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Comment by shaunxcode | Hacker News Reader

The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine? If we don't address that nothing is going to stop the drug abuse let alone the relapse and overdose. I'm not talking about "more 12 step" here but more of a Frommian psychoanalytic approach. You are broken because society is broken. You have the ability to change yourself and subsequently society. A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.

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> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine

People start using drugs for different reasons. It's not correct to say that everyone starts abusing drugs as a form of pure escapism. A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.

> You are broken because society is broken.

Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

> Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

I don't think these are mutually exclusive. Society wide problems cause a huge fraction of the population to experience severe emotional trauma, and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that. If you can understand this process, you can take ownership of it, and have a path to beating the addiction itself.

Ultimately, there is a lot of disagreement about what addiction is and how it really works, but I think this emotional trauma aspect is a key part of explaining why one person can use a drug recreationally or for medical purposes without addiction, and another can't. It explains a lot of weird observations that just didn't make sense with the classical chemical/neutrotransmitter model of addiction.

These links I think help explain this better than I can:

How Childhood Trauma Leads to Addiction - Gabor Maté https://www.youtube.com/watch?v=BVg2bfqblGI

Comic explaining the Rat Park research on addiction https://www.stuartmcmillen.com/comic/rat-park/

These ideas have explained why I personally have never been able to fight addictions through willpower alone, but have been able to eliminate addiction with other techniques that seem unrelated- therapy, meditation, exercise, hobbies, friends, ending bad relationships, etc. It seems that while chemical/physical addiction is a thing, emotionally and mentally healthy people don't experience opioids as a positive thing, such that the effect of the drug itself actually discourages it's use, and even motivates the experience of withdrawal.

Attempts to replicate the Rat Park experiment have failed: https://en.wikipedia.org/wiki/Rat_Park#Criticisms

It gets cited in a lot of pop-science and podcasts, but it's not actually the groundbreaking, universally-accepted study that people think it is.

Likewise Gabor Mate is more of a podcast, pop-science guy, not a real researcher. Take his podcast and YouTube content with a grain of salt.

I don't think psychology has advanced to the point where we can test ideas like this in a peer reviewed study on humans, yet as a personal experience- I have found that it is self evident once I looked deeper into my own feelings and actions. I feel those links do a good job of explaining the idea.

This reminds me, for example of the debate over Carl Jung. Some people say he set the field of psychology back with his scientifically untestable theories. Yet, I think it's obvious there is something to what he was saying, and it's likely he wasn't onto nonsense, but rather he was way ahead of his time.

>Society wide problems cause a huge fraction of the population to experience severe emotional trauma and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that.

So then why weren't addiction problems more widespread historically, like say 1900-1960? Life tended to have a lot more of what are generally considered traumatic experiences back then.

Weren't they? Perhaps they were just using different drugs, e.g. alcohol. You can't use a drug to escape negative feelings if you don't have access to it.

And perhaps nobody cared enough to log it, especially in the lower classes

You just shrugged off opium dens, or moonshining, or whatever substances could be had. The demon liquor and marijuana and heroin were all well known.

But, people didn't care about the poor. Whether or not they do now, they do collect data about them. We don't necessarily have great understanding about prevalence of who used them how often, so we shouldn't pretend there was a significant difference unless there's a reason to. Nostalgia or rose-colored glasses or pretences of a better time aren't valid reasons to break from expectation.

There's absolutely some truth to that though. People do not fall into addiction at the same rate in all societies.

That's tricky though, as access to the drugs varies by society also.

I feel like your first paragraph and your second one contradict each other.

They start for various reasons, like your example of "seeking recreation" and having a certain person nearby.

They don't stop because they cannot stop due to a physical addiction. I do not think personal responsibility is the right topic for that once it has gotten to that point. They've entered a state of physical dependence in which the reason they started is kind of irrelevant, and it's very difficult to quit, through no fault of their own.

> They don't stop because they cannot stop due to a physical addiction.

What you wrote here is actually the issue I was trying to communicate: The notion that addicts are helpless and that the drug and/or society has already determined their outcome is the problem. This sets up a defeatist attitude where people feel like they shouldn't even try to overcome addiction because their contribution to the equation is 0%.

Different addiction programs handle this in a different way. AA/NA famously have the "submitting to a higher power" concept that is very divisive, but appears to work for many people. Other programs basically teach the user that they do have some control over their life, and that they need to start exercising little bits of control to move in the right direction (even if they can't choose to end their addiction tomorrow).

What doesn't work is telling people "it's not your fault" or trying to comfort people by blaming their problems on purely exterior sources. Addiction treatment specialists refer to this as "rescuing behavior" and will go out of their way to discourage it from support groups and in friends and family.

This is the problem with addiction explanations that try to shift the blame to society: They give the user an excuse to continue believing that they are 100% victim with no control over navigating their way out of their situation.

Thinking it’s not my fault worked for me. Your argument is a conservative argument.

Addiction treatment specialists are basically witch doctors

Why don't addicts get large doses of intravenous NAD+ by default? That would alleviate 90% of their addiction inside brain as they are typically brutally NAD+ depleted and on the hunt for anything that raises NAD+/FAD+ in the brain.

Conflating a holistic approach that acknowledges the material effect of the context around a person with the assertion that those things existing nullifies the contribution of said person's agency is one of the very stupidest contributions of individualism to society. Things can materially make abuse more likely. Actions can be taken _by society_ that will make any particular _individual_ abuse less likely, whatever the specifics in each individual situation. It is still largely effort by an abuser and their closest contacts that will make _specific, individual_ abuse less likely in the future. None of these analyses contradict.

There's a division between mitigation, where empowering people to get rid of their addiction, and root cause, around changing society to stop pushing people into addiction.

Not looking more broadly means youll never fix problems like doctors over prescribing pain killers, especially without explaining their risks

It's two separate conversations, for different purposes

> What doesn't work is telling people "it's not your fault"

> trying to comfort people by blaming their problems on purely exterior sources

These are not the same thing.

The former is literal truth. The latter hints at intention, blame, denial.

It's not their fault, but they can get through it. You can hold these two simultaneously.

Why is it not someone’s fault when they get addicted after choosing to do a known-addictive substance? “Not their fault” certainly doesn’t describe all addicts.

They don’t need to be faultless to deserve compassion.

The more life experience I have the more I conclude that assessing the existence and extent of someone's fault is a pointless exercise. People tend to exhaust enormous amounts of pointless energy stuck in that place.

Your last sentence drives it home. They deserve compassion. Who cares about subjective assessment of fault once you reach that conclusion?

Largely agreed.

To your last point, people who believe having an internal locus of control is useful for preventing (not necessarily treating) addiction.

Many people get addicted to drugs after being prescribed them following surgery or injury. I know someone this happened to exactly. They gave him a bunch of opiates for pain management and he took them as directed and wound up an addict. I think a lot fewer people "choose" to get addicted to medicine in this way than either you or the GP are implying.

And now big pharma will "cure" them of the disease they pushed.

Also how is it a vaccine?

When I was a teenager I was prescribed tramadol after a surgery.

I was in considerable pain so I took it as directed. It was hell a strong stuff and I basically slept 18 hours a day.

A week later I was still in pain, but less. I reduced my dosage below the prescription to only take a dose before bed to make it easier to stay asleep.

Well, did I notice the effects of dependence. It was subtle but throughout the day I'd have intrusive thoughts along the lines of "I haven't had a painkiller yet, I should have one"

If I'd taken the prescribed dose till completion I'd hate to think what my brain would have done.

That scared me enough at the right age that I've never taken illicit drugs. And any time I'm prescribed painkillers Ive ignored the dosage and take just enough to manage.

Tell them to take NAD+ boosters like NR or NMN, or even the good old vitamin B3 in large quantities (1g/day). Addiction is often a sign of NAD+/FAD+ depletion in the brain.

You keep posting this over and over again with no source. If addiction to opiates was as simple as taking vitamin B3 and solved easily with the information in an internet comment there would be multiple studies and I suspect all over the news.

Maybe if you looked it up ("NAD therapy"), you'd have found it, like this one:

https://www.webmd.com/mental-health/addiction/nad-therapy-ad...

https://pubmed.ncbi.nlm.nih.gov/31917996/

https://www.mdpi.com/2076-3921/9/5/425

"The late John P. Cleary, MD, explained that we are likely to experience strong cravings for substances like alcohol when our NAD+ receptor sites are empty. That’s because alcohol drives the formation of the chemical compound acetaldehyde, which then interacts with dopamine to yield morphine-like compounds that temporarily quell cravings and withdrawal symptoms. When the NAD+ receptor sites become unoccupied again, however, the withdrawal symptoms and alcohol cravings come rushing in, driving us back to the bottle."

While these points are valid, it's also a highly individualistic perspective. Social bodies have complexities and dynamics of their own. The obsessive pursuit of financial and political resources could also be seen as a kind of addiction, optimizing for one thing to an unhealthy degree while refusing to contemplate the negative consequences. There are certainly big payoffs to be had this way, but foreclosure of other possibilities can eventually lead to a dead end. A more harmonious, proportionate approach may not be as dramatic or impressive, but endure better.

Society encouraging people to take ownership of their actions and consequences is also part of how that would take place.

> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them

This is true for drugs in general, but not many people are stupid enough to take opiods recreationally.

> but not many people are stupid enough to take opiods recreationally.

Recreational opioid use is extremely common. People seek out opioids for their recreational value, including drug-naive users.

Perhaps we should start being honest about which recreational drugs present the greatest dangers of addiction and harm.

At least when I was in school, we were still teaching kids that pot was just as bad as opioids. You can't expect kids to find out that you're lying about the dangers of pot, while expecting them to take the warning about opioids seriously.

I know the UK did research a decade ago to rank which drugs were the most harmful for the drug user and for how the drug user treated those around them.

https://www.bbc.com/news/uk-11660210

>abusing drugs as a form of pure escapism

>start because they're simply seeking recreation

These are the same thing. Happy people don't seek to drown every waking moment in constantly escalating recreation, they got things to lose and when they are out having fun and an opportunity comes around to do drugs they are surrounded by friends and loved ones who care for them enough to not let them ruin their life for lolz.

You shouldn’t dismiss people’s opinions because they’re addicts… I agree with this hypothetical addict that you think should be ignored.

> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.

Let's be clear here: someone's stated reason for using opiates might be recreation, but nobody starts shooting heroin for recreation without some pre-existing reason for self-destruction. It's not a secret that opiates are dangerous. People with normal self-preservation instincts find other ways to recreate.

> > You are broken because society is broken.

What this boils down to is that the addict has to understand, "Society isn't going to help you, so you have to help yourself." That's important for addicts to understand because it is, unfortunately, true. But if we lived in a society which actually gave enough of a shit about its citizens to help them when they have problems, the importance of understanding that society won't help them would obviously take a smaller role.

I want to be absolutely clear here: there is not effective help for the causes of addiction. For example, a common cause of addiction is homelessness. Contrary to HN opinion, the solution to homelessness is simple. The solution to homelessness is homes. Not shelters--don't embarrass yourself with the "I don't know what the word 'home' means" argument. The fact is, 1% of the US military budget would build a home for everyone in the US. It's not difficult: the reason it hasn't happened is that there are a lot of people opposed to it. Instead, we build shelters where nobody has any privacy or feels safe or can have a pet or storage for their belongings (that's just like a home, right!?), and only in places where they don't inconvenience anyone society cares about, and then blame the homeless for being hard to help when they choose not to pretend that our half-assed solution does anything to solve their problems.

> Variations of this concept are frequently used by drug addicts to justify continued behavior.

Think about it as a policy maker. You have a choice whom to blame - an individual or their environment.

If you blame the individual there is nothing you can do - we can’t change other people.

If you blame the environment now there’s something you can do. You can try to reduce supply by making it illegal (only works to a point) or you can try to reduce demand by increasing overall quality of life - housing, healthcare, and generally a way to escape the clutches of the rat race that is life in America for so many.

>Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

Control of what? That's the point of drug abuse - what is there to be controlling? We are gears in someone else's system, purpose is rarely possible in modern society. Address why this is.

>Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.

I feel like the use of this argument should depend on the scope of the person who is speaking.

Law-makers and society-enablers should consider things in the far-scope of "society's fault", whereas this consideration is less useful on a personal scale other than for the purposes of blame-redirection.

I think quite a lot of people ended up addicted to opioids against their will, by starting with being over prescribed highly addictive pain medication which then ended up making them addicted to opioids, and then later on ended up trying to feed that habit from the streets once the easy access to pain meds dried up.

https://www.doj.nh.gov/news/2022/20220303-settlement-purdue-...

Personally I've been avoiding oxycontin like the plague for that reason. I had two surgeries where the doctors wanted to give me oxy to manage the pain afterwards and I refused to take them. It turned out in both cases the pain was manageable with less addictive options, so I'm not clear why they reached straight for prescribing opioids in the first place.

You're not wrong, but addiction is not a certain outcome. Most people who use a substance that can lead to addiction don't become addicted. The question is why can two people, for example, abuse alcohol for a period of their youth, but both don't become addicts?

We need to look at this holistically. Overprescribing is a problem, but we shouldn't be needlessly afraid of these substances. Personally I've been prescribed these medications, I took some and when it stopped hurting I stopped taking them and the bottle sat in my medical cabinet in case I injured myself later. Eventually it expired and I threw it away. It wasn't an issue of will power or anything like that. I just didn't feel the compulsion. I'm the same way with alcohol and other drugs. I enjoy it when appropriate, but I feel no compulsion whatsoever. I, in fact, prefer mental clarity.

But I have people in my life who develop very strong compulsions and become addicted to anything that distracts them from their psychological torments. Reducing access helps, but reducing other circumstances in their life that they may feel the need to numb has to be part of the solution.

> but addiction is not a certain outcome

Not certain but chances are very high with the new class of opioids.

Yep I've seen similar in various countries with a parent. They were prescribed large doses of some opioid pain killers and despite them being aware of the risk of addiction and thus being very careful about dosing (often skipping doses if the pain was tolerable and asking doctors to minimize the dose), in the end they still had a difficult time coming off them. They didn't end up trying to feed that habit from elsewhere, but it was still a lesson in how quickly a dependency can be formed.

I think skipping doses might actually increase the likelihood of addiction.

One of the things I recall that made oxycontin so problematic was Purdue's insistence to prescribe it as a 12-hour dose. There was an article I recall reading on the topic:

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

> Experts said that when there are gaps in the effect of a narcotic like OxyContin, patients can suffer body aches, nausea, anxiety and other symptoms of withdrawal. When the agony is relieved by the next dose, it creates a cycle of pain and euphoria that fosters addiction, they said.

> Peter Przekop, a neuroscientist and physician who oversees the treatment of painkiller addicts at the Betty Ford Center in Rancho Mirage, said that repeated episodes of withdrawal from OxyContin “absolutely” raise the risk that patients will abuse the medication

To me skipping doses is likely to create those repeated episodes of withdrawal which even when minor can end up screwing with the brain's addiction centers. This is why I'd rather take other options that maybe only work for 5-6 hours instead of 12, but don't build this vicious cycle of addiction like oxy does.

Huh, I wasn't aware of that. Will keep it in mind in the future, although hopefully I don't end up needing to do so.

Medication management is a clusterfuck, same with ADHD meds.

Someone people just like to get high; painkillers to H to F seems far fetched but when you are chasing that original euphoria, its a much shorter timeframe than most expect.

They’re adding Fentanyl to everything now. I have Burning Man-adjacent friends who take ecstasy once a year at festivals, and they’re terrified of getting a tainted dose.

This affects many more people than just those addicted to opiates.

Legalize everything and produce it pharmaceutically, and this problems pretty much disappears.

Yeah, and a whole host of other problems show up…

can you elaborate?

“ Illegal drugs increase crime, partly because some users turn to crime to pay for their habits and partly because some users are stimulated by certain drugs to act more violently. Legalization, however, will not affect addiction and its effects on the propensity to violence. Instead of legalizing drugs, better treatment, education, and research are needed to curb dependency on drugs and the adverse health and social effects of drug use.”[0]

[0] https://www.ojp.gov/ncjrs/virtual-library/abstracts/against-...

'illegal drugs' is a pretty broad brush, and treating opiods and psychedelics equivalently is silly. Surely treatment, education and research would all be far easier alongside decriminalization?

"Illegal drugs increase crime, partly because some users turn to crime to pay for their habits "

If all drugs would be illegal, then they would be mostly so cheap that this argument falls apart very quickly. Drugs are only expensive because they are illegal. Poppy and coca are not hard to grow and neither is hemp. And the chemical drugs are way more cheap to produce. So very high quality stuff would remain expensive, the same way a fine wine is expensive, but just to get drunk is cheap (even with taxes).

"and partly because some users are stimulated by certain drugs to act more violently."

And yes, that is true, but one of the most famous and widespread drug that makes people aggressive is already legal - alcohol.

"Legalization, however, will not affect addiction"

And this is up for debate, for some it will be easier to get help, because the stigma and criminalisation is gone, but yes, some might start it, because it becomes avaiable. And I did not look in the recent numbers, but back then when I did - in the netherlands for example, drug use decreased, after marijuhana was legalised. It is quite complex - some people are afraid of anything illegal, some are appealed by it, mainly teenagers who are in most danger of becoming addicts/developing brain damage.

"better treatment, education, and research are needed to curb dependency on drugs and the adverse health and social effects of drug use."

But this is true. And better, than jail people who simply need help.

- The black market is always cheaper.

- Even in a legal market how many people are always buying their own?

- If everything is legal then it's even easier for people to spike drinks and the like.

- Purdue Pharma marketing issue writ large.

- Patients pressuring their doctors to prescribe, or alternatively feeling pressured by their doctors to use a particular drug.

- If it's legal it's easier to purposefully or accidentally overdose (e.g. alcohol today). Especially if it's also cheaper.

Off the top of my head.

That bit about Purdue resonates with me. I'm not firmly against legalization of harder drugs, but that's a case where average people given legal access to pharmaceutical-grade medicine through proper legal venues has been absolutely catastrophic. If I were making a case against legalization, that would be my Exhibit A.

> - The black market is always cheaper.

anecdata: I'm in canada, which has legalized marijuana recently. The black market is cheaper, but all but the most die-hard stoners I know like to buy government weed, because the product is consistent and you know what you're getting.

> - Even in a legal market how many people are always buying their own?

Maybe I'm misunderstanding, but in a legal market even if I don't buy something directly at least I have vastly increased faith that i know what something is.

> - If everything is legal then it's even easier for people to spike drinks and the like.

Who knows, but I strongly doubt that there is a large pool of potential rapists at large who are currently stymied primarily due to the difficulty in acquiring GHB.

> - Purdue Pharma marketing issue writ large. > - Patients pressuring their doctors to prescribe, or alternatively feeling pressured by their doctors to use a particular drug.

There are definitely a bunch of social and policy questions that would need to be addressed when considering legalization, sure.

> - If it's legal it's easier to purposefully or accidentally overdose (e.g. alcohol today). Especially if it's also cheaper.

Almost certainly not, as the majority of overdoses are the consequence of people not knowing what they're taking, or not knowing how to take it.

Hell even in states where it's illegal people prefer to drive to a state where it is legal or get it shipped compared to "street weed." This isn't to say that the market has dried up or anything but it's clearly an inferior good in the economic sense. As soon as as an alternative of comparable price entered the market people immediately switched.

Die-hards make up the most volume for recreational substances. Alcoholics by far consume the majority of alcohol sales, for instance.

MDMA became dangerous after it was made illegal.

When it was legal, it was made by chemists in labs who cared.

The problem with legalizing drugs is ensuring the greedpigs don't take over the industry and actually dealing with the root causes of addiction.

A better way to frame the drug legalization issue is, "should pharmaceutical companies be allowed to profit from incredibly addictive drugs?"

Does that framing change your mind at all? Sure, small-time drug dealers are currently allowed to profit from it. Once they get big enough though, they're usually stopped by the DEA.

The idea of giving this enormous profit incentive to multi-million dollar corporations with huge advertising budgets is absolutely terrifying to me.

This is an inaccurate understanding of the drug economy. The drug cartels that supply the street dealers are multi billion dollar businesses rivaling the size of the big pharma corporations. And the DEA absolutely is not "usually stopping" them. They disrupt low and mid level arms of their operations with some regularity, but it does little to stem the rivers of money flowing towards the groups controlling the illicit drug trade at a high level.

Even if we presume that big pharma is a very corrupt industry and that allowing advertising of narcotics would increase drug use in some populations, bringing the production and distribution into a moderately well regulated market would likely cause a net reduction of usage and overall harm.

Didn't we kind of already try this out some with opiates? Didn't big pharma already push opiates and cause millions of people to become addicted and cause an untold number of deaths and didn't that contribute to the current situation that we are in now with opiate addiction?

I don't see how legalizing it completely where anyone who wants it without a prescription could possibly turn into anything but an absolute mess. How many millions of people will say "O, the government legalized it and I can buy it in a store, it must not be so bad, I might as well try it out", become addicted and have their lives ruined? People can't rationalize their way out of addiction of this stuff easily.

Not exactly, hence the rise of fentanyl. Prior to the rise of fentanyl, new addicts often went from prescription pills like oxycodone to heroin as their lives unraveled because prescription drugs are expensive and hard to get. Some enterprising drug dealers started enhancing their cut heroin with fentanyl which can be imported from China and is extremely dense compared to other opiates, which matters because smuggling is most of the cost. Downward pressure on the prices changed the ratio until you were left with pure fentanyl, so in effect prescription pills were not available enough and drug dealers were able to capture the market with more dangerous but cheaper product.

> bringing the production and distribution into a moderately well regulated market would likely cause a net reduction of usage and overall harm

I don't understand how adding a profit incentive somehow _reduces_ the usage. Because the government would force less consumption somehow?

If they were generic, not marketed (a la nicotine products), and used a system similar to the one used by pseudoephedrine, I think it could work.

I think there will be a really big systemic drive to stop this kind of system because if we’re doing this already for “vice” drugs, why not do it for all drugs even if they don’t get you high? This would remove tons of middlemen and give consumers a lot more control over how they get their medication.

>produce it pharmaceutically

They are... in Mexico... with expert training from China...

With no consequences for chemically altering their products... or getting people killed...

Doesn't sound too different from Big Pharma in the US, at least in certain drug categories...

The problem is not actually the production of the fentanyl itself, but the way it’s mixed in with “heroin” or pressed into pills (plus all the likely accidental contamination from using the same equipment to process fentanyl and stuff like cocaine). If the mixture is not done well, it creates hotspots that can easily cause an overdose due to a much higher density of fentanyl.

And also, this part is not necessarily done pharmaceutically, so there is no standardization of dosage or strength. Which can in part incentivize producers to progressively increase the ratio of fentanyl to <other> so theirs is “stronger”.

I think this highlights the importance of addressing the _why_ even more. Most people are terrified of accidental fentanyl exposure. Some people seek it out. Why is that?

> Some people seek it out.

who's seeking it out? The article doesn't mention it, and the parent poster explicitly say that people are NOT seeking it out.

People that are already addicted may seek out the lowest cost opiate.

Yup.

Heroin will barely make some feel well.

Fent burns the Mu-opioid receptors, once normalized, H will barely get you high.

and, of course, you literally must have it - especially, to sleep.

Why some people try it out is different than why people keep using it. Why people try it out can range from getting addicted after being prescribed something legal to wanting to escape life. Why people keep seeking it out/why they are addicted is hard to rationalize and understand and is like answering the question why do people like sex? You can't peer into your own mind, determine how its working and how you can manually change it. After addiction there usually needs to be some adverse event or events where people realize that the pain is greater than the pleasure, but there are still other people where even majorly adverse events don't change their rationale. Why people use fentanyl over other opiates is kind of simple. It is cheaper than everything else, there is a high supply of it, and it is stronger than everything else.

It’s important to some people’s culture and religion.

Test strips: https://dancesafe.org/

Or on amazon

They give these out in NYC, but make a point to say that the test strips won't catch everything. So still be really careful if you go this route.

Yea it’s like skiing in avalanche terrain. Forecast and observation don’t remove the risk

Yep. I've seen bowls of those available for free at various events. Even if I'm not going to partake of stuff that would need those, I'm happy to see them passed around freely.

Test strips are just as or almost as illegal as the drug themselves in many state. Except without the huge profit margins to incentivize dealers to carry them.

Why are they illegal?

"Paraphernalia."

IN my state it is a felony have a reagent that say tests for THC whereas ownership of the THC itself is legal.

That's idiotic. I put it right up their with "let's reduce pregnancy by making it hard for teens to get condoms so that they don't have sex".

That's very confusing to me. Criminal drug dealers of course want to lower their costs and maximize repeat business, even if that hurts their customers. But people consume different drugs for different reasons, and I don't see the economic benefit in giving them something orthogonal or opposite to what they're actually looking for, when it would be cheaper and safer to just dilute with some inactive filler material.

A likely explanation is that China is using the cartels to wage a 21st century opium war. (The obvious link to China being that China produces most of the chemical precursors to fentanyl, and until recently produced most of the fentanyl itself.) The average American drug user isn’t the customer; he, or rather his eventual death or disability, is the product.

More parsimonious explanation is that the PRC bureaucracy isn't going to waste resources cracking down on precursor producers for legal medicine ingredients when it doesn't cause domestic issues, or issues in the majority of countries, including other eight nation alliance members that have exploited China far more than the US. Like why wage 21st century opium war against only 1/8 of historic grudges. The primary incentive to assist the US med system driven opiate crisis prior during periods of better relations was because it was politically worthwhile to waste PRC resources to cooperate on US war on drugs. If PRC really wants to be nefarious, she would engineer less lethal drugs that keep victims alive longer to drain more American resources. And she would move back to actual drug production instead of maintaining olive branch precursor production. In so much as working with cartels on state level, IMO PRC benefits more from intelligence / influence of triad + cartel relations as they try to make headway into the Americas. The actual killing Americans is incidental because Americans will reliably find other ways to OD.

the cartel, albeit advanced, are basically a village idiot on the ground for the PRC. this all makes sense.

Fentanyl deaths are rising in many Western countries, not just the US. Plus, the US is the primary geopolitical rival to China and hence the most relevant target. It's not worth the effort for China to exact revenge against, for instance, Austria and/or Hungary because neither of those countries are relevant to China now.

It's accidental, the deadly doses are so low that just not separating them perfectly when weighing or packing might contaminate the other.

It’s not always added intentionally. I think a huge number of those deaths are complete accidents

The two chemicals are made in the same superlabs in Mexico, with the LD-50 (lethal dose in half of average users) of one being 4 magnitudes (1,000) the other.

My fentanyl experiences have entirely been as part of surgery: it's part of the balanced triad of anaesthesia and I "recently" injured myself quite badly, resulting in three operations. After one of these, I spent about 36 hours on a fentanyl infusion and more than a month on oral morphine of various doses with my leg in an orthopaedic brace while I was bed-bound. I should point out that the alternative was a lot of screaming: visceral pain of the variety I cannot describe – I had a panicked, "help me" expression on my face and just felt utterly, utterly desperate. I was in a lot of pain and medically the drugs were appropriate, given the injuries I sustained.

I totally get why some people become addicted to drugs. Diazepam made me both in less pain and care less that I was in it. The opiates produced this warm, fuzzy haze of vivid dreams and imaginations and made a difficult time bearable. Fentanyl made me feel less than human but not able to suffer, and it was a necessity at the time.

Of all of them though, diazepam was the most dangerous. It just felt – well, nice. I didn't care that things were bad. I needed it medically to stop neurogenic muscle spasms and it made me both able to sleep well and feel OK about life in a way that is really hard to put into words. I have some in a bag, prescribed for me, in case I need it. Part of me – a small part of me, but a part nonetheless – wants to use it, a lot, when I don't need it. There's a little voice that just says "this makes you feel like you've been tucked up into bed nicely". I really can't explain it, but I know that voice is a temptation and a gateway to something that I don't want to have – but at the same time, I know that that drug both saves me from agony and helps me medically if I need it. I'm really not sure how I feel about that. I haven't had any in months, but the psychological aspect remains.

I can only imagine what "real" drug addicts go through. It must be incredibly hard, and individual's range of experiences will be very broad indeed.

Once you actually don't need it anymore, throw it far away and do not look back. Benzos and opiates ruin lives because of that little voice. That voice will be strong enough one day that if you have those close by you will take a few, because why not?

That voice is the voice of addiction. Once it starts it never fully goes away. It just gets less frequent.

My mother spent 6 weeks sedated with Fentanyl, on top of Alzheimer's. After a few days I realized she would survive. But she was in a hellish state for over a year, hallucinating and constructing parallel realities.

Ironically, she worked on the UK medical trial for Fentanyl when it was first introduced for surgery.

Fentanyl is strong but short acting opiate mostly used during surgeries. I am curious why it was used for such a long duration as 6 weeks.

I think you assume folks want to check out of life because they think fentanyl is a better choice, when instead fentanyl makes folks check out of life. Have you ever spoken with an addict who wants to get clean? It's bleak, they're basically enslaved by the substance. Having a vaccine to break the cycle is a huge boon.

I guess I'm a bit torn on this. Even if we had an extremely fair and equitable society with growth I imagine there'd still be plenty of people who feel rejected or lonesome at times. Or just like the feeling that these drugs give them above normal drugs.

I drink alcohol a couple times a week and do edibles once a month. I'm sure some would argue I'm not fulfilled but I think the easier explanation is that a lot of times doing mind-altering drugs is...fun? And can be social.

That sounds like a healthy amount of drugs. For people with self control like that, I think it would be healthy to trip once or twice a year and use stimulants (cocaine) for a party once a year.

A heroin vacation to an opium den on occasion sounds wonderful.

I certainly have used drugs socially (LSD in clubs or concerts can be fun), but also use them cannabis alone frequently.

This is the crazy thing about this whole issue. Some people can use drugs that are extremely harmful responsibly. It's a once-in-a-while excursion away from ordinary life. There's nothing wrong with having a scary drug, like heroin, a few times a year...except that for some people it leads to their entire life unraveling.

This idea that we're all the same and because drugs are physically addictive (i.e., sustained use leads to withdrawal of use ceases) means everyone would become addicts if they tried it is a D.A.R.E. style falsehood. It's true for some, but seemingly not most.

Even drugs/activities that don't seem physically very addictive, like pot and gambling, seem to have their addicts. I question what proportion of addiction is chemical and what is something deeper going on.

It's a pity though. I don't think I'm prone to addiction, but for the sake of my fellow humans and a functioning society I reluctantly accept that these things shouldn't be widely accessible. I've become much more of a prohibitionist as I've gotten older.

I appreciate the selflessness and pragmatism. Many responsible users are much more dismissive of prohibition.

It seems selfless but not pragmatic. Prohibition doesn't seem to make the opiate problem smaller, it just makes it more dangerous for users, the public, and the people selling it.

I have known quite a few friends from earlier in my life who became serious addicts and ruined their lives or ended their lives by it. I would not describe a single one as having started using because they were mad at society, sad, or lonesome. It was always some strange kind of strange, arrogant fetishization of drug-life and crime-life. There is an almost "drug life is THE life, and everyone else is lame" attitude in many circles, and I got a little too close to comfort to falling into it at one point in my life.

This doesn't mean there aren't a hundred reasons people get trapped in drugs. But a very real one is just because many people come to believe it's cool and tough, and end up fetishizing it until it's too late to get out. And like I said, in my hometown, this was the predominant reason.

Were they bored, did they not have exciting career or family prospects, was it ennui? Low-grade emotions can lead to addictive behaviors, not only high intensity trauma. The decision to subscribe to a malignant anti-authority lifestyle still shows that something is wrong, if it becomes so attractive an alternative to forsake one's life for.

Reading HN, I get the strong suspicion many people didn’t grow up around drugs.

People don’t always think they are throwing away their lives. They think “this makes me cool” and “it’s no big deal” and “anyone who’s anyone does it”. Often there’s the confident assertion “this ruins other peoples lives but I’m too good/special for that”. And often they don’t even realize it’s a problem, even when they’ve hit rock bottom, even when they’ve ruined their families lives for their drug addiction.

I’m not claiming other, much sadder reasons don’t exist. Or that we shouldn’t do something to help people survive and recover, like this vaccine that could mean thousands of lives saved, thousands of fewer mothers crying at funerals.

But there is also a lot of personal responsibility involved, and we can’t make this claim, that I see so many people on HN try to make, that people who have ruined their life (and more importantly, often their families lives) thru their own choices have no responsibility. That it’s all fault of vague “society” and if we just ban together with <vague handwavy socialist/utopian/whatever vision>, that people will stop making bad decisions about their lives.

Society doesn’t have to be a big nebulous thing. It can just mean the immediate family, the community, the town, the local economic situation.

> The decision to subscribe to a malignant anti-authority lifestyle still shows that something is wrong, if it becomes so attractive an alternative to forsake one's life for.

"anyone using [opioids]...wants to die, just a little, i think"

> Why do so many people want to check out of life completely by abusing medicine?

This isn’t how it works.

Few people, if any, want to “check out.” What happens is that people are exposed to opiods via one of two channels (they are prescribed painkillers, or they party with someone who has acquired them) and they quickly get hooked because these drugs are cripplingly addictive.

So the only “why” questions we have to ask are:

1) Why do people take opiods the first time

2) Why do people continue

The answer to 1 is either because their doctor said so, or because they like to party and have no foresight. The answer to 2 is because if they stop, they experience the worst sickness imaginable.

Society is not broken and we don’t need weird conspiratorial explanations for any of this.

>Society is not broken and we don’t need weird conspiratorial explanations for any of this.

Life expectancy plummeting through deaths of despair, juxtaposed with widespread addiction (as much to drugs without physical dependence as opiates).

I think it's

> 1) Why do people take opiods the first time

that the GP is getting at. While doctors over-prescribing opiates is definitely a thing (esp. in the US), I'm not convinced that many people get hooked on opiates due to partying. I think it's more commonly:

"Used as an escape from a life that is unmanagable for some reason"

That's not conspirational. There's good evidence to show that life circumstances have a big effect on both initially becoming addicted and success when attempting recovery. The answer to this might look like a better welfare state or similar.

I think it'd be more likely that someone discovers opioids mask their pain while using them for legitimate purposes. After that is when gaming the doctor, street buys, and finally substitutions take place.

There are plenty of other fairly common reasons that don't involve simple escapism, with young people it's just as likely to be simple peer pressure or experimentation. It also doesn't help that it's common to treat drug highs as some sort of enlightening experience that needs to be experienced to understand.

Except that its nonsense. People know what opiates are. If you keep taking them and dont stop, you get physical withdrawal. That wont happen over night and its not "the worst sickness imaginable". And unless you did something even more stupid like switching to methadone it will be over in a few days.

It is quite simple, at some point, you decided to continue taking them despite knowing this to be problematic.

I would also like to add, that i have met very few addicts who blame the drug. Its most of the time relatives who like the story of their loved one getting tricked.

If it was only the fear of withdrawal, the opioid crisis would be solved next week. Literally. But the unfortunate problem is that people relapse. Because what ever made them take opioids every day didnt get fixed with a withdrawal. And if your life still sucks, its very easy to go back.

"investigating systems in their totality rather than focusing on isolated interactions within them" is not inherently conspiratorial. It's far weirder to suggest that "more people want to party for no particular reason" or "more doctors prescribe pain meds for no particular reason" than it is to suggest reasons that might contribute (say, "more people are suffering from chronic pain than before as the disparity between productivity and wage has widened" or "pharmaceutical companies are naturally incentivized to sell as much of their product as possible and those incentives may occasionally drive morally dubious decisions").

You make a good point regarding incentive structures in pharma - but this is nothing like what OP was saying. OP is asking for a “Frommian psychoanalytic approach,” whatever that is.

Your point about chronic pain increase is totally implausible. Automation of manual labor should result in less chronic pain, not more. The problem here is overprescription, and it’s my fault that my comment didn’t make that clear.

As regards:

> It's far weirder to suggest that "more people want to party for no particular reason"

I never said that. The number of people who want to party and have no foresight has remained constant. But access to opiods (and their normalization) has skyrocketed, due to aforeforementioned over-prescription.

Sorry, I missed this reply when you made it 11 days ago. Happy to respond:

Automation of manual labor _should_ result in a _lot_ of benefits to workers. But here's the thing: Automation is, largely, capital. And under capitalism, ownership of capital is private. That means that the benefits from automation are largely under control over the owners of it. And that ownership is for the purpose of making a profit. It is more profitable to automate as much as possible while simultaneously working the workers who are left as hard as possible, while paying the minimum amount to successfully do so.

This leads to a situation like we have in the U.S., where productivity has massively skyrocketed while median real wage has actually _decreased_ since the 70s. That median real wage means workers who can pay for less for a given hour for work, which means workers who need to work more _somewhere_ in order to support their conditions of work (pay for a place to live, pay for food, etc). Working more hours means getting less rest, which means less recovery, which means ::drumroll:: more chronic pain. The stats bear this out, and it's trivial to corroborate: The lowest-wage earners work more hours for less pay than they did fifty years ago, while percentage of take-home that goes to mortgage/rent has increased. This is a recipe for misery, and the most unbelievable thing about it is that it's not patently obvious to everyone. "Over-prescription" exists in those conditions: Pharma both has the incentive to sell more than is necessary, and no incentive to cure the actual _cause_ that bring people to seek a remedy for pain in the first place. "Partying", in this analysis, is not just a thing people "like to do" that they are now suddenly doing with more-abundant pain meds--it is a thing people are doing _with pain meds_ because those meds are _the thing that makes the general pain of being alive easier to deal with_, a thing large-scale abuse of substances (notably, alcohol) has been doing for thousands of years, where increased consumption has correlated strongly with increased human misery.

The party to addiction pathway is very regional, only affluent or hard-working teens can transverse that.

Probably because it feels good.

Sometimes the simple answers are the most likely. Even if you have a great life, it’s tempting to have such experiences.

Sure, a lot of people use it as an escape though. But I imagine my dumbass brother in law died because he was trying to have fun, not check out of life. Miss him.

> Probably because it feels good.

This is the dirty little secret of 1980’s-style approach to keeping people off drugs: they feel great.

The old (current?) approach suffers from intellectual dishonesty of ignoring the physical pleasure.

I think you presume that human behavior must seem to have a cognitive reason for the "why", when it's entirely possible that the "why" is simply physiological/neurological. In the case of intense opiates, which have a profound effect on human neurology, it would be bizarre to not consider that in the "why".

I think this undermines the issue a bit. A lot of people get addicted to these substances completely by accident and aren't initially seeking to "check out of life." But once you are hooked, it can be a devastatingly difficult road to get off. For sure there are plenty of people who go out looking for escapes and I do agree it is something that needs to be addressed.

Usually the "society" issue is framed as some sort of welfare crisis. I have a more-than-one-hand-full of friends and acquaintances from earlier in life who ruined or ended their life with drugs. And so I don't know anything statistically, but I have seen what caused the people near me to fall into it, and it wasn't some welfare crisis.

The number 1 reason I experienced is because some social circles fetishized it. It was a very cool, tough, and a superior lifestyle. Anyone who didn't do drugs was a loser, drugs were for winners.

When there is a strong cultural-current of this attitude, it can draw people in and ruin their lives by the time they realize it's all wrong.

I've seen some of this as well, though through my own anecdotal experience people in my life I've seen struggle with drugs do or did so because:

1. Ongoing health issues they can't afford to resolve. Chronic pain. Mental health issues. Sleep disorders.

2. Inability to cope with high levels of stress due to financial insecurity, bad relationships, or loneliness.

I think the cultural attitudes you describe may have some relation to other problems. Most people I've encountered seek escapism when their life experience is poor and they're unable to change their circumstances or unaware of ways to change their circumstances.

I think my point is that it can be both. There is a lot we can do to help in the cases you point out. But I just don’t think the problem is entirely solvable, or even mostly solvable, without changing a destructive sub-culture, which we can’t do in any way I can think of.

At least we are working on things like this vaccine to save lives. That’s something.

> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine?

I don't do powders, opioids, etc but I do have some friends within tech and the festival scene that do. My observation is that most people that die from fentanyl don't know they're taking it. They think they're doing cocaine, ketamine, heroin, or some other substance. Fentanyl presence is usually a case of cross contamination when the particular substance is being cut at each hierarchial level of the drug food chain. That's not to say that there isn't some small subset of dealers who don't purposefully drop in some fentanyl, but largely that'd be a stupid decision. The users life expectancy shrinks and their risks skyrocket when they come in contact with fentanyl, this is known.

If you want to stop the deaths, then you have to allow drug distribution that comes from clean rooms. At present, everyone should be using test kits, but fentanyl in particular is hard to test for because a single grain hiding in a mound can get and overdose a user.

If you want people to stop using drugs, well, I have less to say. The history of humanity is using intoxicants whether it be for recreation, psychological well-being, or medical necessity. We've only recently in the history of humanity gone on moral crusades to villainize it.

Chemically addictive substances are a little more challenging. Things like heroin, cocaine, and methamphetamine aren't drugs you can benefit from, but people still do them. Largely, it's because they got hooked on pain killers or some other "numbing" medication. Better availability to harm reduction resources, therapy, social safety nets, etc would improve metrics across the board in the chemically addictive substances category.

Humans were not evolved to resist these kinds of poisons. Nothing like this exists in nature. It’s an extremely potent chemical.

It's not that nothing like this exists in nature, it's that evolutionarily speaking nothing like this existed in the areas human first evolved. Or if they did, we either evolved to resist them, thus no longer see them as toxic, or we're still in an arms race with the life that produces them (which means they would be much less toxic than fentanyl, but still toxic).

Plants (and fungi, and animals) evolved to create noxious chemicals that keep animals from eating them, keep animals from breeding, or outright kill the animals. The Golden Poison frog's toxin is about 40 times more lethal than fentanyl.

The golden poison frog looks pretty scary to me. The yellow color. The big eyes. I would not try to eat it. But a white powder or pill that is equally lethal doesn’t ring any evolutionary alarm bells.

Could you please link to or expand about plants producing toxins that specifically keep animals from breeding? It's news to me, and a web search has failed me. Is that long-term pest control, or something else?

The term you want to search for is "phytoestrogens".

From wikipedia: "It has been hypothesized that plants use a phytoestrogen as part of their natural defence against the overpopulation of herbivore animals by controlling female fertility.[3][4]"

Though wikipedia also says: "These compounds in plants are an important part of their defense system, mainly against fungi.[19]"

So it could be that plants are principally targeting fungi for the most part, and just serendipitously targeting animals as well.

I'd say the opposite, nature creates all kinds of powerful attractants and poisons. There are plenty of things that will kill you at the micrograms dose. There are plenty of natural things that are horribly physically addictive.

> The real issue here that people don't seem to want to face is the WHY.

Drugs get you high. Ants get drunk, goats chase psychedelic lichen, and dolphins pass around puffer fish like a dutchie.

> Why do so many people want to check out of life completely by abusing medicine

The short term benefits always outweigh the short term costs, but we're moving to a point in history where even it even seemingly outweighs the long term costs. There's no real disincentive anymore.

I think a case can be made that Martin vs. Boise had the most to do with this. That ruling was meant to push cities into creating the necessary facilities and number of beds to correctly address their homelessness problem; instead, it seems that many cities have used it as a way to entirely ignore the issue.

Instead of building the facilities, they're just throwing up their hands and allowing the kind of "public camping" that quickly turns into public open-air drug markets. Unsurprisingly, the population and markets grew.

> A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.

The twelve steps are about quite a bit more than "just" that. They're also targeted towards a person that is at a specific stage of addiction _and_ willingness to address it. It's not general purpose and you can't force people into it, particularly when their drug of choice is so easily available and socially acceptable.

You have to reduce the inflow of drugs. You have to stop drug markets from forming. You have to convince addicts to seek treatment.

On the last point, I think the most effective strategy would be confiscation. If you are caught with drugs for personal use, they should be taken and destroyed, and you should be given information and transportation to a treatment center if you desire. Otherwise, you should be free to go. If the state doesn't interject itself at some level then I don't think you stand a chance.

>You have to reduce the inflow of drugs.

And this is how we get fentanyl. Why import 2 tons of drugs when you can import 2 ounces with the same power.

Attempting to reduce the inflow has just created a violent black market and a dangerous police state.

There is so much reductive thinking in this thread, it is painful. Fentanyl has been on the market since the 1960. The deaths started spiking in 2014. Did we step up enforcement majorly in 2014? Or did something else start this rise?

Why import anything if you could produce it domestically? Is it possible that basic enforcement has obvious impact? If we allowed labs to produce it domestically, do you think we would see more, or less? What mechanism drives that outcome? What if this is already starting to happen?

The creation of the DEA has had a negative value outcome with respect to the amount of drugs in our society, I'll grant you, but I have a feeling that's due to it being setup as a paramilitary organization as opposed to a knowledge and tactical care based organization focused on the ground level issues surrounding actual users and user/dealers.

Fixing society doesn't increase revenue. The opposite, actually.

For example: The more people are depressive, the more pills can be sold. If people kill themselves due to depression, that's too bad, but they didn't buy any pills to begin with.

Diabetes is great, because people depend on insulin. A never-ending money maker! Fat people are great! They eat more, thus spend more! Some of them get their fat surgically sucked out of their bodies, which also pays! When they get more and more sick, they need more and more medicine, which pays even more!

The transhumanism movement is awesome, because transitioned people require pills! Every day!

Sadness? There's a pill for that!

Drug addicts? Lets invent a vaccine for that!

Fantastic!

Society isn't getting fixed, because nobody actually has any interest in that. Those in power/money certainly don't give a fuck and rather want more money, while the actual people are mostly too stupid to figure out that the whole system needs changing.

Instead they whine, complain and protest and go voting, without realizing that it does basically nothing. Yes, voting actually does nothing. We didn't get to this point because voting helps anything. We got here, because voting doesn't matter.

Decades of evidence lay in front of everyone out there to see, yet for some reason every couple years people actually believe their button-pressing/their X-making actually gives them power over what's going to happen!

There's no vote allowing you to change who pays all the money to the politicians, law makers and judges. There's no vote that allows you to change the underlying corruption that's going on. There's no vote that enables you to decide what actually happens with your money.

You're fucking hilarious. You're not wrong per se, but also hilarious.

"Society needs fixing!!!111" well then get together with enough people and fucking fix it.

Politicians won't do it for you.

Better get your guns ready, btw, because it's definitely not going to happen peacefully.

A good metaphor for addiction is speeding. You're driving down and empty highway, you want to get where you're going faster. You're not going to actively look down at your speedometer. You know you're probably breaking the prescribed limit a bit, but who cares. The when you finally are faced with looking at the speedometer, say when you get to windy section or a speed trap, you look down and you're going 25mph over the limit and you have no idea how you ended up going so fast, but by that time, you're brakes are squealing or worse.

I would ask a different 'why', which is 'why is fentanyl so easily accessible?'. We know where it's made, how it gets into the US, a long list of reasons for why people start taking it. But why hasn't the supply of fentanyl to the US been restricted?

Given how many lives this destroys, how many people it takes out of the potential workforce, how many social problems this causes (crime, homelessness, exasperated mental health issues) - why isn't there the political will to change this?

I answered this at length in a forum some months back and sadly can't find the text (for now).

The abridged version is: there too much money to be made.

Fentanyl has gone from direct primary import (which was blocked) to banning of exporting precursor drugs from bulk suppliers in China (to slow down | stop Mexican drug labs from mixing them to make Fentanyl) to where things are today ...

relatively mobile "popup" drug lab networks that start with bulk pre precursor drugs to make the precursor drugs that are funneled to final product labs.

It's a hell of a whack a mole game across Mexico, the USofA and Canada with a process that's tough to break, the initial drugs used are too useful for too many things to ban outright and the production aspect is broken down into many replaceable parts.

( I had references to most of those stages in the original comment, apologies for not having them to hand ).

Appreciated, the context is useful.

Do you really think that Michael Jackson and Prince wanted to "check out"?

My assessment is that if even people at that level of wealth and success can get addicted to opioids and die, pretty much anyone can.

Addiction, whether alcohol, drugs, cigarettes, etc., is something that is a genuine medical issue needing treatment. Thankfully, the medical community seems to be shaking off the social stigma about addiction and treating it properly now, but progress has been very slow.

While I agree with you, at the same time, I can't help but think having someone take a pill or shot weekly/monthly/etc is whole lot simpler and easier than fixing the homeless problem, the cost of medical care, and training up (and paying) hundreds of thousands of new mental health professionals, among the dozens and dozens of different reasons people turn to drugs like this to 'escape'.

Do we have a clear picture for where we want this to go in the future? Though not exactly the same, does this start to walk the path towards a "soma" equivalent?

> Why do so many people want to check out of life completely by abusing medicine?

Painkillers can provide relief for emotional pain as well as physical pain.

Even something like Tylenol can help people going through painful breakups.

Unfortunately opioids are addictive and users build up tolerance, which is bad for people with chronic pain of any variety.

It's not that simple: https://www.wcvb.com/article/ex-cop-describes-descent-from-h...

> I'm not talking about "more 12 step" here but more of a Frommian psychoanalytic approach.

Do you have any evidence that that works better than (say) buprenorphine or naloxone, which target the underlying neurological problem?

>The real issue here that people don't seem to want to face is the WHY.

I doubt that it's always a "choice". But it wouldn't surprise if there was many main causes.

There’s also the medical systems unwillingness to help certain people and medicate; then people end up on the street getting more dangerous drugs in an uncontrolled fashion.

Something else I wonder is how have we managed to convince generations that smoking is not only horrible to your health and frowned upon but alcohol is acceptable?

Do you think at any point in the last 100 years if drugs were readily available uptake would be low?

“It is no measure of health to be well adjusted to a profoundly sick society.”

Also, this: https://www.dailymotion.com/video/x305n83

Whoa, you’re so out of touch with reality. Yikes.

Because it is there.

I'm homeless and living in the Tenderloin in San Francisco.

People here want you to

- Be in a gang (or a prostitute, thief, ex-con and so forth) - Be on drugs (or in rehab for drugs) - Have a mental illness (so you can go to therapy) - Be disabled - Find religion

There isn't a position for "I ran out of money and my family wouldn't support me, and at some point finding web development work became too hard as the technology became more complicated." People want you to "get better." I don't do drugs, I don't smoke, I don't drink, I don't steal or assault anyone.

I just don't have any money.

But people here are morons. They need to have a reason for why someone is poor other than "I'm a person of average intelligence that doesn't know how to find a paying job in this society." I don't want to be psychoanalyzed, be put into rehab, go to church or join any number of the lonely people who have to have a support group because society is awful. I don't have problems other than being poor - if you managed to buy into the crypto ponzi scheme at the right time then no one is asking you to "find god" or "get better".

People are social animals. If you put them in a position where those are the options (jail, crime, drugs, psychoanalysis, religion, disability) they'll take the least unpalatable. There's a whole lot of people who walk around here with canes they don't need because otherwise the San Francisco General Assistance office won't spring for them to have housing. Also known as an apartment with a bed and a door that locks.

If I make more than 1500 dollars I lose my health insurance through Medi-cal.

And I'm no defender of a lot of these people. The bastards that set up tents on the sidewalk and smoke meth are just awful. But on the other hand, I have absolutely no idea how to get a job. None. I've done construction before and all I ended up with was bad memories and scarred hands. I could work "security" by putting on a t-shirt and standing outside a soup kitchen, but that's just bullshit make work the charities give out so the poor can buy shoes and feel special about themselves. Real security jobs outside of bars are a good way to get killed. And that's about it. I'm staying at a homeless shelter and have the clothes on my back so how am I supposed to get a job?

There's your why.

So let me give you a when. When, not if, your industry is automated or the code becomes too complicated for you to understand anymore you'd better have enough savings or a social network so you don't become homeless. Or you'll have to crawl into one of the buckets that allows society to make sense of you.

And today I'm sitting in the San Francisco library looking to make a contribution to a software project for free and I just don't know that I care anymore. And if you tell me it'll get better, then I have to ask if you're about to be laid off or not and what your plans are.

Thank you for sharing. I'm sorry.

You've explained this much more clearly than I've seen done before. Maybe because I hear my voice in yours.

Skip the web dev and be a writer. Surely other HNers can hire patientplatypus for this?

If you check the comment history it is unlikely that anyone here wants to listen to what this person has to say, let alone provide them with work. I have skimmed through a few of the comments and IMO there is nothing in there that warrents the downvotes / dead comments, which appear to not even get replies (tut tut HN, breaking your own "rules" again)

I do wish this person well however, I hope luck smiles down on them soon.

This comment will go the way of the dodo soon enough .!.. :-)

I’m not sure why it’s getting praised. The guy hijacked a thread discussing drug addiction so he could get on a personal soapbox and drone on about his own problems while trying to diminish others.

It was in response to this comment:

"The real issue here that people don't seem to want to face is the WHY."

They provided an answer to "why?". I think thats fair. Maybe I am wrong. I checked further on the comment history, it appears to me someone has it out for this person, as the other topics are not soapboxing at all, and most or dead without comments.

Care to discuss further?

Upon second reading, I misinterpreted GP and I don’t think they had any bad intent. So apologies to them for that.

As for the shadowbanning I’m not sure either. It’s not particularly new and like you kinda mentioned they don’t really say anything egregious, at least that I saw. Some accounts seems to be shadow banned at creations and the user doesn’t seem super active, but I’m not sure how all that works under the hood. I guess it’s even possible the GP comment was already dead, and was later vouched.

It seems relevant to me in a discussion of a vaccine to prevent people inadvertently getting addicted to drugs and having their lives spiral out of control for someone to bring up what it's like when you're not addicted to drugs and have your life spiral out of control.

GP mentioned that it's expected he'd be addicted to drugs because then the system would be able to categorize and address his needs better.

It's not a 1:1 match for the article topic, but I come to HN for the comments, especially ones that engage my curiosity, like GP's did.

I've been homeless and I think part of that is just for someone with no problems it doesn't make sense to be inner-urban homeless in these crim-ridden areas. I assume those people are all fucked up for one reason and therefore as a sane person I don't want to be around them.

I had a very strict rule when I was homeless. Stay away from other homeless people. Camp on the edge of town. Ride the bus into rural areas.

How did I get a job with just the clothes on my back? I hitch-hiked to north dakota in the oil fields where a man is a man and they don't give a fuck what you look like. They hired me to do day labor, and once you have enough money for a van or a short stay airbnb it only gets easier from there.

Get the fuck out of tenderloin, and san francisco at all costs. Hitch-hike if you must. If you want guaranteed housing you can also look into doing seasonal harvesting work for fisheries in alaska. They'll pay your flight from seattle and then cover your food/shelter while you're working.

Yeah, this right here.

Fishery: paid for transportation to the job, free housing and food on the job, and at the end of it you have a couple grand that hasn’t been blown on anything — free to do whatever you want with.

Tough work. You’re on a boat for 1-2 months. You work 12ish hours a day. If your body is able (or you can make it able), it’s good.

Next up is getting housing and cleaning yourself up for greener pastures. Oil fields is one. Lineman/tower climber is another.

Easy six figures. After a year of doing nothing but work, figure out what you want to do from there.

The work will distract you from your problems, and the change in environment will reset your mindset.

Lots of well-paid trades work in Washington for people that don’t have anything to lose.

I can't guarantee that I can help you find a new job or master skills but I'm willing to try. My email is kodah@pull.dev.

I'm sorry for your situation, but you also have to realize, things are partly your fault. You mention you could be a bouncer at a bar, but you would have to go to the gym to develop enough muscle. And possibly start using chemicals to alter your bone density and muscle mass. In your situation, I'd say you have to go "all in" on something, whatever it is. If you just half ass it and complain that the world is against you, you will not go anywhere. That's just how it is.

`And possibly start using chemicals to alter your bone density and muscle mass.` Just when you think you've seen some depraved/inhumane takes you see someone suggest that actually this homeless person deserves to be where they are because they're not risking enough of their health by taking hgh/ped to get a meager paycheck as a bouncer at a bar where they could very well get stabbed or shot providing security for a bunch of tech workers that hate their guts.

` If you just half ass it and complain that the world is against you, you will not go anywhere` This man is homeless what are you talking about?

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