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> Addiction is a predictable outcome of inequality and lack of social safety net in the US. If you don't give people any way to solve their problems they'll settle for feeling better about their problems.

Opiate addiction doesn't give a damn about the size of your bank account, your social class, or how loving your family is.

The president's own son has struggled with addiction. Heck go back in history and you'll find the roots of the Opium war in China are tied to the emperor's own son dieing from an opium overdose.

Opiates destroy people at the neural level.

Yes there needs to be medical interventions for addicts. There also needs to be enforcement actions to reduce the supply of the drugs in the first place. Don't just target street dealers either, this crisis started with Perdue and other big pharma players. They shouldn't be able to wash their hands of responsibility simply by writing a big check.

> Opiates destroy people at the neural level.

So do coffee, tobacco, antidepressants and antipsychotics.

Coffee and tobacco are not neurotoxic

Sorry, that's wrong, at least as far as caffeine is concerned, and certainly as far as adverse behavioural effects ("behavioural toxicity") are concerned in humans.

https://www.sciencedirect.com/science/article/pii/S131901642...

Oh, interesting, thanks. I'm not sure why you're downvoted. What about nicotine?

No idea on that front. The caffeine one struck a chord because I'm a slow metaboliser, and it can cause me issues with anxiety under the wrong circumstances. It does make me wonder how many cases of anxiety are at least exacerbated by genetic issues with processing caffeine and other stimulants.

Curse you science! Still, this is just in rats. Rats with their weak rat brains. My superior human brain can easily absorb this caffeine with no ill effects!

That Kang et al. study was 50mg/kg of caffeine administered three times a day. That would be about a hundred cups a day of coffee for my body weight. Don't they say the dose makes the poison?

Opiates are not neurotoxic.

There are many reports of opiate neurotoxicity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949075/

https://www.pharmacistsmb.ca/files/2001/May-June/Opioid_Indu...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007125/

Neurotoxic in the sense of having adverse events of a neurological nature.

Neurotoxic does not mean “your neurons are damaged”, at least not how those articles define it.

So there are two totally different definitions of neurotoxic used in the medical field?

No, the scientific field uses it differently than the layman.

Neurotoxic to a scientist means “can have negative impact to neuron function, whether temporary or permanent”.

The layman thinks neurotoxic means “kills your brain cells”.

What makes you think any of us were using the lay definition?

Because if someone said “opioids are neurotoxic” from a scientific definition, it’s stating the obvious.

Both definitions are correct.

From Wikipedia:

> Neurotoxicity is a form of toxicity in which a biological, chemical, or physical agent produces an adverse effect on the structure or function of the central and/or peripheral nervous system. It occurs when exposure to a substance – specifically, a neurotoxin or neurotoxicant– alters the normal activity of the nervous system in such a way as to cause permanent or reversible damage to nervous tissue.

Brain cells getting killed is a normal process, you could call it pruning. Cells grow back, you know!

Both contain practically the entire family of beta-carbolines, which includes several neurotoxic alkaloids.

People oversell this stuff. I was on hydromorphone for a week, and some times fentanyl, and I still have some oxycodone left.

One year later, with the spare oxy in my closet, do you know how often I take it? Zero times.

These drugs helped me handle, with minimal fuss, massive physical trauma. And for 9/10 people opiates are not addictive. You will ban them and rid doctors of them over my dead body.

Did the opioid epidemic simply not happen in your world?

> Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.[0]

> OxyContin taken at 12-hour intervals could be “the perfect recipe for addiction,” said Theodore J. Cicero,[0]

> Patients in whom the drug doesn’t last 12 hours can suffer both a return of their underlying pain and “the beginning stages of acute withdrawal,” Cicero said. “That becomes a very powerful motivator for people to take more drugs.”[0]

Richard Sackler:

> When another family member sent him a press cutting in 2001 about 59 deaths in a single state linked to their drug, he responded: ‘This is not too bad. It could have been far worse.’ Then he asked a friend why addicts deserved sympathy, since ‘they are criminals’.[1]

Preventing companies from pushing doctors to prescribe medication in a manner that encourages addiction isn't anything like saying they should be banned.

[0] https://www.latimes.com/projects/oxycontin-part1/

[1] https://www.spectator.co.uk/article/the-scandal-of-oxycontin...

If you've never needed a high grade analgesic, you're going to lecture from a screen. But I recovered without significant emotional trauma and with great sleep and rest as a result of a month of oxycodone which I tapered with ibuprofen.

The opioid epidemic happens because 1/10 is a crazy ratio. It means every doctor is creating multiple addicts a week.

I'm fine with them denying this degree of painkiller to most people so long as ones like me can receive it. From my actual lived experience that it is not addictive, and that all of fentanyl, hydromorphone, and oxycodone were tremendously helpful, I'm not going to go along with this banning stuff.

The ratio is probably more like 1/5 if you believe the results of the Capture Rates study on wikipedia https://en.wikipedia.org/wiki/Substance_dependence.

That said, I agree with you that patients who need these drugs should get them. I had to get emergency surgery a few years ago and they also gave me morphine, oxycodone and fentanyl at the hospital. I find it hard to imagine how awful the experience would have been without medication.

> That said, I agree with you that patients who need these drugs should get them. I had to get emergency surgery a few years ago and they also gave me morphine, oxycodone and fentanyl at the hospital. I find it hard to imagine how awful the experience would have been without medication.

Almost no one is suggesting this medication should be banned. A significant driver of the problem was that Purdue pushed heavily for 12 hour dosing periods despite knowing that the medication wore off in only 8 hours for a non-negligible number of patients. Their motivation for this was explicitly financial.

Patients were faced with following the dosing periods Purdue were strong-arming which meant enduring 4 hours of pain, finally salved by an addictive opiate or taking the medication more frequently than prescribed, running out early, and exposing many of them to black market alternatives.

>> Addiction is a predictable outcome of inequality and lack of social safety net in the US. If you don't give people any way to solve their problems they'll settle for feeling better about their problems.

>Opiate addiction doesn't give a damn about the size of your bank account, your social class, or how loving your family is.

He didn't say that addiction only affects poorer or more marginalized people, he said it's more likely to affect them. Which is true. Yes this means the president's son can get addicted too. Anyone can. Which is why it's a big deal for people with less access to resources such as expensive rehab and medical care

> Buprenorphine just makes opiate dependence more manageable.

"More manageable" is a very creative way of saying less deadly, I congratulate you on your turn of phrase.

In all seriousness though, buprenorphene has a number of benefits aside from being difficult to overdose on. It lasts much longer and lacks the euphoric effects of other opioids. People on buprenorphene tend to get their life back together, and if you're truly concerned about getting someone off opioids that's a much better starting point.

> it doesn't make you stop wanting to change how you feel

that's actually one of the things buprenorphine and methadone help with, but as you point out it's easier for that part to work if you have a good life already

> Addiction is a predictable outcome of inequality and lack of social safety net in the US.

I don't know why this keeps getting repeated. The southern neighbor of the US, Mexico, suffers from greater inequality and substantially less social safety net and does not have any comparable opiate situation as the US.