Comment by seltzered_ | Hacker News Reader

Comment by seltzered_ | Hacker News Reader

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I think the question to ask is what created the opioid problem in the first place - I tend to think it's lack of regulation in the pharma space.

I've criticised the author (Chris Rufo, associated with the conservative and intelligent design group Discovery Institute) in his earlier pieces (see https://www.reddit.com/r/SeattleWA/comments/acwqng/podcast_s... ) where he used seemingly incomplete estimates on the funding used in homeless initiatives and suggesting unproven solutions (large tents, sanitariums).

I'm not denying the homeless and drug problems in Seattle. I live in the same neighborhoods where I've seen people shoot up in starbucks bathrooms and on the street, RV camps of bicycle chop shops and filth. The King County complaint Rufo links to ( https://www.krcomplexlit.com/wp-content/uploads/2018/01/King... ) arguably means the local government is trying to take that first step in recognizing "addiction is the common denominator for most of the homeless", right?

And if you tightly regulate the “pharma space” and those drugs are harder to get, the same addicts will just find a substitute drug. The “War on Drugs” has been an abysmal failure.

If you lock up the users, you’re just spending more money housing non violent offenders. If you lock up the sellers, someone else will take their place. Homeless drug addicts don’t fear jail, how could it be any worse than life on the street addicted to drugs?

I have no idea what the answer is, but I suspect it is a better social safety net where people think they have a fair shot in society where they don’t view drugs as an escape or have the mindset of having nothing to lose. I honestly haven’t thought about solutions that deeply.

If heroin were freely available (it costs almost nothing to produce), heroin addicts could be productive members of society, and would have nothing to fear in seeking treatment.

Nodding is the only thing dangerous about heroin addicts who have access to heroin, everything else is a symptom of prohibition. Additionally, long-term heroin addicts who have a consistent supply don't really nod much, or for long. It's the gaps in supply (of unadulterated drugs with a predictable purity) and the consequent simultaneous reduction of tolerance and increase in desperation that causes accidental overdoses and deep nodding.

Nodding is of course dangerous for drivers and operators of heavy machinery, but it should be treated like we treat any other sort of chronic seizure issue.

Portugal found a solution: treatment and decriminalization of all drugs. Prohibition never addresses a social ill, except it helps the prison-military-congressional-industrial complex $$$. Prohibition and "tough on crime" are Nixon's solution to political enemies and Reagan uncaring, absence of Golden Rule what they don't wish to understand about others outside of their limited/sheltered experience.

Seizures (untreated) make one ineligible to drive and even when treated typically get a 90 day ban while medically evaluated.

Nodding and seizures are different things. An experienced drug user will know when their drugs are going to make them too sedated to drive.

Drugs are often an escape but not always from immediate societal pressure. Ppl with (emotional) pain with likely eventually self-medicate. That is, addiction is a symptom. The problem is, we tend to want to treat that symptom and remain in denial that there are underlying root problems.

Even though I wish I could say that I was insightful enough to think about that when I originally posted, if you define a social safety net from the social viewpoint, it would also probably help if people dealing with emotional issues had someone to turn to and we treated clinical depression as a medical issue more often than we do.

But, I am far out of my area of expertise to know anything about clinical depression.

Np. We're on the same side. The gist of my point is we (i.e., USA) are fond of treating symptoms and then we wonder why they persist.

Frankly, imho, this is often driven by politicians. They're fond of make campaign promises to solve Issue X. The problem is, they've gotten the problem wrong.

We are absolutely feeling the pain of a lack of social safety nets for all kinds of problems.

Unpopular opinion: I’m ok putting non-violent people in jail when they break the law. We need reform in the jails and prisons, not more lenient sentencing.

And because I’m sure it needs to be clarified, not every law breaker needs to go to jail immediately.

Why is jail necessarily the best answer? Fines and restitution, community service, court mandated counseling, "night jail" (must report to jail after work) and other tools would work better for preventing and correcting the harms of many (if not most?) types of nonviolent crime. Traditional jailing creates all kinds of assorted harms that actively prevent rehabilitation and which probably don't provide much deterrence.

Your suggestion of reform is indeed necessary, but some of the things I suggested above would fall outside of what most people would consider "jail." We are stuck on this singular "solution", and why? It doesn't seem to be very effective.

I agree with you so I should clarify what I mean by “jail”. The reform aspect is absolutely crucial and I am not advocating for simply locking people up as we do today. When I say “jail” I should probably say something like “adequate social safety nets supported by state mandated rehabilitation” but the marketing needs work.

I agree that some “non violent offenders” should go to jail if they break the law. I don’t agree on a lot of the laws that are on the books that stop consenting adults from making their own decisions. Some things that are currently illegal that shouldn’t be:

- selling drugs to adults.

- adults buying drugs

- prostitution (either side)

I only agree with 1 and 2 and to a lesser extent 3 in the presence of free universal healthcare and adequate safety nets.

If we simply legalized all drugs tomorrow I don’t think it would solve many problems. We have to also look at and treat the underlying cause of addiction and drug abuse.

Results matter. Incarceration is great for satisfying a need for punishment and vengeance, but as correction it has been clearly demonstrated to make problems worse. Jails and prisons function as networks for criminals to connect and share and are extremely effective at promoting gang activity. If we want to deal with problems then we are going to have to stoop to the kind of methods that are used with medical care such as pledging to do no harm and using evidence based interventions.

I clarified in other comments but we also need reform in our jails and prisons. What we do today is just release people to the street which also doesn’t work.

The point is if you break the law the state should have the ability to force corrections.

I’m completely in support of reinventing what those corrections are.

What kind of reform are you proposing?

Fundamentally we should focus on rehabilitation instead of punishment. If the non-violent offense is theft in support of a drug habit then rehabilitation should be made available. It should not be optional.

What does rehabilitation entail for you?

If we're looking at addiction as a mental illness to be rehabilitated from, I would posit that forcibly housing them with a bunch of other mentally ill people, some of whom may be violent, would be traumatic enough to most people that it would more than negate the benefits of many rehabilitative interventions.

Rather than focus on what might not work I would rather put energy into finding what does. Things that do not work: what we do today. Things that might work: some form of rehabilitation.

If locking up drug addicts in a room and telling them to sort it out doesn’t work maybe we should try a new form of rehab instead of just saying “well I guess rehab doesn’t work”.

Addicts aren't born as fully formed heroin junkies, they all have a first time when they used an opiate or opioid. If you're living on the street and stealing handbags to buy heroin, you got there through a series of crises, each one an intervention point. Not being able to steal your dad's oxys from the medicine cabinet, or not being put on opioid painkillers for three months straight, are two of those intervention points.

If you think the war on drugs is a failure then you're missing the point of it. Cops can't arrest homeless people because being homeless isn't a crime. However if drug use correlates with homelessness then making drugs illegal is an indirect way of making homelessness illegal.

Solutions to the housing, homeless and drug problem exist but the voters and politicians don't want them.

The regulation on pharma should not be aimed at reducing supply (which is how it's done today, trying to avoid prescribing pain meds to anyone who is addicted) but on reducing the introduction of dependence. It's not going to solve everything, but there's a reason people are winning lawsuits against the Oxycontin manufacturers.

I think a big part of it is the decline in social structures and lack of meaning in many people's life. Happy people with a meaningful life are much less likely to take drugs.

This is the problem. This is the core problem. This is the reason, even with intervention, rehab, psychiatry, access to modern "tools", substance addiction is so hard to fight. This is why the "War on Drugs" has been a failure. All these comments address symptoms.

Can someone give their reason as to down voting this comment?

There have been numerous articles posted here as of late relating to loneliness, suicide rates, etc. What do you need to see the bigger picture? I don't understand why this is so difficult. I feel like there must be some ideology in the way here or maybe politics or cognitive dissonance. I mean you could have just ignored the comment if you were in ambivalent disagreement.

Having worked in social services for 14 years it has become clear to me that social support, ie healthy family structures, friends and coworkers, as well as having a meaningful reason to get out of bed in the morning are the most important factors when it comes to overcoming addiction. I'm not aware of much research regarding this aspect of treatment. All I can say to that is that I have a very paranoid and pessimistic view as to why.

Can someone give their reason as to down voting this comment?

I didn’t downvote the parent, but the idea that only unhappy people use drugs isn’t true. Maybe if you limit it to hard drugs or maybe if you limit to “abusing drugs”? I have no strong opinions.

Alcohol and marijuana are both drugs, plenty of happy people drink and smoke weed. On the other hand, plenty of opioid addicts started taking the drug legally because of a real pain and then got addicted.

Those aren't the users who end up homeless though. I know plenty of people who use Marijuana and alcohol, but it doesn't become a problem. I even have someone in my family who got addicted to opioids because it was overprescriped for treating pain. However, even that didn't turn into a major problem.

There is research that confirms this. Johann Hari talks quite a bit about it in his interview with Sam Harris:https://samharris.org/podcasts/142-addiction-depression-mean...

Most famous is probably the Rat Park study: https://en.m.wikipedia.org/wiki/Rat_Park

Blaming the drugs is an easy out and probably is more pleasing to people coming from a puritan world view.

> I tend to think it's lack of regulation in the pharma space.

Maybe it's time we start acknowledging that perhaps the environment is at least partially to blame for individual problems. Why are people staying with drugs that they hate? Could it be that there are societal issues which keep them from becoming mentally well enough to combat their other problems?

> I tend to think it's lack of regulation in the pharma space.

According to what I've read online though, most of the illegal opioids are not prescription, but rather from Chinese manufacturers via Mexican drug cartels.

I think that the thing that started this was the demand for psychedelics and pain killers among the rich tech workers of Silicon Valley, LA, SF, Seattle, etc, which have infected the west coast with the false notion that drugs are a 'victimless' crime. I've personally witnessed many very educated, very rich college students, take opioids -- not from a doctor's prescription -- but because they thought it would be fun. Perhaps they are not the addicts talked about here, but the fact is that their ability and desire to pay thousands for this stuff means that the drug cartels are enabled, enriched, and now have an incentive to market to less individually-wealthy, but larger markets.

> I think the question to ask is what created the opioid problem in the first place - I tend to think it's lack of regulation in the pharma space.

The opioid addiction crisis is a complex issue, and the data defies reduction to any particular cause.[0] It's become popular to blame the issue on the pharma industry, but to do so is an oversimplification large enough to call a mischaracterization, and focusing primarily on that area will not solve the problem.

I think that the reason for the popularity of this misconception is that it throws a bone to almost anyone's ideological predispositions. It blames both "big business capitalism" and "the out-of-touch elite", it avoids laying blame on doctors, or on homeless urban addicts, or on poor rural addicts, or on the suburban middle class, or on a culture that fosters both urban homelessness and rural poverty, and it's a simple explanation that has intuitive appeal.

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846593/

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