Expert sounds alarm on new wave of US opioids crisis
theguardian.com
theguardian.com
These retired agents didn't see the drug war as a war on "bad guys," but as an effort to stop the destruction drugs wrought in people's lives. After all their work, their own government undermined their efforts.
My own doctor was taken in by Big Pharma's sales pitch and wound up going to prison for over-prescribing their pills. https://en.wikipedia.org/wiki/William_Hurwitz. Though to hear Big Pharma tell it, there was no such thing as over-prescribing.
If you want to get an idea of how out-of-hand the prescription frenzy got, take a look at John Temple's book American Pain, which describes the pill mills in South Florida. Towns in Appalachia used to send charter buses to these pharmacies. After a 12-20 hour bus ride, each passenger would pick up hundreds or thousands of pills, then ride home to sell them in their small country towns.
Some of the pill mills, which were fully licensed by the state of Florida, were cash-only and would haul garbage bags full of money to the bank each day at closing. For a summary of Temple's book, see https://adiamond.me/2020/01/american-pain-by-john-temple/
The damage that the US-led war on drugs has done throughout the world is staggering. It's probably going to take decades until all the brainwashing and propaganda washes away and we get some form of legalization in Europe, not to mention other parts of the world that take it even more seriously.
The drugs aren’t making a conscious choice of destroying someone’s life. Those agents are. They’re by definition worse than the drugs (premeditated vs not).
Psychedelics likely have various mental health treatment uses but they are for some bizarre historical reasons considered dangerous.
Mental health medication like benzos are also tricky. They are amazingly affective but also amazingly addictive and withdrawals can be fatal
Any drug with a high is a dopamine button. It’s easy to hit that button instead of doing something else to feel good. It’s easy to stop doing other things in favor of just hitting that button all day. But the effects of that button diminish over time, so you hit it more often, and the more you hit it the less other things you want to do.
Psychedelics powerfully activate and deactivate different parts of the brain, changing the way you think and process information. Controlled and intentional, this has huge potential for positive mental health outcomes. With chronic recreational use, cannabis leads toward negative mental health outcomes like depression, disordered thinking, anxiety, and low agency.
Quitting is an interesting grey area for cannabis; culturally and functionally people misusing the drug are able to do so indefinitely, usually not reaching the “rock bottom” emergency state that other drugs (hopefully) convince the user to seek treatment. So it feels like “just weed” isn’t serious enough to warrant a 30 day treatment center, but the behavior patterns can be so ingrained it can be hard to see breaking them without.
The sense of increased focus after smoking is a big plus for me, but the decrease in focus after that coupled with the overall disorganized thinking is a big minus. Disorganized thinking can be great if you are trying to generate a variety of ideas, but bad if you are trying to communicate them. Learning more about what is actually happening in my brain with focus, memory, agency, etc has been one of the biggest motivators in pulling back from chronic use. I don’t enjoy it much knowing that I’m avoiding other things or going to be grumpy and depressed later because of it.
Agree about the grey area for quitting. There isn’t a rock bottom, but with chronic use there is a kind of dull limbo where everything feels harder to do, but you’re demotivated to make a change. It is literally a drag - it slows and lessens you overall.
What helped me quit was really seeing it for what it is - it was making a few hedonistic experiences “richer” but kind of draining the color out of all the experiences outside of that. I never had any negative effects while high - like anxiety so it seemed harmless. For practical tips think of something to do for the first few days at least when you’d normally toke up if youre just bored at home. Out with friends, walking, playing a new game, hobbies, etc
Young man laid up at home with nothing to do but sit on the couch playing video games and drink beer. Add in a big bottle of pain pills to take "as needed" and you've got an addict.
When he recounted this to be, he was frustrated that they didn't give him a small prescription to start with, but more or less gave him a large quantity up front and let him dose himself.
He managed to beat the addiction, and when I'd met him it was in a software development gig so it's not like it ruined his life or anything. He certainly wasn't happy with how casually he'd been treated was the jist of the story.
Edit: just realized I had a different friend at the same company who had been on benzos and dealt with the withdrawal... The three of us chatted quite a bit and I imagine that was the context for the conversation but it's been a decade or so.
I did recover, though. Today, I run 40-50 miles a week, lift 6 days a week, work in software making five times what the Army ever paid me, haven't touched a painkiller in 7 years, and don't even drink.
Make of it what you will, but people are individuals and medical policy should reflect this. Pill mills are a problem but physicians deserve the judgment and discretion you should expect of someone we spend up to a decade training and licensing.
Fast forward to 2022, she needed heart surgery and was in the ICU for three weeks afterward. She never asked for pain meds and regularly refused them when asked. I think she had became so accustomed to denying people pain meds, that she even denied herself, though it was clear she was in pain.
[1]: https://www.nytimes.com/2019/08/18/health/opioids-purdue-pen...
One can learn how to handle pain yourself. Some people went very far with this.
While younger, I was a bit advanced in those technics - basically it is about accepting the pain and working with it.
In my theory, pain was like a alarm sound - and a painkiller just deactivating the alarm, but therefore maybe stopping a adequate body response.
Nowdays I got a bit softer as currently I am on weak painkillers, but a very low dose compared to the recommendations. And for my (disease related) empty stomach, this is probably way better. Also less extra stress on the liver and kidneys.
But even so, I experienced the feeling, that can put people into the path of addiction. Just one more pill and everything feels fine again. No more struggle, being calm again. But this is dangerous.
To this day I'm still surprised by it, and appreciative for whatever it is that allows my body to apparently recognize and then silence the pain signals.
https://www.acep.org/life-as-a-physician/ethics--legal/emtal...
Some hospitals voluntarily do more than the law requires to treat such patients.
So somebody with a serious medial condition could be discharged, but only once that condition was treated and unlikely to further deteriorate. And then there's also a bunch of other rules hospitals that accept medicare have to follow for all patients, which are similar in spirit to EMTALA. And then there are going to state rules on top of all of this. Violations are severe with penalties able to be imposed on both the hospital and the doctors/staff involved - up to and including loss of license, and they are not covered by malpractice insurance. And the courts have invariably ruled on the side of patients, so I don't think there's any doctor that's going to be looking to try to short-serve the requirements of the law. Part of the reason you can find a million negative articles about it!
https://www.theguardian.com/tv-and-radio/2021/aug/03/cocaine...
I also get so frustrated with all the border bullshit. Doing anything at the border is trying to solve the problem two thousand miles from the root cause. And pretending that migrants (people trying to come to the US permanently) have anything to do with drug runners is about as stupid as it gets.
Do no harm was destroyed by the knee jerk reaction by the government.
Now, my poor wife is in constant debilitating pain from hypermobile Ehlers-Danlos but gets treated like she's drug seeking. While multiple joints are dislocated.
I wish everyone who made decisions that led to this mess would suffer what my wife suffers, and get treated the same way by the medical establishment.
I’ve had similar experiences with them not giving me proper painmeds are having all 4 of my wisdom teeth removed. They gave me 2 weeks of Tylenol #3 and some homeopathic bullshit and expected that to be good enough. Luckily my stepdad is a serious medical patient with lots of the good stuff, but it’s bad when I’m raiding my own parents pill closet to get any sort of relief after that many wisdom teeth came out all at once.
I can see the argument here morally (and I agree with it), but in practice I know far more people negatively affected by drug addictions and drug addicts than I know people unable to get pain management medication they need. I imagine my experience may be typical, and so I am unsurprised the pendulum has swung so far.
Then you may see the unitary flaw in the system, at perhaps a larger scale, wherein people are not receiving what they need. One "right-sized" problem, not two problems. Why addiction, or better, why addiction now, what has caused the rise in such? Whatever that need was, were it met, would prevent addiction and we might then cease adding yet one more special of lenses, mirrors, and films to our ever-evolving panopticon, one more trackable in the Salesforce of the Surveillance State.
We need to look at some reasons as to why people can see, say, Tranq in Philadelphia and say, "That looks like my best option, there."
If this is indeed a spectrum (certainly debatable), with increased access definitionally increasing addiction, the argument that one side of the spectrum is strictly better is wrong.
Maybe it hurt you that bad, but it’s not par for the course.
You should have stopped there.
Luckily, when I called the dentist back and frantically explained the situation, they let us get an opioid. She took a minimal amount, and was able to function normally. She only used a few pills in total over the course of a couple days, but it prevented absolute heartbreaking agony.
So that’s great that it worked for you. But your case has no bearing on somebody in the other situations either, so you don’t need to bring it up as a gotcha.
Opiods seem to be treated as almost essential for dental surgery in the US, and as a rare escalation path elsewhere.
How do you measure that? Opioid overdoses accounted for at least 72,800 deaths last year [0] and there are countless more addicts out there whose entire lives are ruined because of that addiction. Many of those people, if they ever recover, will never take opioids again for any real medical pain relief like you did for your wisdom teeth because of the very real risk of relapse. Additionally, opioid withdrawal is, according to almost everyone who's gone through it, is one of the worst experiences you can feel.
I'm not taking the side that it definitely doesn't outwheigh the need of those who genuinely need them. On the whole I actually probably agree with that. But stating that so confidently and ignoring the very real pain, lost lives, and broken families caused by opioid addiction because you had your wisdom teeth pulled and wanted opioids feels pretty dismissive and not a serious argument.
They blame the coal barrons for not leaving anything behind. They certainly had some problems, but many of those were handled a generation before the closures, especially for the union mines. The problem was more systemic than just coal barrons leaving nothing there. You had multiple entire industries essentially die off. Mines closed, steel mills closed, many factories closed (a lot of shoe, textile, and home goods). Part of that was consolidation from local and regional brands into national ones. Another large part of it was globalization and outsourcing manufacturing to cheaper markets. So what were these barrons expected to leave behind if there were no jobs to create? It seems to me the blame lies more with the CEOs of the national brands and the sectors that replaced manufacturing. We don't see any real tech presence in the smaller Appalachian cities (aside from some pork barrel defense firms in a couple). Instead, we have a vicious cycle of population concentration and all the problems that come with that.
That the Sackler family remains at liberty is conclusive proof that the FDA was bought and owned on the question of opioids, and had no ability or intention of acting in the public good. Most other countries would have stopped this.
A similar theme pervades most of the checks and balances of the U.S. Constitution in general. These were brilliant controls in 1789 that have long since been disabled by an ocean of cash.
“It’s so easy to demonise Purdue and the Sacklers. I agree that what they did was terrible. I think a number of them should be in jail. But I’ve thought for some time that the issue behind it all is the structure of the system,” he said.
I really do get that sentiment, but IF the USA legal system had properly prosecuted Purdue execs from the get-go - there's a reasonable chance others would have been less inclined to also play the 'but what we're doing is technically not too illegal' card and try to run the same playbook.
The structure is doubtless a legal manifestation of Swiss cheese, but that doesn't mean the state can't react violently to a violent attack against its most vulnerable citizens.
https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...
The problem I have with your statement about the legal system is IMO Purdue and the Sacklers corrupted the justice department, legal system, and various Federal agencies. This was not some overnight thing. This took decades of works by multiple generation of the family. The system we have today is in large part thanks to the Sacklers.
Though Dopesick did make it fairly clear that federal agencies had been corrupted, as part of the original approval granting process. They didn't properly explore that angle, unfortunately.
- https://www.smithsonianmag.com/smart-news/1000-mile-long-sto...
-https://mallhistory.org/items/show/274
100 years and more information than ever, yet we have’t figured out this out-of-sight, out-of-mind problem.
Every problem has a different solution, but our inability to mobilize and solve the problem before it becomes a crisis seems to share a common theme.
Namely that our representatives and government officials have chosen to ignore the problem; I feel journalists have played a large part in exposing the problem and even then it's been an uphill battle.
> Or do people just not know how to solve it? What would you propose as a solution?
The political will to treat our fentanyl and opioid addicts is sort of there but the funding is not. Right now governments have been battling the Sacklers in court and it seems our collective state and federal government isn't really winning.
I'll go back to the Dust Bowl: My fantasy is to bus all of the addicts to the people who need to see this non-stop. No violence.
Bring them to the state/Federal officials where they work of course, but I'd love to see them bused to near the Sacklers' home; and to their retreats of choice. Non-stop. Until there's nowhere for them to run except out of the country.
And the opioid-wealthy become pariah until they clean-up their own mess.
As an immigrant who never learned how to be politically active and am a bit old and crusty now, I wouldn't even know where to start; but it's a fun fantasy at least.
The center of this country (outside of a few major urban/sub-urban areas) is hollow.
Between the loss of agriculture as a family job, loss of industrial jobs, and opioid use after decades of methamphetamine use, it's bleak.
And no one really cares. As a general rule, we're told, "just move to Chicago (St. Louis, Kansas City, wherever)". That's not a solution, or a possibility for a lot of folks.
Then we need to work to make it a solution and a possibility, because I don't know what the alternative is. I'm from Appalachia, though my former oil-town retains a meager amount of relevance via the nearby industrial dairy farm. The owner of the only grocery store retired and nobody was interested in taking over, so the storefront laid empty until the government gave tax breaks to a hardware chain to set up shop and stock a little corner in the back with groceries so that it wouldn't become a food desert. But the situation isn't sustainable; there's not enough jobs. The population is declining. Most everybody drives to neighboring towns to work. I got out and moved to a big city, and wild horses couldn't drag me back.
I love the idea of small towns; not everyone needs to live in a big city (and almost nobody should be living in a remote cabin in the woods either; what an isolating experience). But if they're not economically viable, I'm not going to pay people to live there just so that small towns can continue to exist as a concept. What I will pay people to do is move to a city where they can find opportunity, and fight for more housing so that it's more affordable to do so.
these things are not written in stone, or the laws of physics. Layers of policy and taxation choices have led to this. Nothing says that the current system is stable, either.
When my wife and I drove to Kentucky--from NYC--for a road trip in the late 2000s, it was disappointing just how much more of the same we saw. Back then, it was strip malls. Walmarts.
A lot of the day-to-day Americana and culture we were hoping to see was simply fantasy or diluted, as most of the money--and therefore the culture--comes from large companies and interests.
The problem is this is completely untrue. One party had been talking about coal-mining industry ending and promoting job retraining for over a decade if not longer. Federal funds were administered to pre-empt this exact problem that was foreseen. That same party had frequently about the need for social programs to support this transition so people can still be productive. The problem is, this party never wins in Appalachia - all of their policies are ignored. Nobody takes the job training. Everyone locally votes against it and opposes those social support systems.
The problem isn't costal elites ignoring the issue, it's that no matter what one party does to help resolve the problem the other party says don't trust them do it on your own. Which isn't possible when entire industries aren't viable any more.
It's pretty similar to people desperately needing health care in the same regions and yet refusing to get it because it's been slandered by the party they vote for.
Fundamentally the issue is that one party has not supported policies to help this region for ages, but still gets voted for due to a few key touch button issues.
What are you talking about? Appalachia was a core part of the FDR coalition. From 1932 until 2000, West Virginia voted Republican just three times: Reagan, Nixon, and Eisenhower (each just once, in landslide re-elections for those candidates).
West Virginia and similar places were the base that provided the majorities for Democrats’ social welfare programs of the 20th century. Who is more qualified to conclude that whatever crumbs they get from social welfare don’t compensate for the downsides of economic change from globalism and social change from immigration?
I would imagine the American development pattern makes the economics even less favorable. Cars are very expensive and most (all?) small towns are designed exclusively for car-dependency. Infrastructure cost scales with sprawl too, so city costs to maintain infra are presumably high per-capita.
I'm not sure what the solution is. We could subsidize rural areas more (we already do quite significantly, but clearly the handouts aren't sufficient). But I think in the end we have to accept that times change, and certain lifestyles just aren't sustainable.
My wife and I presently had twins, and we spent 7 days living in the hospital with a lot of help from nurses and so on, and it cost us $130. Which was me paying for 3 days of living there because the 3 days was the max you had to pay. Sure I pay 39% in taxes on the first $120k of my yearly income and then around 55% on anything above this (well except for a bunch of sort of loop holes to invest before taxes), but it’s basically still pretty nice to have that sort of healthcare system.
I’m bipolar type 2 and I have ADHS. Now in case you don’t know, this involved a lot of trial and error with a psychiatrist to find the best medication for me. During this I learned that many prescription medications which are “normal” in the US are illegal or at least only used in extremely severe cases here in Denmark, because of how dangerous the side effects are. This is due to heavy government regulation, because we don’t elect politicians the way you do. We don’t have a winners takes all system which tends to lead to conservative governments which are heavily influenced by the private sector. Hell, you can even see it in our own local “opioid crisis” which was caused by deregulation by right leaning government (though to be fair, Danish conservatives would probably be considered communists by US standards).
As I understand it, you Americans have the ability to both influence national and stateside policies. So that if your national government fails you, then you can still regulate your local laws. Which probably should have meant voting for politicians who would regulate your healthcare system in your states and ban medicine that is clearly a threat to public health. That you chose to not do this, and then blame your costal elites is just baffling to me.
But maybe I just don’t understand your country well enough?
The other big issue, is like a lot of things in the US, if someone has money healthcare is great. It's probably the best in the world. Those who get elected have money and don't personally feel the healthcare issue. Heck, politicians at the federal level have their own healthcare system making them even further removed.
One of the biggest voting blocks is seniors, and they have already have access to what many say could be a step towards universal healthcare if opened to everyone. So they are also not inclined to think about it too much.
All in all, it's complicated.
Fun fact... many people know that Coca-Cola originally included cocaine as an ingredient, but fewer are aware that 7-Up was originally made with lithium.
"The product, originally named "Bib-Label Lithiated Lemon-Lime Soda", was launched two weeks before the Wall Street Crash of 1929. It contained lithium citrate, a mood-stabilizing drug, until 1948... Its name was later shortened to "7 Up Lithiated Lemon Soda" before being further shortened to just "7 Up" by 1936."
I have been misdiagnosed a number of times and was finally treated in the US for a major condition the doctors missed here in Denmark.
We get a number of privileges for our very high tax: childcare is cheap, education is free, and births cost us virtually nothing but let's not try and overstate the value of our system to theirs. Ours too is broken, it's just a matter of degrees and where.
Our middle-class, in return, gets taxed to high heaven while our income disparity between rich and poor continues to widen.
I think healthcare in the US is beyond messed up. In my area which is a large city in the North East US it is very difficult to be able to get into ER because rooms are filled with people who are trying to get non-urgent care. These people have no money, no insurance and their only way to get care is to go to ER. System is rotten to the core.
I also did not get your last paragraph are you talking about the US or Denmark? I would be shocked to hear income inequality problem is worse in Denmark.
The less said about our mental healthcare the better.
> I also did not get your last paragraph are you talking about the US or Denmark? I would be shocked to hear income inequality problem is worse in Denmark.
I was shocked too when I first heard it but live here long enough and it's very obvious. Income inequality has increased over the last thirty years with a Gini coefficient of 30 [1] in 2022.
[1] https://www.dst.dk/en/Statistik/emner/arbejde-og-indkomst/in...
While all systems have their issues, it cannot be undersold how absolutely captive American health is to the profit motive of private companies. If it does not leave room for profit in the US, we are told to die.
I would love a Medicare for all, because that's the most cost-effective system we can possibly get short of having no system at all. It'd also increase job mobility--nobody tied to their jobs for "benefits"--and put a sane check the price of basic-level care.
However not all countries with public healthcare are drug-free--Portugal just manages, not solves, its problem despite 50 years of public health--and that's because the incentives to both sell and use these powerful painkillers don't merely go away with a public system. Medical doctors were also complicit; or the more responsible ones, yanked-away the prescription out of caution but unintentionally drove their patients to the black market.
I'll concede that a streamlined system would have helped alert the powers that be sooner, but I'm not convinced that the powers-that-be would have done anything concrete until it became a crisis.
I'll keep my reasonable tax rates and absolutely top notch health care I receive through my employer, thank you very much.
You really don't. You live in a country that is either 11 million or 6 million people with fully enforceable border controls and immigration controls. You can control who comes into you country. You can control the goods that come into your country. Your population rivals one of the larger metropolitan areas of the USA.
Problems don't scale linearly. At 6 million people you can afford to fund pensions through nothing but an oil extracting operation out of your country. 7.7% Unemployment at 11 million people is, believe it or not, much less debilitating than 4% unemployment at 332 million people. There are more unemployed persons than the entire population of Sweden. And these populations cluster, and they depress local economies, and they drain their local workforce and social services. Then crime happens, and populations move, and housing prices fluctuate, and then this spreads. But here's the trick: You only need so much space to live. So much money to eat. So much space to grow food. You only have so many hours in the day you can work. Any doctor can see 20 patients a day, spending 30 minutes on each consultation. You don't need that many doctors to meet that demand at 6 million people. You need a lot more doctors to meet that demand at 332 million. Costs and living standards are relatively fixed beyond a tolerable level of comfort. Scandinavian countries achieved this comfort. But this comfort doesn't scale. Because problems don't scale linearly.
Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri. Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are.
The GDP difference seems more than enough to counter it, maybe, but socially, geographically, and historically, the US is a relatively libertarian project where "high taxes and free healthcare" are anathema.
Isn't that just the last 4 decades though? Before that, US had very high taxes and was not against spending on social programs. That all changed with Reagan and after, but it's not some set of core American values, but rather just the current, and relatively recent, dogma.
> Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri.
Short of draconian measures like in China (also a very large country), which nobody wants.
> Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are.
This is what I want to dig into. The heart of this argument is that publicly funded hospitals are forced to cover for those who neither contributing to the system nor are paying out-of-pocket for it.
> So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient.
Are you certain the EMTALA is really the cause of the problems we see today? I agree that it made it worse, but the cost of medical care was ballooning before the 1980s. I'm not sure what it was so I'd love to hear input from you or others.
Still, you do bring up a good point: Given that you have individuals that can't contribute to the system even if they would otherwise and given that it will also balloon costs, how do we solve this?
Perhaps its a taxation issue.
I doubt this will ever get traction but I'd love to see a compromise where we replace the blanket constitutional right where "you're a citizen if you're born here" with something different but equivalent at the amendment level.
Chasing down and returning migrants--this just funds the very problematic human traffickers--is a bandaid solution; it's inefficient; and it doesn't solve the needs of both Americans as well as our neighbors.
Instead, why not just ID them on the spot--state level with RealID, to make it palatable--make them pay a fine that is effectively the cost of a tax to fund the public infrastructure; and make such an ID either the requirement of using the triage service.
Or if they're undocumented, just treat them once and give them a choice after triage: Deportation or ID.
Carelessly thought out, I think that this sets up a two-tier residency system ripe for abuse: If said "temp" residents had children, what's the status of their children, for example.
But that's an incredibly unpopular solution. Every politician goes around orally fellating the small business ethos because it feeds into the meritocratic delirium. So essentially, Americans will backhandedly wail about illegal immigration while eating cheap fast food and hiring them to paint their walls.
There have been attempts to implement an ID system, especially when it comes to voting locally. But it was deemed racist. Because it meant only citizens who had the ID could vote. And some citizens didn't have IDs. And a portion of those people were poor minorities. And they didn't want to get them because it infringed on some rights. Or something. So America has this contrived system of registering to vote where people get tricked into also registering their political affiliation which is often used by politicians to sling mud at other politicians and political statisticians to pull slightly more accurate numbers out of their asses.
In some locales you straight up have to register with your affiliation to be able to vote. There's a significant segment of illegal immigrants who may or may not vote to support local political constituents that have their interests at heart, and a political party that appeals to those illegal voters. This political party uses this voter demographic for their benefit, because these local political constituents that are voted in have a voice in who the party as a whole can nominate for higher political parties. Since part of the political establishment is based on elections are based on representatives who then choose other representatives. And so the cycle continues.
Also, nobody wants to fucking pay taxes
It's the opposite, actually. Denmark is a part of Shengen zone, which means it has no border controls at all. When you enter neighboring country, you'll only know this because a sign on the road will tell you so. Similarly, migrants are free to roam entire Shengen zone and get in and out of Denmark as they please (unless emergency measures are introduced to stop them).
I’m not sure where you got the idea that we have right border control, we basically have no border control. Sometimes we have temporary border controls, but typically your only checked if you’re “suspicious” (which means non-Scandinavian looking, in a weird car or transporting goods”, or very unlucky. It’s been like this since the EU opened its internal borders. I’m usually not even checked in border control when I fly within Europe.
As far as keeping illegal drugs out, well, I imagine we’re like every country considering we can’t even keep drugs out of our prisons.
Do you imagine for example that the non-broken healthcare systems of the world are what is preventing opiate addiction there from becoming as severe as it is in the US?
Most young adults have no pressing need for healthcare except possibly birth-control pills for the young women (since those require a prescription in the US) and if the millions of young adults in the US who have become addicts during this crisis had unmet health-care needs at a significantly higher rate than their counterparts who did not become addicts, addiction researchers would almost certainly have noticed by now, and I probably would've heard about it from journalists who cover the issue.
Oh, yeah, I’m not saying that healthcare is the only factor or even the most important factor, just that it is relevant (and it does seem to be where the US opioid crisis _started_; oxycodone and similar were made available in ludicrous quantities as a substitute for actual medical care).
Granted, it is probably much harder to put the genie back in the bottle now it’s out there.
Anecdotally: cardiologist, inpatient rehab, dental work, maintenance medication, labs/blood work, mental health meds/counseling, ER visits and ambulance rides, and more.
These are things that non-addict young people do not usually need unless they’re big athletes or suffer from serious trauma.
Having access to these things also improves the likelihood of a full recovery from addiction (IMO).
Politically, it's nearly the opposite, where conservatives use the outcome of the epidemic as evidence that cities are dangerous hellholes, and actively fight solutions to minimize harm (monitored usage sites, needle exchanges, etc).
In terms of generally ignoring solutions to the problem, politicians as a whole seem to be the problem, rather than it being a city vs rural thing. Most likely liberals don't care about rural areas because they aren't winning those voters, and conservatives need the epidemic to harm cities so they can use it as fodder, so they won't help the rural areas, especially since they're going to win those areas anyway.
Also, it's kind of wild to blame the dust bowl on politicians and the coastal elite when it was primarily farming practices to blame. Why are coastal cities to blame for ignoring a problem that doesn't directly affect them when the affected areas are actively causing the problem, and not solving their problem locally? In the end it was the politicians who solved that problem.
This fear was so pervasive they had my terminally ill father on stupidly high doses of methadone which nearly killed him, simply because they were too afraid of prescribing more traditional opioids.
One thing that was jarring, though, was that American sites tended to talk about strong opioids as aftercare as a matter of course; European ones never mentioned them. I got by on ibuprofen, myself.
[1] https://www.technologyreview.com/2023/08/11/1077750/why-is-i...
Our society is too heterogenous for us to make public benefit a goal. Every type of benefit is perceived as a zero-sum game.
Add in the fact that Americans tend to vote against their self-interest(1) in order to conform to the ideology with which they identify, and it’s turtles all the way down.
(1)This is more easily recognized when viewing the behavior of some other group, but it’s identifiable among all groups.
While I feel blessed my healing went well, I was only in pain that might've warranted more than a NSAID for about a day. With nothing to do as I was on leave from work, I enjoyed the bliss of the opioid high, but thankfully did not became an addict.
My entire 30+ year existence was shaped by this, and I never even used.
A lot has to do with the availability of health care in Europe (universal health care), and specifically addiction care.
I'd wager that Europe and most of the world was slower--thankfully--in adopting a new painkiller like Oxycontin and dodged a bullet, by seeing what the US was already facing.
We start with over-prescription of opioids. Pharma companies make money selling them. Doctors may even make money in kickbacks (a practice that should be illegal).
The disastrous War on Drugs that made opioids cheaper and easier to obtain (eg black tar heroin) than cannabis.
Those who became addicts from a legal prescription turn to illegal products. Illegal pills are expensive. Street heroin is much cheaper.
To feed this habit, it eventually leads to crime. And what do we do with petty criminals including those charged with drug posession? Whey we incarcerate them of course. That's expensive and ineffective but prisons create jobs. Some private prisons have a direct profit motive to fill their prisons as they're paid by the state per-inmate.
Oh and convict labor is yet another profit opportunity.
A lot of people self-medicate because of unresolved trauma, just as a coping mechanism or whatever. If you're an average worker this might be just going to a bar and having a few drinks. But that's relatively expensive. Poorer folks would once sit out on the streets or in a park, often in a group, and do the exact same thing except it would be a bottle in a brown paper bag. If you're homeless, you're even more likely to self-medicate.
Yet police harass the second groupo. We criminalize all sorts of things, including feeding people [1].
Fentanyl makes all of this worse because it's so cheap to produce that it laces other drugs to give them a kick. The amount can wildly vary so you may accidentally get a lethal dose.
We have a societal failure by robbing people of basic hope and dignity and then profiting off incarcerating them.
[1]: https://www.jacksonville.com/story/news/2014/11/05/90-year-o...
The Sackler family was shielded from any consequence solely because they have money and power.
People will sometimes ask me why I sound so pro-China at times. It's not that I'm pro-China, its that I'm jealous of China. That if this happened in China, the Sacklers would have been executed by the state for the substantial harm they caused to society to make a buck and the message sent to others that they will not get away with this anti-social behavior.
I lived in China for years; it's the ultimate authoritarian state--the amount of control, and the degree to which it has been perfected, is astounding--far beyond what Russia or any other authoritarian gov has.
This hasn't always been the case but it is now.
Because I've never seen stats to back that up, other than that illegal synthetic opioids are the leading cause of OD.
Those aren't necessarily the same thing, and I would like to know more about the actual reason behind OD's.
The number of overdose deaths are spiking, driven by fentanyl. That is 100% fact based.
Now you have to make a qualitative judgement: I think most ODs are accidental when this is studied. Did a whole shitload of drug users just become unusually suicidal? I would say it’s safer to assume “no” unless you see evidence to the contrary.
http://publichealth.lacounty.gov/sapc/MDU/SpecialReport/Fent...
Look at figure 2 here: https://nida.nih.gov/research-topics/trends-statistics/overd...
If you have good opioids in hand then there's no need to buy opioids of uncertain strength from dubious sources. Thus your dosage is more controllable.
If your supply is reliable then there is no seesaw of deprivation when you're out and overindulgence when you're flush.
For further data, apply the same logic that keeps people from oding on alchohol.
Th way I see it, alcohol issues wouldn't be reduced if you made it illegal and less people drank it, but now people are drinking unregulated moonshine that makes them blind or kills them because it contains methanol and isopropanol.
Opioids are incredibly addictive. At one point something like 25% of the male population of China 'regularly consumed' opium, i.e. they were addicted to it, and China has always been a country with at least a certain sense of order.
Opium is also special, even among other dangerous drugs. It takes over your brain's reward system and makes things you previously regarded as pleasurable as uninteresting compared to opium. It permanently destroys people.
Making it common as beer is a terrible idea. Rather I think it's likely that the opium sellers and everyone associated with the distribution and marketing of opioids need to be dealt with quite brutally.
Don't think of things like carfentanil as a drugs. Think of them as chemical weapons.
Given the choice between antidepressants and opioids, I'll take opioids.
Let's take the moral failure out of it. Imagine if Tylenol was random dosages that ranged from fake to a dosage that would induce total liver failure. That would be absurd.
Any entity participating in an endeavour which as part of its activities distributes, markets or which through propaganda or political action defends the use of opioids must be destroyed, because opioids are a chemical weapon.
They aren't 'illegal drugs'. They're a means to destroy somebody, and that is all they are.
But just answer the question plainly. I really want to know.
What I know about the opioid class of drugs is that tolerance builds so the dosages commonly increase, too much stops the heart, and trying to stop causes violent withdrawal.
To me, opioids sound far more dangerous, enough to get its very own disorder.
At the risk of pedantry, opioids don't work directly on heart function.
Too much opioids in the system cause respiratory depression. That can go on to become respiratory arrest, which can then cause cardiac arrest.
Same end result, but the point is, opioid overdose is primarily a respiratory concern. In my county some EMS do not even carry Narcan (which is a debate in itself) but are directed to focus on positive pressure ventilation and transport to ER or, if carried, to gently titrate Narcan such that the person becomes gradually more alert at the ER and may be more open to addiction help, rather than the "heroic dose" that you get with IN (intra-nasal) Narcan.
Antidepressants increase suicide risks for some while decreasing for majority, saving large numbers.
More people in US die of overdose than suicide.
You're advocating for Portugal's model, but note that it's subject to economics and politics (see https://knowledge.wharton.upenn.edu/article/is-portugals-dru...), while the withdrawal symptoms are not.
I think a two-prong approach is necessary and I worry about the perverse incentive of healthcare specialists or medication experts wanting to maintain a pool of addicts long-term.
I had an informal debate with a former roommate--and to help him along the above was the one counterargument I thought of and I still don't have a good solution. Opiods are in a class of their own.
wtaf? this is literally what caused the current crisis in the first place
Government leaders do not want to clearly define the rules, but still want to pin the problem on others. If the government makes the rules clear, and the policies result in failure, then they get blamed.
If the government outsources the policing, then the government leaders can point fingers and satisfy public outrage, at the expense of the affected public which is not politically powerful enough to do anything about it.
Unless it’s absolutely chronic pain, I think we’ve definitely over prescribed even in Europe. (Source: german)
I refused it and endured the pain. The physicians had never seen anyone do that before.
Hydrocodone was sent home recently with a family member after surgery, any this same person had oxycontin years before after a broken leg.
I've only seen fentanyl as an injected solution in hospital settings, including my own.
But I agree, being completely pain free shouldn't be an expectation unless you are terminally ill. Much less for acute or injury related pain.
On a side note, in hospitals they probably wouldn't need as much pain medication, if they invested in better mattresses, lighting and food.
What does legit pain care look like? Does it include the prescription of narcotics to outpatients on an ongoing basis, or for more than a couple days? While the safety of oxycontin was misrepresented, I assume there are still some problems with how other narcotics are administered to outpatients.
Oh, sure, let me just go ahead and write up a national level opiate plan here in a HN comment. I'll get right on it. /sarcasm
A sibling was on low dose hydrocodone for years for back and ankle issues. Seemed to be fine from my perspective.
I realize this begs the question of is "chronic pain" basically just an addiction? I'm not qualified to answer that though.
I also wonder how many people, including physicians, really understand the transition required. I had an elderly friend who went on some sort of narcotic after a surgery. They were told after the fact that since they were on it for a month, it would take them a year to wean them off. I don't have the dosing or med name, but that seemed insane to me. It was ultimately a contributing factor in their death due to some side effects and other complications.
Imagine if handguns were really good at treating pain, but had like a 30% chance of killing the patient. Would it be puritanical to not prescribe handguns to everyone with pain?
And if patients who thought they would not ruin their lives were upset about not being able to get handguns and complained about engaging in “handgun seeking behavior?”
Because that’s the deal here. Prescription painkillers are effective and easy, but are extremely dangerous. Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction.
OxyContin should have been used for legit pain care.
If they were "as effective" they would not result in more pain.
Additionally, pain ruins more lives than opioids and has been doing so for thousands of years. Ever tried to hold a job when you're in agony and have only slept a few hours that week?
People with untreated or untreatable pain tend to just kill themselves. That is NOT a better outcome than addiction.
At present removing pain from people requires highly addictive substances that I consider to be chemical weapons or tools for destroying a person. Without a breakthrough-- some kind of non-opioid non-brain affecting painkiller, there's no way to achieve pain reduction without destroying the person.
It might be puritanical, but puritanism worked. A society with opioids doesn't.