A few years ago, I talked to three retired federal law enforcement agents who had each spent 20+ years fighting the cartels that were bringing drugs into the US from Mexico and South America. All three felt betrayed by the US government. They said, essentially, "We put our lives on the line many times to try to stop the flow of drugs. Then the government turned around and basically gave the pharmaceuticals license to sell this stuff professionally, through people's personal physicians."
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/
My mom worked as an ER physician in Pennington Gap, VA during the early years of opioid abuse there (late nineties through through the early oughts) [1]. She would constantly complain about drug seekers there and refused to give out pain meds. According to her, she was the only doctor who would refuse to give out pain meds.
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.
Just a point - the same people who thought they were “saving” people with a drug war were destroying lives themselves over drugs that not so many years later are legal and accepted to possess. Somehow they’re not harmful anymore. It’s all BS.
In the early 2000s I was a pharmacist intern and then early in my career working retail pharmacy as a PharmD. I knew the pill mills around me, I would provide DEA agents with clear examples and little to nothing was done about it. What I did get were credible legal threats from patients and physicians for not carte blanche filling what was written by their doc and then I started getting pressure from my district manager (after all I was denying big fat cash payers!). At the same time I saw pharmacist going to jail for "inappropriate dispensing" while the doctors who were running the pill mills were getting in no trouble at all. I left outpatient pharmacy as fast as I could. It was clear no on wanted to do anything to actually solve the issues at hand.
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.
The idea of someone going to a bank with a garbage bag full of cash and depositing it into a pharmacy's business account is insane. That's the kind of thing that can only happen when the system is fundamentally corrupt.
A friend of mine was a mechanic in the air Force and took a wrench to the knee. The VA basically prescribed him a giant bottle of benzos and told him to take them as needed.
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.
sounds like the only difference between the Columbian Drug Cartels (cocaine producers and street pushers distribution network) and the American Drug Cartels (Big Pharma and pill mill distribution network) is the latter paid taxes
And funny enough, here I was just thinking about how these jerks are making it so that, after the midwit backlash against all the criminal behavior encouraged by the Biden admin, I'll get to just live in pain the next time I have an injury!
I was in the care of a pain clinic when the fire hose was abruptly shut off. I wasn't being given oxycontin, but I still suffered from the sudden change. I went from sustainable maintenance to a drug that gave me serious side effects, but the doctors refused to listen. Even when a sleep study objectively showed the damage the buprenorphine was doing, I was told it's that or nothing. The doctors were terrified of new scrutiny of their prescription activity, so they just cut people off.
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.
The harm to society of people who need them not getting pain drugs far outweighs the pain to society of those who don’t need them abusing them.
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'm glad this article is highlighting the environment that this happened in. The lack of hope is what is at the root of the issue for many. If you have no decent job prospects and multiple issues in your life, you won't care about what a drug will do to you as long as you get to forget those problems for a while. Pretty similar for alcohol too.
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.
I am more aghast at the pharma barons that have retained their wealth, as that was a quick cycle of unequal riches and ruin that looked nothing like the impact of coal upon society (as it was able to empower industrialization for a long duration). There was no long-duration benefit to OxyContin mass-marketing.
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.
The biggest problem is/was the quest for greater corporate profits, which drives consolidation, cost-cutting, offshore outsourcing, reducing the power of the unions, product enshittification, etc.). When the mission of a company is to deliver value to its shareholders -- the mantra of capitalism -- this is the end result, and it's highly destructive. We saw it at the end of the 19th century, and we're seeing it again from the end of the 20thC until now.
“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.
Check out the book empire of pain. It goes back the beginning of the Sackler rise and covers how we go to where we are today.
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.
I see this as analogous to the Dust Bowl, where the politicians and coastal elite ignored or dismissed the growing problem until it was too big to ignore.
The flip side of this and something that is barely ever talked about, is that for patients with severe chronic pain, access to medicine for relief has become nearly impossible. Often even if you get a legitimate prescription pharmacies will not fill it due to fear/quotas being enforced.
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.
I had surgery and the pharmacy didn't want to fill my real legit oxycodone prescription until after they'd talked to someone at the OR. We overcompensating and went too far the other way.
A while back I was having wisdom teeth removed, and fell down a bit of a rabbithole looking for coherent guidance on what you can do afterwards (this ranged from the HSE and NHS websites saying “don’t drink alcohol or smoke for a couple of days” to dentist websites giving dire warnings about drinking coffee within the first week - the answer seems to be “no-one really knows”).
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.
It ends with an effective, non-addictive alternative to opioids for pain management + more funding and care for rehab (including the drugs to wean opioid users off them, like methadone) to current addicts. [1] explains why the first part is difficult. The second part is difficult because many opioid addicts are already in marginalized areas or groups (ex. rural Appalachia) that don't get much of any support.
You're missing one major piece to make it end - hope. These marginalized places need decent jobs so people have hope for the future. Otherwise we'll have the same problems with different substances, including alcohol.
Doubly marginalized because if you point out they are marginalized some joker will come in and claim they are an overclass and don’t deserve any sympathy.
Methadone is far more habit forming and difficult to quit than any other opioid out there. It has a dose-independent severe withdrawal that can last for months compared to “traditional” opioids that last maybe a week or two at most. If you are on it for any length of time it’s extremely improbable you are getting off of it, and it comes with many of the same dangers as traditional opioids do.
In the USA if your problem can’t be solved in a way that produces a profit, you must solve it yourself or live with the consequences.
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.
In Australia, I had septoplasty surgery for my deviated septum and was prescribed 3 different pain meds: oxycodone, tramadol, and something else I don't remember for about 2 weeks (with an invitation to call back if I needed more).
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.
lets not forget how the US government first forced doctors to give out more and stronger pain medications by
1)issuing edicts that “pain is the fifth vital sign” (i.e. equivalent to pulse, bp, temp, respiratory rate), AND
2) tying reimbursement to “patient satisfaction”
Both ideas could have helped improve healthcare, but without safeguards, they became a way to empower drug addicts to demand strong pain meds, and empowered pharmaceutical companies to supply them - a great example of what Thomas Sowell would call “second order effects” that are almost never considered when enacting new government policies
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.
Just FYI, kickbacks to doctors are illegal. Currently the most pharma can do is send reps to "educate" doctors and include a lunch under a certain price point.
They downvoted him because they hated hearing the truth.
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.
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.
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.
Indeed. It’s created a system where everyone’s scared. So those who need it legitimately often cannot get it. Which honestly is a false sense of security at this point as it’s easier to get these drugs on the street rather than legitimately through a doctor and that’s what most now do. If anything, the abrupt disappearance of legitimate pharmacy grade drugs made way for the current problem Fentnyl. Taking away and restricting OxyContin literally made the issue worse. Almost no one can get their hands on pharmaceutics opioids and yet the overdose rate has skyrocketed! People just don’t learn… You take something away and people only tend to want it more. Prohibition simply does not work and we have years of experience and history to show this time and time again and yet not a single thing has changed. Never see any new approaches or ideas to fix this issue because it goes far deeper than drugs themselves. People want to self medicate because they suffer, but we haven’t discussed why so many suffered and what we could do about it. Probably because the answer to that question isn’t going to be easy and hard work will be involved.
Believe it or not, this concept of having strong pain killers available to the public is somewhat American-centric. Much of Europe does not consider the need for strong pain killers available in society, and pain tolerance is quite different in, for example Germany or the Netherlands, where it has been nearly impossible to get anything strong for pain for many decades.
I guess the central point is that us very hard to distinguish between genuine and fraudulent use cases; in absence of infallible diagnostics, doctors can choose to move the know to "stricter" (decreasing fraudulent use, but making genuine use much harder) or "looser" (viceversa). I see a similar problem with mental diseases, where the common pattern nowadays is 1) get convinced that you are neurodivergent 2) iterate n doctors until you find the diagnosis you like.
"Oxycontin was misclassified due to fraudulent reportings of the drug's capabilities and marketing campaign. However that should have never affected people getting legit pain care, but it definitely did."
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.
I don’t think it’s puritanical at all as narcotics for painkillers are dangerous.
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.
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.
[+] [-] diamondap|2 years ago|reply
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/
[+] [-] nsagent|2 years ago|reply
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...
[+] [-] op00to|2 years ago|reply
[+] [-] 303uru|2 years ago|reply
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.
[+] [-] _heimdall|2 years ago|reply
[+] [-] zdragnar|2 years ago|reply
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.
[+] [-] insane_dreamer|2 years ago|reply
[+] [-] knightofmars|2 years ago|reply
https://www.theguardian.com/tv-and-radio/2021/aug/03/cocaine...
[+] [-] ofslidingfeet|2 years ago|reply
[+] [-] bloopernova|2 years ago|reply
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.
[+] [-] Der_Einzige|2 years ago|reply
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.
[+] [-] giantg2|2 years ago|reply
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.
[+] [-] chasil|2 years ago|reply
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.
[+] [-] insane_dreamer|2 years ago|reply
[+] [-] Jedd|2 years ago|reply
“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.
[+] [-] not1ofU|2 years ago|reply
https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...
[+] [-] keneda7|2 years ago|reply
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.
[+] [-] nobodyandproud|2 years ago|reply
- 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.
[+] [-] JohnMakin|2 years ago|reply
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.
[+] [-] fragmede|2 years ago|reply
[+] [-] rsynnott|2 years ago|reply
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.
[+] [-] mdorazio|2 years ago|reply
[1] https://www.technologyreview.com/2023/08/11/1077750/why-is-i...
[+] [-] giantg2|2 years ago|reply
[+] [-] PaulHoule|2 years ago|reply
[+] [-] JohnMakin|2 years ago|reply
[+] [-] subpixel|2 years ago|reply
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.
[+] [-] dannyw|2 years ago|reply
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.
[+] [-] ghufran_syed|2 years ago|reply
[+] [-] bravetraveler|2 years ago|reply
My entire 30+ year existence was shaped by this, and I never even used.
[+] [-] misiti3780|2 years ago|reply
[+] [-] insane_dreamer|2 years ago|reply
A lot has to do with the availability of health care in Europe (universal health care), and specifically addiction care.
[+] [-] jmyeet|2 years ago|reply
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...
[+] [-] malfist|2 years ago|reply
This hasn't always been the case but it is now.
[+] [-] MSFT_Edging|2 years ago|reply
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.
[+] [-] throwxzd|2 years ago|reply
[deleted]
[+] [-] fifteen1506|2 years ago|reply
[deleted]
[+] [-] nicepplonly|2 years ago|reply
[deleted]
[+] [-] swayvil|2 years ago|reply
[+] [-] impossiblefork|2 years ago|reply
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.
[+] [-] nobodyandproud|2 years ago|reply
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.
[+] [-] lom|2 years ago|reply
[+] [-] insane_dreamer|2 years ago|reply
wtaf? this is literally what caused the current crisis in the first place
[+] [-] pierat|2 years ago|reply
[+] [-] jdefr89|2 years ago|reply
[+] [-] jb1991|2 years ago|reply
[+] [-] curtisblaine|2 years ago|reply
[+] [-] giantg2|2 years ago|reply
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.
[+] [-] prepend|2 years ago|reply
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.
[+] [-] impossiblefork|2 years ago|reply
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.
[+] [-] curtisblaine|2 years ago|reply