP by 2100. Your objections apply to this measure equally. But by quantifying the magnitude we can compare it to things like the cost of remediation.

Quantifying an effect also has the benefit of exposing the estimate to more effective refutation. The more numerate debate we subject policy preferences to, the stronger they'll be.

This seems like a prevailing attitude, but I think it is based on a debunked thought processes.

People used to think that heroin or other substances were inherently addictive in and of themselves. This was because of experiments on mice in Skinner boxes. But that is not how addiction works. Addiction is, in great measure, the result of animals being unhappy and trying to do something about it.

This has been proven both in humans and in mice. Mice, and humans, generally don't get addicted when they have good things to do.

To focus on the opioid side of our social dysfunction is just as useless as focusing on any other SYMPTOM of dysfunction.

When I hear people talking about how horrible the epidemic is, I can't stop helping thinking of a flu analogy:

This sniffling epidemic is really terrible. We should ban sniffling because sniffling people suffer, we need to protect them* if they sniffle. But let's not worry about people washing their hands... that's unrelated.

* Generally implied is that by protecting people it means putting people in cages if they disobey our social commands.

I heard an interesting podcast about how the pain scale used in hospitals and clinics is directly responsible for the opioid crisis, and it was intentionally designed to sell pain killers. You know the sheet you get when you visit a doctor that asks “how severe is your pain on a scale of 1-10”?

The well intentioned scientist (June Dahl) who championed the widespread adoption of the pain scale recalls that when she was giving talks about it and it started to get a little traction, the pharma industry started pouring money into her campaign. At the time she thought it was just unbiased grant money without an agenda, but she later realized the intent was to sell more drugs.

https://www.gimletmedia.com/science-vs/opioids-how-america-g...

I think it's the same issue as the prison population being so enormous. When someone does crime/drugs the country collectively just thinks that these people did it to themselves.

I've heard people casually refer to criminals/addicts as animals, it's ridiculous.

Yes that's sad. But consider: what would you call someone who injected strangers with noxious drugs and enjoyed their torment? An animal? Is it so big a leap to think the same, when they're doing it to themselves?

Yes, it's a major leap and the fact that you can't see it is concerning.

If you are enjoying someone else's tourment, especially after you inflicted that tourment onto them, then you are a psychopath.

People who take drugs aren't taking it for the hangover, they are taking it for the high. If you remove the tormenting hangover, 100% of users would be fine with that.

You should seek psychiatric help and I'd be happy if my tax dollars were used to help you with your mental problems.

Ha! Just playing devil's advocate, to help folks understand the alarm with which some folks see drug abuse.

I actually work in helping abusers control their addiction. I have all the access to mental health services I need, thanks.

No, no person is a animal and it's misguided and inappropriate to make the comparison.

People who behave cruelly aren't animals, they're people who behave cruelly and we should seek to minimize/stop their cruelty and ability to inflict it.

Drug users, willing or no, also aren't animals. Drug users who want to stop should be given all the tools necessary to kick their habits. Drug users who don't want to stop should be given the tools necessary to reduce the harm to themselves and to society.

Anything else is barbaric.

Technically, we are animals.

We're not discussing taxonomy, so this is completely irrelevant.

This "I'm not arguing this, but it could be argued" is such a waste of time.

If you say it's "not so big a leap", make the argument? After all it doesn't matter if a leap is big or not, that's always related to the gap it needs to cross. If argument holds and you end up on the other side, it wasn't so big a leap. But it's pointless to talk how a leap is feasible instead of simply making it, leaving that as some sort of exercise for the reader.

I guess it would be actually two arguments, 1.) calling sociopaths animals 2.) the equating of injecting others with something for the purpose of torturing them with injecting oneself with drugs, for the reasons and purposes people actually do that.

Not sure how you would funnel the wide variety of reasons people end up addicted to drugs into something that could be compared with a single situation and motivation like that hypothetical torturer, but then again you haven't made the argument yet, so maybe you know something I overlooked.

What would you call someone who compelled strangers to buy low-quality things they don't need? What would you call someone who tricked children into getting addicted to mobile games? What would you call someone who knowingly buys products manufactured under poor labor conditions? What do you call someone who willingly eats meat produced in cruel environments?

You can play this game all day. This isn't the point. They're all people — they have families, wants and needs, they dream at night. They're all just trying to get by one way or another. They're no more discardable than you or me.

Your premise seems to be that all death should evoke equal concern. I think people being forced by threat of violence to commit violence against another group of people and dying during it is far worse than someone chosing of their own volition to use a recreation drug and making a mistake with their own life.

I'd bet many people share my differentiation. I don't think it's primarily a 'visual' difference.

Some blame needs to rest on the shoulders of the CDC, even the AMA[1] has come out against the guidelines the CDC put up over two years ago that others have used as guidance, incorrectly. The CDC needs to clarify the guidelines or just flat out back off so that those in pain and prescribed pain medication can get it. Far too often the guidelines are being used by non Doctors to deny needed medication

https://www.painnewsnetwork.org/stories/2018/11/14/ama-calls...

More people die from it every year than Vietnam

[Kind of off-topic] I'm guessing you mean by 'than Vietnam', 'than Americans died in the Vietnam war"? (Well I think so. Apologies if not.) That's a pretty macabre unit. Can you imagine how a Vietnamese person would feel reading that? Maybe in Vietnam they say 'More people die from [something] every year than America' - meaning what they call the American War[0]. Wouldn't that sound super-weird. That's something like how what you said sounds to me. Only for them it would mean 1-3 million.

[0] or the Resistance War Against America.

edit: Downvoter, care to explain how I can improve my comment? Thanks.

They are just using synecdoche. From the context of the comment and the shared culture of the audience people can understand what they are talking about. It's no different than how people in America know that if you talk about changes in government policy after "nine eleven" you mean the terrorist attacks not the sports car.

I'm downvoting because you are getting offended for others (I'm assuming you are not Vietnamese). Avoiding common expressions because you are trying to guess that someone might be offended is going too far in caring and politeness.

ps. You could also use car deaths per year (somewhat similar number) but then anyone who has lost relatives in car accidents might get offended by using these macabre numbers.

You're being pedantic for the sake of outrage.

>You're being pedantic for the sake of outrage.

Eh no.

Imagine you're sitting in Canada and say "The opiod epidemic kills more people annually than WW II", and then when confronted, you say "Of course I mean Canadian lives in WW II!"

Americans may only see 55000 deaths in Vietnam. The rest of the world (and HN is international in audience) sees a lot more.

Possibly a better way to put it is to simply point out that the war caused something like 1.3-4.2 million deaths.

A similar bit of misfocus shows up in comments about the Holocaust, which technically refers to the 6 million Jewish dead rather than the estimated 17 million total.

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