The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine? If we don't address that nothing is going to stop the drug abuse let alone the relapse and overdose. I'm not talking about "more 12 step" here but more of a Frommian psychoanalytic approach. You are broken because society is broken. You have the ability to change yourself and subsequently society. A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.
> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine
People start using drugs for different reasons. It's not correct to say that everyone starts abusing drugs as a form of pure escapism. A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.
> You are broken because society is broken.
Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
I feel like your first paragraph and your second one contradict each other.
They start for various reasons, like your example of "seeking recreation" and having a certain person nearby.
They don't stop because they cannot stop due to a physical addiction. I do not think personal responsibility is the right topic for that once it has gotten to that point. They've entered a state of physical dependence in which the reason they started is kind of irrelevant, and it's very difficult to quit, through no fault of their own.
> A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.
Let's be clear here: someone's stated reason for using opiates might be recreation, but nobody starts shooting heroin for recreation without some pre-existing reason for self-destruction. It's not a secret that opiates are dangerous. People with normal self-preservation instincts find other ways to recreate.
> > You are broken because society is broken.
> Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
What this boils down to is that the addict has to understand, "Society isn't going to help you, so you have to help yourself." That's important for addicts to understand because it is, unfortunately, true. But if we lived in a society which actually gave enough of a shit about its citizens to help them when they have problems, the importance of understanding that society won't help them would obviously take a smaller role.
I want to be absolutely clear here: there is not effective help for the causes of addiction. For example, a common cause of addiction is homelessness. Contrary to HN opinion, the solution to homelessness is simple. The solution to homelessness is homes. Not shelters--don't embarrass yourself with the "I don't know what the word 'home' means" argument. The fact is, 1% of the US military budget would build a home for everyone in the US. It's not difficult: the reason it hasn't happened is that there are a lot of people opposed to it. Instead, we build shelters where nobody has any privacy or feels safe or can have a pet or storage for their belongings (that's just like a home, right!?), and only in places where they don't inconvenience anyone society cares about, and then blame the homeless for being hard to help when they choose not to pretend that our half-assed solution does anything to solve their problems.
Many people get addicted to drugs after being prescribed them following surgery or injury. I know someone this happened to exactly. They gave him a bunch of opiates for pain management and he took them as directed and wound up an addict. I think a lot fewer people "choose" to get addicted to medicine in this way than either you or the GP are implying.
> Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
I don't think these are mutually exclusive. Society wide problems cause a huge fraction of the population to experience severe emotional trauma, and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that. If you can understand this process, you can take ownership of it, and have a path to beating the addiction itself.
Ultimately, there is a lot of disagreement about what addiction is and how it really works, but I think this emotional trauma aspect is a key part of explaining why one person can use a drug recreationally or for medical purposes without addiction, and another can't. It explains a lot of weird observations that just didn't make sense with the classical chemical/neutrotransmitter model of addiction.
These links I think help explain this better than I can:
These ideas have explained why I personally have never been able to fight addictions through willpower alone, but have been able to eliminate addiction with other techniques that seem unrelated- therapy, meditation, exercise, hobbies, friends, ending bad relationships, etc. It seems that while chemical/physical addiction is a thing, emotionally and mentally healthy people don't experience opioids as a positive thing, such that the effect of the drug itself actually discourages it's use, and even motivates the experience of withdrawal.
While these points are valid, it's also a highly individualistic perspective. Social bodies have complexities and dynamics of their own. The obsessive pursuit of financial and political resources could also be seen as a kind of addiction, optimizing for one thing to an unhealthy degree while refusing to contemplate the negative consequences. There are certainly big payoffs to be had this way, but foreclosure of other possibilities can eventually lead to a dead end. A more harmonious, proportionate approach may not be as dramatic or impressive, but endure better.
> Variations of this concept are frequently used by drug addicts to justify continued behavior.
Think about it as a policy maker. You have a choice whom to blame - an individual or their environment.
If you blame the individual there is nothing you can do - we can’t change other people.
If you blame the environment now there’s something you can do. You can try to reduce supply by making it illegal (only works to a point) or you can try to reduce demand by increasing overall quality of life - housing, healthcare, and generally a way to escape the clutches of the rat race that is life in America for so many.
>Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
I feel like the use of this argument should depend on the scope of the person who is speaking.
Law-makers and society-enablers should consider things in the far-scope of "society's fault", whereas this consideration is less useful on a personal scale other than for the purposes of blame-redirection.
These are the same thing. Happy people don't seek to drown every waking moment in constantly escalating recreation, they got things to lose and when they are out having fun and an opportunity comes around to do drugs they are surrounded by friends and loved ones who care for them enough to not let them ruin their life for lolz.
>Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
Control of what? That's the point of drug abuse - what is there to be controlling? We are gears in someone else's system, purpose is rarely possible in modern society. Address why this is.
I think quite a lot of people ended up addicted to opioids against their will, by starting with being over prescribed highly addictive pain medication which then ended up making them addicted to opioids, and then later on ended up trying to feed that habit from the streets once the easy access to pain meds dried up.
Personally I've been avoiding oxycontin like the plague for that reason. I had two surgeries where the doctors wanted to give me oxy to manage the pain afterwards and I refused to take them. It turned out in both cases the pain was manageable with less addictive options, so I'm not clear why they reached straight for prescribing opioids in the first place.
You're not wrong, but addiction is not a certain outcome. Most people who use a substance that can lead to addiction don't become addicted. The question is why can two people, for example, abuse alcohol for a period of their youth, but both don't become addicts?
We need to look at this holistically. Overprescribing is a problem, but we shouldn't be needlessly afraid of these substances. Personally I've been prescribed these medications, I took some and when it stopped hurting I stopped taking them and the bottle sat in my medical cabinet in case I injured myself later. Eventually it expired and I threw it away. It wasn't an issue of will power or anything like that. I just didn't feel the compulsion. I'm the same way with alcohol and other drugs. I enjoy it when appropriate, but I feel no compulsion whatsoever. I, in fact, prefer mental clarity.
But I have people in my life who develop very strong compulsions and become addicted to anything that distracts them from their psychological torments. Reducing access helps, but reducing other circumstances in their life that they may feel the need to numb has to be part of the solution.
Yep I've seen similar in various countries with a parent. They were prescribed large doses of some opioid pain killers and despite them being aware of the risk of addiction and thus being very careful about dosing (often skipping doses if the pain was tolerable and asking doctors to minimize the dose), in the end they still had a difficult time coming off them. They didn't end up trying to feed that habit from elsewhere, but it was still a lesson in how quickly a dependency can be formed.
Someone people just like to get high; painkillers to H to F seems far fetched but when you are chasing that original euphoria, its a much shorter timeframe than most expect.
They’re adding Fentanyl to everything now. I have Burning Man-adjacent friends who take ecstasy once a year at festivals, and they’re terrified of getting a tainted dose.
This affects many more people than just those addicted to opiates.
I think this highlights the importance of addressing the _why_ even more. Most people are terrified of accidental fentanyl exposure. Some people seek it out. Why is that?
That's very confusing to me. Criminal drug dealers of course want to lower their costs and maximize repeat business, even if that hurts their customers. But people consume different drugs for different reasons, and I don't see the economic benefit in giving them something orthogonal or opposite to what they're actually looking for, when it would be cheaper and safer to just dilute with some inactive filler material.
My fentanyl experiences have entirely been as part of surgery: it's part of the balanced triad of anaesthesia and I "recently" injured myself quite badly, resulting in three operations. After one of these, I spent about 36 hours on a fentanyl infusion and more than a month on oral morphine of various doses with my leg in an orthopaedic brace while I was bed-bound. I should point out that the alternative was a lot of screaming: visceral pain of the variety I cannot describe – I had a panicked, "help me" expression on my face and just felt utterly, utterly desperate. I was in a lot of pain and medically the drugs were appropriate, given the injuries I sustained.
I totally get why some people become addicted to drugs. Diazepam made me both in less pain and care less that I was in it. The opiates produced this warm, fuzzy haze of vivid dreams and imaginations and made a difficult time bearable. Fentanyl made me feel less than human but not able to suffer, and it was a necessity at the time.
Of all of them though, diazepam was the most dangerous. It just felt – well, nice. I didn't care that things were bad. I needed it medically to stop neurogenic muscle spasms and it made me both able to sleep well and feel OK about life in a way that is really hard to put into words. I have some in a bag, prescribed for me, in case I need it. Part of me – a small part of me, but a part nonetheless – wants to use it, a lot, when I don't need it. There's a little voice that just says "this makes you feel like you've been tucked up into bed nicely". I really can't explain it, but I know that voice is a temptation and a gateway to something that I don't want to have – but at the same time, I know that that drug both saves me from agony and helps me medically if I need it. I'm really not sure how I feel about that. I haven't had any in months, but the psychological aspect remains.
I can only imagine what "real" drug addicts go through. It must be incredibly hard, and individual's range of experiences will be very broad indeed.
My mother spent 6 weeks sedated with Fentanyl, on top of Alzheimer's. After a few days I realized she would survive. But she was in a hellish state for over a year, hallucinating and constructing parallel realities.
Ironically, she worked on the UK medical trial for Fentanyl when it was first introduced for surgery.
Once you actually don't need it anymore, throw it far away and do not look back. Benzos and opiates ruin lives because of that little voice. That voice will be strong enough one day that if you have those close by you will take a few, because why not?
That voice is the voice of addiction. Once it starts it never fully goes away. It just gets less frequent.
I think you assume folks want to check out of life because they think fentanyl is a better choice, when instead fentanyl makes folks check out of life. Have you ever spoken with an addict who wants to get clean? It's bleak, they're basically enslaved by the substance. Having a vaccine to break the cycle is a huge boon.
I guess I'm a bit torn on this. Even if we had an extremely fair and equitable society with growth I imagine there'd still be plenty of people who feel rejected or lonesome at times. Or just like the feeling that these drugs give them above normal drugs.
I drink alcohol a couple times a week and do edibles once a month. I'm sure some would argue I'm not fulfilled but I think the easier explanation is that a lot of times doing mind-altering drugs is...fun? And can be social.
I have known quite a few friends from earlier in my life who became serious addicts and ruined their lives or ended their lives by it. I would not describe a single one as having started using because they were mad at society, sad, or lonesome. It was always some strange kind of strange, arrogant fetishization of drug-life and crime-life. There is an almost "drug life is THE life, and everyone else is lame" attitude in many circles, and I got a little too close to comfort to falling into it at one point in my life.
This doesn't mean there aren't a hundred reasons people get trapped in drugs. But a very real one is just because many people come to believe it's cool and tough, and end up fetishizing it until it's too late to get out. And like I said, in my hometown, this was the predominant reason.
That sounds like a healthy amount of drugs. For people with self control like that, I think it would be healthy to trip once or twice a year and use stimulants (cocaine) for a party once a year.
A heroin vacation to an opium den on occasion sounds wonderful.
I certainly have used drugs socially (LSD in clubs or concerts can be fun), but also use them cannabis alone frequently.
> Why do so many people want to check out of life completely by abusing medicine?
This isn’t how it works.
Few people, if any, want to “check out.” What happens is that people are exposed to opiods via one of two channels (they are prescribed painkillers, or they party with someone who has acquired them) and they quickly get hooked because these drugs are cripplingly addictive.
So the only “why” questions we have to ask are:
1) Why do people take opiods the first time
2) Why do people continue
The answer to 1 is either because their doctor said so, or because they like to party and have no foresight. The answer to 2 is because if they stop, they experience the worst sickness imaginable.
Society is not broken and we don’t need weird conspiratorial explanations for any of this.
"investigating systems in their totality rather than focusing on isolated interactions within them" is not inherently conspiratorial. It's far weirder to suggest that "more people want to party for no particular reason" or "more doctors prescribe pain meds for no particular reason" than it is to suggest reasons that might contribute (say, "more people are suffering from chronic pain than before as the disparity between productivity and wage has widened" or "pharmaceutical companies are naturally incentivized to sell as much of their product as possible and those incentives may occasionally drive morally dubious decisions").
Except that its nonsense. People know what opiates are. If you keep taking them and dont stop, you get physical withdrawal. That wont happen over night and its not "the worst sickness imaginable". And unless you did something even more stupid like switching to methadone it will be over in a few days.
It is quite simple, at some point, you decided to continue taking them despite knowing this to be problematic.
I would also like to add, that i have met very few addicts who blame the drug. Its most of the time relatives who like the story of their loved one getting tricked.
If it was only the fear of withdrawal, the opioid crisis would be solved next week. Literally. But the unfortunate problem is that people relapse. Because what ever made them take opioids every day didnt get fixed with a withdrawal. And if your life still sucks, its very easy to go back.
that the GP is getting at. While doctors over-prescribing opiates is definitely a thing (esp. in the US), I'm not convinced that many people get hooked on opiates due to partying. I think it's more commonly:
"Used as an escape from a life that is unmanagable for some reason"
That's not conspirational. There's good evidence to show that life circumstances have a big effect on both initially becoming addicted and success when attempting recovery. The answer to this might look like a better welfare state or similar.
Sometimes the simple answers are the most likely. Even if you have a great life, it’s tempting to have such experiences.
Sure, a lot of people use it as an escape though. But I imagine my dumbass brother in law died because he was trying to have fun, not check out of life. Miss him.
I think you presume that human behavior must seem to have a cognitive reason for the "why", when it's entirely possible that the "why" is simply physiological/neurological. In the case of intense opiates, which have a profound effect on human neurology, it would be bizarre to not consider that in the "why".
I think this undermines the issue a bit. A lot of people get addicted to these substances completely by accident and aren't initially seeking to "check out of life." But once you are hooked, it can be a devastatingly difficult road to get off. For sure there are plenty of people who go out looking for escapes and I do agree it is something that needs to be addressed.
Usually the "society" issue is framed as some sort of welfare crisis. I have a more-than-one-hand-full of friends and acquaintances from earlier in life who ruined or ended their life with drugs. And so I don't know anything statistically, but I have seen what caused the people near me to fall into it, and it wasn't some welfare crisis.
The number 1 reason I experienced is because some social circles fetishized it. It was a very cool, tough, and a superior lifestyle. Anyone who didn't do drugs was a loser, drugs were for winners.
When there is a strong cultural-current of this attitude, it can draw people in and ruin their lives by the time they realize it's all wrong.
I've seen some of this as well, though through my own anecdotal experience people in my life I've seen struggle with drugs do or did so because:
1. Ongoing health issues they can't afford to resolve. Chronic pain. Mental health issues. Sleep disorders.
or
2. Inability to cope with high levels of stress due to financial insecurity, bad relationships, or loneliness.
I think the cultural attitudes you describe may have some relation to other problems. Most people I've encountered seek escapism when their life experience is poor and they're unable to change their circumstances or unaware of ways to change their circumstances.
> The real issue here that people don't seem to want to face is the WHY. Why do so many people want to check out of life completely by abusing medicine?
I don't do powders, opioids, etc but I do have some friends within tech and the festival scene that do. My observation is that most people that die from fentanyl don't know they're taking it. They think they're doing cocaine, ketamine, heroin, or some other substance. Fentanyl presence is usually a case of cross contamination when the particular substance is being cut at each hierarchial level of the drug food chain. That's not to say that there isn't some small subset of dealers who don't purposefully drop in some fentanyl, but largely that'd be a stupid decision. The users life expectancy shrinks and their risks skyrocket when they come in contact with fentanyl, this is known.
If you want to stop the deaths, then you have to allow drug distribution that comes from clean rooms. At present, everyone should be using test kits, but fentanyl in particular is hard to test for because a single grain hiding in a mound can get and overdose a user.
If you want people to stop using drugs, well, I have less to say. The history of humanity is using intoxicants whether it be for recreation, psychological well-being, or medical necessity. We've only recently in the history of humanity gone on moral crusades to villainize it.
Chemically addictive substances are a little more challenging. Things like heroin, cocaine, and methamphetamine aren't drugs you can benefit from, but people still do them. Largely, it's because they got hooked on pain killers or some other "numbing" medication. Better availability to harm reduction resources, therapy, social safety nets, etc would improve metrics across the board in the chemically addictive substances category.
It's not that nothing like this exists in nature, it's that evolutionarily speaking nothing like this existed in the areas human first evolved. Or if they did, we either evolved to resist them, thus no longer see them as toxic, or we're still in an arms race with the life that produces them (which means they would be much less toxic than fentanyl, but still toxic).
Plants (and fungi, and animals) evolved to create noxious chemicals that keep animals from eating them, keep animals from breeding, or outright kill the animals. The Golden Poison frog's toxin is about 40 times more lethal than fentanyl.
I'd say the opposite, nature creates all kinds of powerful attractants and poisons. There are plenty of things that will kill you at the micrograms dose. There are plenty of natural things that are horribly physically addictive.
> The real issue here that people don't seem to want to face is the WHY.
Drugs get you high. Ants get drunk, goats chase psychedelic lichen, and dolphins pass around puffer fish like a dutchie.
> Why do so many people want to check out of life completely by abusing medicine
The short term benefits always outweigh the short term costs, but we're moving to a point in history where even it even seemingly outweighs the long term costs. There's no real disincentive anymore.
I think a case can be made that Martin vs. Boise had the most to do with this. That ruling was meant to push cities into creating the necessary facilities and number of beds to correctly address their homelessness problem; instead, it seems that many cities have used it as a way to entirely ignore the issue.
Instead of building the facilities, they're just throwing up their hands and allowing the kind of "public camping" that quickly turns into public open-air drug markets. Unsurprisingly, the population and markets grew.
> A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.
The twelve steps are about quite a bit more than "just" that. They're also targeted towards a person that is at a specific stage of addiction _and_ willingness to address it. It's not general purpose and you can't force people into it, particularly when their drug of choice is so easily available and socially acceptable.
You have to reduce the inflow of drugs. You have to stop drug markets from forming. You have to convince addicts to seek treatment.
On the last point, I think the most effective strategy would be confiscation. If you are caught with drugs for personal use, they should be taken and destroyed, and you should be given information and transportation to a treatment center if you desire. Otherwise, you should be free to go. If the state doesn't interject itself at some level then I don't think you stand a chance.
Fixing society doesn't increase revenue. The opposite, actually.
For example: The more people are depressive, the more pills can be sold. If people kill themselves due to depression, that's too bad, but they didn't buy any pills to begin with.
Diabetes is great, because people depend on insulin. A never-ending money maker! Fat people are great! They eat more, thus spend more! Some of them get their fat surgically sucked out of their bodies, which also pays! When they get more and more sick, they need more and more medicine, which pays even more!
The transhumanism movement is awesome, because transitioned people require pills! Every day!
Sadness? There's a pill for that!
Drug addicts? Lets invent a vaccine for that!
Fantastic!
Society isn't getting fixed, because nobody actually has any interest in that. Those in power/money certainly don't give a fuck and rather want more money, while the actual people are mostly too stupid to figure out that the whole system needs changing.
Instead they whine, complain and protest and go voting, without realizing that it does basically nothing. Yes, voting actually does nothing. We didn't get to this point because voting helps anything. We got here, because voting doesn't matter.
Decades of evidence lay in front of everyone out there to see, yet for some reason every couple years people actually believe their button-pressing/their X-making actually gives them power over what's going to happen!
There's no vote allowing you to change who pays all the money to the politicians, law makers and judges. There's no vote that allows you to change the underlying corruption that's going on. There's no vote that enables you to decide what actually happens with your money.
You're fucking hilarious. You're not wrong per se, but also hilarious.
"Society needs fixing!!!111" well then get together with enough people and fucking fix it.
Politicians won't do it for you.
Better get your guns ready, btw, because it's definitely not going to happen peacefully.
A good metaphor for addiction is speeding. You're driving down and empty highway, you want to get where you're going faster. You're not going to actively look down at your speedometer. You know you're probably breaking the prescribed limit a bit, but who cares. The when you finally are faced with looking at the speedometer, say when you get to windy section or a speed trap, you look down and you're going 25mph over the limit and you have no idea how you ended up going so fast, but by that time, you're brakes are squealing or worse.
I would ask a different 'why', which is 'why is fentanyl so easily accessible?'. We know where it's made, how it gets into the US, a long list of reasons for why people start taking it. But why hasn't the supply of fentanyl to the US been restricted?
Given how many lives this destroys, how many people it takes out of the potential workforce, how many social problems this causes (crime, homelessness, exasperated mental health issues) - why isn't there the political will to change this?
I answered this at length in a forum some months back and sadly can't find the text (for now).
The abridged version is: there too much money to be made.
Fentanyl has gone from direct primary import (which was blocked) to banning of exporting precursor drugs from bulk suppliers in China (to slow down | stop Mexican drug labs from mixing them to make Fentanyl) to where things are today ...
relatively mobile "popup" drug lab networks that start with bulk pre precursor drugs to make the precursor drugs that are funneled to final product labs.
It's a hell of a whack a mole game across Mexico, the USofA and Canada with a process that's tough to break, the initial drugs used are too useful for too many things to ban outright and the production aspect is broken down into many replaceable parts.
( I had references to most of those stages in the original comment, apologies for not having them to hand ).
Do you really think that Michael Jackson and Prince wanted to "check out"?
My assessment is that if even people at that level of wealth and success can get addicted to opioids and die, pretty much anyone can.
Addiction, whether alcohol, drugs, cigarettes, etc., is something that is a genuine medical issue needing treatment. Thankfully, the medical community seems to be shaking off the social stigma about addiction and treating it properly now, but progress has been very slow.
While I agree with you, at the same time, I can't help but think having someone take a pill or shot weekly/monthly/etc is whole lot simpler and easier than fixing the homeless problem, the cost of medical care, and training up (and paying) hundreds of thousands of new mental health professionals, among the dozens and dozens of different reasons people turn to drugs like this to 'escape'.
Do we have a clear picture for where we want this to go in the future? Though not exactly the same, does this start to walk the path towards a "soma" equivalent?
There’s also the medical systems unwillingness to help certain people and medicate; then people end up on the street getting more dangerous drugs in an uncontrolled fashion.
Something else I wonder is how have we managed to convince generations that smoking is not only horrible to your health and frowned upon but alcohol is acceptable?
I'm homeless and living in the Tenderloin in San Francisco.
People here want you to
- Be in a gang (or a prostitute, thief, ex-con and so forth)
- Be on drugs (or in rehab for drugs)
- Have a mental illness (so you can go to therapy)
- Be disabled
- Find religion
There isn't a position for "I ran out of money and my family wouldn't support me, and at some point finding web development work became too hard as the technology became more complicated." People want you to "get better." I don't do drugs, I don't smoke, I don't drink, I don't steal or assault anyone.
I just don't have any money.
But people here are morons. They need to have a reason for why someone is poor other than "I'm a person of average intelligence that doesn't know how to find a paying job in this society." I don't want to be psychoanalyzed, be put into rehab, go to church or join any number of the lonely people who have to have a support group because society is awful. I don't have problems other than being poor - if you managed to buy into the crypto ponzi scheme at the right time then no one is asking you to "find god" or "get better".
People are social animals. If you put them in a position where those are the options (jail, crime, drugs, psychoanalysis, religion, disability) they'll take the least unpalatable. There's a whole lot of people who walk around here with canes they don't need because otherwise the San Francisco General Assistance office won't spring for them to have housing. Also known as an apartment with a bed and a door that locks.
If I make more than 1500 dollars I lose my health insurance through Medi-cal.
And I'm no defender of a lot of these people. The bastards that set up tents on the sidewalk and smoke meth are just awful. But on the other hand, I have absolutely no idea how to get a job. None. I've done construction before and all I ended up with was bad memories and scarred hands. I could work "security" by putting on a t-shirt and standing outside a soup kitchen, but that's just bullshit make work the charities give out so the poor can buy shoes and feel special about themselves. Real security jobs outside of bars are a good way to get killed. And that's about it. I'm staying at a homeless shelter and have the clothes on my back so how am I supposed to get a job?
There's your why.
So let me give you a when. When, not if, your industry is automated or the code becomes too complicated for you to understand anymore you'd better have enough savings or a social network so you don't become homeless. Or you'll have to crawl into one of the buckets that allows society to make sense of you.
And today I'm sitting in the San Francisco library looking to make a contribution to a software project for free and I just don't know that I care anymore. And if you tell me it'll get better, then I have to ask if you're about to be laid off or not and what your plans are.
I've been homeless and I think part of that is just for someone with no problems it doesn't make sense to be inner-urban homeless in these crim-ridden areas. I assume those people are all fucked up for one reason and therefore as a sane person I don't want to be around them.
I had a very strict rule when I was homeless. Stay away from other homeless people. Camp on the edge of town. Ride the bus into rural areas.
How did I get a job with just the clothes on my back? I hitch-hiked to north dakota in the oil fields where a man is a man and they don't give a fuck what you look like. They hired me to do day labor, and once you have enough money for a van or a short stay airbnb it only gets easier from there.
Get the fuck out of tenderloin, and san francisco at all costs. Hitch-hike if you must. If you want guaranteed housing you can also look into doing seasonal harvesting work for fisheries in alaska. They'll pay your flight from seattle and then cover your food/shelter while you're working.
I'm sorry for your situation, but you also have to realize, things are partly your fault. You mention you could be a bouncer at a bar, but you would have to go to the gym to develop enough muscle. And possibly start using chemicals to alter your bone density and muscle mass. In your situation, I'd say you have to go "all in" on something, whatever it is. If you just half ass it and complain that the world is against you, you will not go anywhere. That's just how it is.
It's provocative in rats, but there's lessons from similar attempts that need to be considered. Cocaine-specific vaccines have been in development for years, and they haven't been successful. The biggest problem is that you need people to maintain an enormous concentration of antibodies against the drug so that even minute quantities are captured within seconds of entering the blood stream. Even if you can achieve an initial therapeutic levels, you need to constantly boost the vaccine to maintain high antibody titer. All of these attempts have targeted people with cocaine use disorder and are able to focus on shots every few weeks to months. We're nowhere close to developing something that would work as a routine preventative vaccination.
We do have a once a month injection of naltrexone that can block all opioids, which can be effective in the right person. A targeted approach to fentanyl alone would probably work in people who don't have an opioid use disorder (and therefore wouldn't be as prone to substitution with an alternative opioid). This is an interesting step, but our understanding of immunology is far too limited to make this realistic in the near term.
Someone in my family died from fentanyl at 26. I knew him since he was a little kid. We don't know if they were aware of the presence of that substance, but they certainly were in a higher risk situation. They had a decent life and a loving, if imperfect, family. They just happened to fall into a rougher crowd in middle school and, despite more than a decade of support and help and money, never really broke out of it.
One of my last conversations with this individual: they were excited to go to some convention in Minneapolis that was all about mushrooms and psychedelics. What struck me was how excited they were, how into that community they were. I couldn't relate. I thought to myself, isn't there anything in your life more exciting than this? Rewind 12 years, and I also have a memory of his fascination with tagging buildings on YouTube. The art of it aside, I was so struck by his ignorance to the fact that you're damaging someone else's personal property without their consent.
To deepen the mystery: I grew up in an unstable household, suffered emotional abuse and physical abuse on one occasion. I remember sleeping at a friend's house for a week and begging them not to call the police. When I look at this deceased person's life, whatever grievances they had, it really pales in comparison to my experience. And yet I never touched drugs. It makes me think some choices are not our own - and if it is predestined in some way at birth, well then yes, more compassion is necessary.
Whatever your personal views, it is objectively true that a vaccine would prevent some people from dying, so it's likely a good on balance.
I appreciate you sharing your experience, but keep in mind two things:
1. It's unclear what your family member was going through. Your own experience is much more salient to you, but battles are more and more invisible to external viewers, so it makes sense that you would characterize your experience as more difficult. It can be true that you had a horrible experience, and so did this person. There's a reason the "walk to school uphill both ways" meme exists.
2. Your sample size here is very small. Even if it is true that your experience was worse (we can't know for sure), your actions in that circumstance shouldn't be generalized to people-in-general, and the same applies for your family member.
> It makes me think some choices are not our own - and if it is predestined in some way at birth, well then yes, more compassion is necessary.
I'd encourage you to challenge whether predestination / loss of control is the qualifier for compassion. How can we know, for certain, why people make the choices they do? If you were predestined or not, we don't currently have a way to know.
Would people deserve compassion if everything they go through is a direct and pure result of their choices and nothing else?
> they were excited to go to some convention in Minneapolis that was all about mushrooms and psychedelics. What struck me was how excited they were, how into that community they were. I couldn't relate. I thought to myself, isn't there anything in your life more exciting than this?
Are you always this judgmental of others’ interests? Do you have these feelings towards someone excited about e.g. a new video game or a programming conference?
Actually, no. Had he been drawn to a programming conference, I wouldn’t have been able to draw a line between the dangers he’d been near and those interests. But when you see someone in a situation, and see them drawn to the wrong things for the wrong reasons, yes of course it triggers at least concern. I wish a lot I had been wrong.
> "a vaccinated person would still be able to be treated for pain relief with other opioids [such as morphine]"
Good to hear, but at its worst, my pain was only relieved by fentanyl (administered by a professional in a hospital). Noticeably better than Dilaudid (hydromorphone).
Is morphine a reliable replacement for fentanyl? Fentanyl is used quite often in palliative care because it lacks the side effects of morphine, is this correct?
Does this prevent death or just the perceived effects of the drug? This could be very dangerous for users who relapse. There is a known pattern of users who get off opioids then relapse and die because their bodies can no longer tolerate the doses that they were used to taking before they quit. This could have a similar effect where users take the drug, don't feel it, and then increase their dose to lethal levels hoping that they can get high again or believing that the drugs they purchased are diluted or ineffective.
The abstract of the underlying research paper: https://www.mdpi.com/1999-4923/14/11/2290/htm
contains the quote "Vaccination prevented decreases on physiological measures (oxygen saturation, heart rate) and reduction in overall activity following FEN administration in male rats." These physiological measures are the precursors to overdose, which occurs when low oxygen saturation becomes hypoxia and becomes fatal.
To summarize, yes, this vaccine prevents overdose, as well as the other drug effects.
My point of confusion is still my initial question. It was actually the description of the mechanism, as given, that had me questioning it's effects on the overall toxicity/danger of ingesting the drug.
"Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys. Thus, the individual will not feel the euphoric effects and can ‘get back on the wagon’ to sobriety,” said the study’s lead author Colin Haile"
They clarify that this causes a user to not feel the positive effects of the drug, but I would assume that if the drug was also able to prevent overall mortality, they would be excited enough to mention it.
That's strange that they describe the selling point as being that you can't get high anymore. If it's really attacking and neutralizing the chemical per se, and if it's truly neutralized in every way, that would mean it would stop overdoses. That seems like a much bigger selling point.
If the vaccine only suppresses opioid euphoria, users would continue dosing assuming they needed a higher dose to feel the effects leading to overdose and have possible respiratory failure.
This is kind of strange. Is it really fentanyl-specific, or does it effect all opioids? Problems either way; if just fentanyl, then, duh, that's not the only way to get high. If all opioids... So it makes opioids no longer available for pain relief... forever? ("vaccine"?). (Major surgery and recovery without opioids is no walk in the park, it's PTSD-inducing excruciating pain).
It claims to block the ability to get high -- does it also block overdose potential? Or is this just going to lead to lots of people OD'ing as they try to take enough to get high?
One way or another, it seems likely to lead to even greater harm as addicted people look for something else that does work.
Honestly seems like a bad idea overall, based on wrong and unuseful ideas about the nature of addiction.
>This is kind of strange. Is it really fentanyl-specific, or does it effect all opioids?
This is answered in the article.
>“The anti-fentanyl antibodies were specific to fentanyl and a fentanyl derivative and did not cross-react with other opioids, such as morphine. That means a vaccinated person would still be able to be treated for pain relief with other opioids,” said Haile.
>Problems either way; if just fentanyl, then, duh, that's not the only way to get high.
Yes, but fentanyl is considerably more dangerous than most of those other methods. Mis-judging your poorly-cut heroin dose by a milligram at least doesn't kill you. That's part of the point of targeting fentanyl itself with a vaccine - it would be accepted by the drug-taking public, because most of them don't want to be taking fentanyl in the first place: there are other ways to get high.
This is an incredible opportunity to save lives. You need to familiarize yourself with accidental opioid overdose deaths. Most people who die from a fentanyl overdose were not intending to ingest fentanyl. Fentanyl is often used to boost the strength of more expensive opioids sold on the street. Fentanyl is very cheap to produce compared to heroin or whatever is the flavor of the month pressed pill. People die because the recreational dose for an opioid like heroin isn't many orders of magnitude away from the LD50
"Once feared, illicit fentanyl is now a drug of choice for many opioid users: People with opioid-use disorder are increasingly seeking out illicit fentanyl, often smoking it."
(I really do know that everything you read in popular media about drug use in general, and opioid use specifically, cannot necesssarily be trusted. But my understanding from several sources is that this is so. The fact that fentanyl is cheaper for the effect is a reason a user might choose it too, or it may simply be what is available, or affordable)
Whether users are intentionally seeking and/or aware of getting fentanyl or not, I am saying that the consequences of making someone's dose not have the effect they are looking for can often be that they take more (getting more of all of the substances that were in the dose, known or unknown), or that they switch to an alternate supply/substance. Either of which can have very dangerous outcomes.
I won't tell you what you need to familiarize yourself with, or assume I know what you are or are not familiar with.
> “The anti-fentanyl antibodies were specific to fentanyl and a fentanyl derivative and did not cross-react with other opioids, such as morphine. That means a vaccinated person would still be able to be treated for pain relief with other opioids,” said Haile.
Not really clear if it prevents ODing but the article says:
> Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys.
Oh boy, the pharmaceutical companies can sell a new product to help solve the mess that one of their previous products created.
An opioid that's more potent, more addictive, and more deadly than heroin should never have gone to market in the first place. It speaks of enormous corruption and a complete lack of ethics when regulators didn't see an issue with fentanyl and let it move forward.
The "but people are in pain" argument doesn't hold up very well when heroin is safer and has less potential for abuse but they already made illegal in the US.
I would suggest becoming actually educated before developing strong opinions.
The drug is extremely useful and saves lives in a clinical setting; chances are it will save your life or someone you know and love. It's literally used _every hour_ around the clock in ERs.
Nearly all problematic Fentanyl in the US is illegally imported and created by third parties overseas. It is not manufactured by those big bad US Pharma companies.
Yup, people don't realize but whereas a brick of heroin is a lot, a brick of fentanyl can supply a decent sized city. Because small amounts are so valuable, it's super easy to smuggle, and for a long time the Chinese would produce and sell it at rock bottom prices (I'm guessing that was state sponsored as a finger to the west for opium and the opium wars, which they're still very sore about)
I’m aware of it being used for epidurals, but honest question - how does this particular painkiller save someone’s life instead of another, less potent painkiller at a higher dosage?
Yes, most of the fentanyl that's abused comes from illegal sources. However, like cocaine, methamphetamine and heroin, I put some of the responsibility on the people who created it and promoted its use in the first place.
It's naive to think we could make "super heroin" and it would stay restricted to safe, controlled medical environments. I'm not convinced the good it does in certain cases outweighs the enormous harm it's also responsible for.
> An opioid that's more potent, more addictive, and more deadly than heroin should never have gone to market in the first place.
This is a little misplaced.
Fentanyl is a medically useful drug. Fentanyl had years of use as an anesthetic
agent (and still does - it is an essential ICU medication) before the idea of marketing it for other purposes occurred.
And without defending the pharma industry and their role one bit. The vast majority of fentanyl these days is not from big pharma, and it's arguable what relative role fentanyl played vs all the other drugs
Specifically, the demand for illegitimate fentanyl today was mostly driven due to addictions from other medications that were NOT fentanyl - such as oxy, hydrocodone and even the "safe" tramadol.
Having said that, it's going to be a hard sell that all opioids should be banned. There is some middle ground between reserving for palliative and acute critical illness and having PCPs prescribe for simple back pain.
> heroin is safer
It is a smidge more complex. Fentanyl has some pharmacologic properties that make it safer for controlled use in sick patients. Heroin has similar metabolite related side effects as morphine.
A memory that un-repressed itself about a year ago was being a teenager and hearing my mom wailing, "I can't do it anymore. I'm done." in the later stages of her cancer treatment. Apparently shortly after that they had a fairly significant intervention with the physicians and she got fentanyl patches. I got about another year with her.
I completely agree that there's a ton of recklessness in the history of opioid prescription. It's been a horrible plague on society that will have generations of lasting impact. But there's uses for it. I dunno, maybe heroin patches could have become a thing?
Eh. I'm an an antique Schedule II drug. The literature notes that people with my condition don't seem to end up addicted to said drug (or its pals). Probably because we're just glad to take the edge off the pain. It's already rather potent, as painkillers go, as it previously was given to women in labor.
However, as my condition becomes more severe, a time will come when I will have to "graduate" to something stronger. The end of that choo-choo train looks like fentanyl or something very much like it, assuming I don't just up and die first. I'm glad that there is something there.
A friend of mine, his mother died of the same thing many years ago, when it was poorly understood and largely untreated. She was kept in a distant corner of the house so that the screams were less bothersome. Raving in pain, she would curse his name for not helping her to die. That's what it looks like at the end when there's not enough painkillers.
So I guess if you get your way, can I bunk at your place?
I joke, but only a little. You don't have a lot of skin in this particular game. Consequences are far away, third-order at best. I dunno, maybe listening to someone howling away might bring it home, maybe not.
To someone like me, it looks like someone who won't really be affected at all just trying to yank one of the few solutions I have left away, and for no good reason at all.
If I fall off a ladder and break my leg, I want the good stuff. I’ve found old bottles of expired Vicodin and such around that I was prescribed but never finished. I have zero interest in recreationally using opiates. I also have zero interest in bravely tolerating agonizing pain if I don’t have to.
It's easy to say this when you already know that you, personally, can resist the temptation of abusing drugs like Vicodin.
Personally, I refuse all pain killers except OTC and local anesthetics like novocaine. I rather risk biting through my tongue than getting addicted to that shit.
If the manufacturers and regulators were more concerned with human lives than making money, they would have quietly buried the research. It may have entered the illegal market eventually, but there wouldn't be factories producing large quantities of the drug like there are now.
They should have known that an opioid 50 times more potent, deadlier, and more addictive than heroin would be responsible for the worst drug epidemic the world has ever seen.
While fentanyl is amazingly effective in a controlled environment like an operating room, it's not the only option at their disposal. I suppose if this vaccine took off and you got it, it'd be good to keep an electronic medical ID on you.
Right, and Case bought betaphenethylamine instead of speed which was way harsher. That's exactly what is going to happen, some more potent drug that escapes the vaccine is going to get more popular. It's a bandaid solution that ignores the root cause (drug prohibition)
actually have a friend who nearly died from snorting fentanyl passed off as cocaine. fortunately an ambulance got there in time and saved him with narcan. his doctor friend also snorted coke with him, was carrying narcan in her purse and managed to Pulp Fiction herself on the way down.
Opioid overdoses are typically due to overestimation of one's tolerance or underestimation of the strength of the drug being taken, and what you are responding to is a way that a weakened fentanyl effect could lead to that.
Readit News
People start using drugs for different reasons. It's not correct to say that everyone starts abusing drugs as a form of pure escapism. A lot of drug users start because they're simply seeking recreation and someone is nearby to make drugs available to them. It's as simple as that.
> You are broken because society is broken.
Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
They start for various reasons, like your example of "seeking recreation" and having a certain person nearby.
They don't stop because they cannot stop due to a physical addiction. I do not think personal responsibility is the right topic for that once it has gotten to that point. They've entered a state of physical dependence in which the reason they started is kind of irrelevant, and it's very difficult to quit, through no fault of their own.
Let's be clear here: someone's stated reason for using opiates might be recreation, but nobody starts shooting heroin for recreation without some pre-existing reason for self-destruction. It's not a secret that opiates are dangerous. People with normal self-preservation instincts find other ways to recreate.
> > You are broken because society is broken.
> Variations of this concept are frequently used by drug addicts to justify continued behavior. "It's not my fault, it's society's fault!". Taking ownership of actions and consequences is one of the key pivot points in helping people get control.
What this boils down to is that the addict has to understand, "Society isn't going to help you, so you have to help yourself." That's important for addicts to understand because it is, unfortunately, true. But if we lived in a society which actually gave enough of a shit about its citizens to help them when they have problems, the importance of understanding that society won't help them would obviously take a smaller role.
I want to be absolutely clear here: there is not effective help for the causes of addiction. For example, a common cause of addiction is homelessness. Contrary to HN opinion, the solution to homelessness is simple. The solution to homelessness is homes. Not shelters--don't embarrass yourself with the "I don't know what the word 'home' means" argument. The fact is, 1% of the US military budget would build a home for everyone in the US. It's not difficult: the reason it hasn't happened is that there are a lot of people opposed to it. Instead, we build shelters where nobody has any privacy or feels safe or can have a pet or storage for their belongings (that's just like a home, right!?), and only in places where they don't inconvenience anyone society cares about, and then blame the homeless for being hard to help when they choose not to pretend that our half-assed solution does anything to solve their problems.
I don't think these are mutually exclusive. Society wide problems cause a huge fraction of the population to experience severe emotional trauma, and the process of addiction largely seems to be an experience of trying to escape the feelings associated with that. If you can understand this process, you can take ownership of it, and have a path to beating the addiction itself.
Ultimately, there is a lot of disagreement about what addiction is and how it really works, but I think this emotional trauma aspect is a key part of explaining why one person can use a drug recreationally or for medical purposes without addiction, and another can't. It explains a lot of weird observations that just didn't make sense with the classical chemical/neutrotransmitter model of addiction.
These links I think help explain this better than I can:
How Childhood Trauma Leads to Addiction - Gabor Maté https://www.youtube.com/watch?v=BVg2bfqblGI
Comic explaining the Rat Park research on addiction https://www.stuartmcmillen.com/comic/rat-park/
These ideas have explained why I personally have never been able to fight addictions through willpower alone, but have been able to eliminate addiction with other techniques that seem unrelated- therapy, meditation, exercise, hobbies, friends, ending bad relationships, etc. It seems that while chemical/physical addiction is a thing, emotionally and mentally healthy people don't experience opioids as a positive thing, such that the effect of the drug itself actually discourages it's use, and even motivates the experience of withdrawal.
Think about it as a policy maker. You have a choice whom to blame - an individual or their environment.
If you blame the individual there is nothing you can do - we can’t change other people.
If you blame the environment now there’s something you can do. You can try to reduce supply by making it illegal (only works to a point) or you can try to reduce demand by increasing overall quality of life - housing, healthcare, and generally a way to escape the clutches of the rat race that is life in America for so many.
I feel like the use of this argument should depend on the scope of the person who is speaking.
Law-makers and society-enablers should consider things in the far-scope of "society's fault", whereas this consideration is less useful on a personal scale other than for the purposes of blame-redirection.
>start because they're simply seeking recreation
These are the same thing. Happy people don't seek to drown every waking moment in constantly escalating recreation, they got things to lose and when they are out having fun and an opportunity comes around to do drugs they are surrounded by friends and loved ones who care for them enough to not let them ruin their life for lolz.
Control of what? That's the point of drug abuse - what is there to be controlling? We are gears in someone else's system, purpose is rarely possible in modern society. Address why this is.
This is true for drugs in general, but not many people are stupid enough to take opiods recreationally.
https://www.doj.nh.gov/news/2022/20220303-settlement-purdue-...
Personally I've been avoiding oxycontin like the plague for that reason. I had two surgeries where the doctors wanted to give me oxy to manage the pain afterwards and I refused to take them. It turned out in both cases the pain was manageable with less addictive options, so I'm not clear why they reached straight for prescribing opioids in the first place.
We need to look at this holistically. Overprescribing is a problem, but we shouldn't be needlessly afraid of these substances. Personally I've been prescribed these medications, I took some and when it stopped hurting I stopped taking them and the bottle sat in my medical cabinet in case I injured myself later. Eventually it expired and I threw it away. It wasn't an issue of will power or anything like that. I just didn't feel the compulsion. I'm the same way with alcohol and other drugs. I enjoy it when appropriate, but I feel no compulsion whatsoever. I, in fact, prefer mental clarity.
But I have people in my life who develop very strong compulsions and become addicted to anything that distracts them from their psychological torments. Reducing access helps, but reducing other circumstances in their life that they may feel the need to numb has to be part of the solution.
This affects many more people than just those addicted to opiates.
Or on amazon
I totally get why some people become addicted to drugs. Diazepam made me both in less pain and care less that I was in it. The opiates produced this warm, fuzzy haze of vivid dreams and imaginations and made a difficult time bearable. Fentanyl made me feel less than human but not able to suffer, and it was a necessity at the time.
Of all of them though, diazepam was the most dangerous. It just felt – well, nice. I didn't care that things were bad. I needed it medically to stop neurogenic muscle spasms and it made me both able to sleep well and feel OK about life in a way that is really hard to put into words. I have some in a bag, prescribed for me, in case I need it. Part of me – a small part of me, but a part nonetheless – wants to use it, a lot, when I don't need it. There's a little voice that just says "this makes you feel like you've been tucked up into bed nicely". I really can't explain it, but I know that voice is a temptation and a gateway to something that I don't want to have – but at the same time, I know that that drug both saves me from agony and helps me medically if I need it. I'm really not sure how I feel about that. I haven't had any in months, but the psychological aspect remains.
I can only imagine what "real" drug addicts go through. It must be incredibly hard, and individual's range of experiences will be very broad indeed.
Ironically, she worked on the UK medical trial for Fentanyl when it was first introduced for surgery.
That voice is the voice of addiction. Once it starts it never fully goes away. It just gets less frequent.
I drink alcohol a couple times a week and do edibles once a month. I'm sure some would argue I'm not fulfilled but I think the easier explanation is that a lot of times doing mind-altering drugs is...fun? And can be social.
This doesn't mean there aren't a hundred reasons people get trapped in drugs. But a very real one is just because many people come to believe it's cool and tough, and end up fetishizing it until it's too late to get out. And like I said, in my hometown, this was the predominant reason.
A heroin vacation to an opium den on occasion sounds wonderful.
I certainly have used drugs socially (LSD in clubs or concerts can be fun), but also use them cannabis alone frequently.
This isn’t how it works.
Few people, if any, want to “check out.” What happens is that people are exposed to opiods via one of two channels (they are prescribed painkillers, or they party with someone who has acquired them) and they quickly get hooked because these drugs are cripplingly addictive.
So the only “why” questions we have to ask are:
1) Why do people take opiods the first time
2) Why do people continue
The answer to 1 is either because their doctor said so, or because they like to party and have no foresight. The answer to 2 is because if they stop, they experience the worst sickness imaginable.
Society is not broken and we don’t need weird conspiratorial explanations for any of this.
It is quite simple, at some point, you decided to continue taking them despite knowing this to be problematic.
I would also like to add, that i have met very few addicts who blame the drug. Its most of the time relatives who like the story of their loved one getting tricked.
If it was only the fear of withdrawal, the opioid crisis would be solved next week. Literally. But the unfortunate problem is that people relapse. Because what ever made them take opioids every day didnt get fixed with a withdrawal. And if your life still sucks, its very easy to go back.
> 1) Why do people take opiods the first time
that the GP is getting at. While doctors over-prescribing opiates is definitely a thing (esp. in the US), I'm not convinced that many people get hooked on opiates due to partying. I think it's more commonly:
"Used as an escape from a life that is unmanagable for some reason"
That's not conspirational. There's good evidence to show that life circumstances have a big effect on both initially becoming addicted and success when attempting recovery. The answer to this might look like a better welfare state or similar.
Life expectancy plummeting through deaths of despair, juxtaposed with widespread addiction (as much to drugs without physical dependence as opiates).
Sometimes the simple answers are the most likely. Even if you have a great life, it’s tempting to have such experiences.
Sure, a lot of people use it as an escape though. But I imagine my dumbass brother in law died because he was trying to have fun, not check out of life. Miss him.
This is the dirty little secret of 1980’s-style approach to keeping people off drugs: they feel great.
The old (current?) approach suffers from intellectual dishonesty of ignoring the physical pleasure.
The number 1 reason I experienced is because some social circles fetishized it. It was a very cool, tough, and a superior lifestyle. Anyone who didn't do drugs was a loser, drugs were for winners.
When there is a strong cultural-current of this attitude, it can draw people in and ruin their lives by the time they realize it's all wrong.
1. Ongoing health issues they can't afford to resolve. Chronic pain. Mental health issues. Sleep disorders.
or
2. Inability to cope with high levels of stress due to financial insecurity, bad relationships, or loneliness.
I think the cultural attitudes you describe may have some relation to other problems. Most people I've encountered seek escapism when their life experience is poor and they're unable to change their circumstances or unaware of ways to change their circumstances.
I don't do powders, opioids, etc but I do have some friends within tech and the festival scene that do. My observation is that most people that die from fentanyl don't know they're taking it. They think they're doing cocaine, ketamine, heroin, or some other substance. Fentanyl presence is usually a case of cross contamination when the particular substance is being cut at each hierarchial level of the drug food chain. That's not to say that there isn't some small subset of dealers who don't purposefully drop in some fentanyl, but largely that'd be a stupid decision. The users life expectancy shrinks and their risks skyrocket when they come in contact with fentanyl, this is known.
If you want to stop the deaths, then you have to allow drug distribution that comes from clean rooms. At present, everyone should be using test kits, but fentanyl in particular is hard to test for because a single grain hiding in a mound can get and overdose a user.
If you want people to stop using drugs, well, I have less to say. The history of humanity is using intoxicants whether it be for recreation, psychological well-being, or medical necessity. We've only recently in the history of humanity gone on moral crusades to villainize it.
Chemically addictive substances are a little more challenging. Things like heroin, cocaine, and methamphetamine aren't drugs you can benefit from, but people still do them. Largely, it's because they got hooked on pain killers or some other "numbing" medication. Better availability to harm reduction resources, therapy, social safety nets, etc would improve metrics across the board in the chemically addictive substances category.
Plants (and fungi, and animals) evolved to create noxious chemicals that keep animals from eating them, keep animals from breeding, or outright kill the animals. The Golden Poison frog's toxin is about 40 times more lethal than fentanyl.
Drugs get you high. Ants get drunk, goats chase psychedelic lichen, and dolphins pass around puffer fish like a dutchie.
> Why do so many people want to check out of life completely by abusing medicine
The short term benefits always outweigh the short term costs, but we're moving to a point in history where even it even seemingly outweighs the long term costs. There's no real disincentive anymore.
I think a case can be made that Martin vs. Boise had the most to do with this. That ruling was meant to push cities into creating the necessary facilities and number of beds to correctly address their homelessness problem; instead, it seems that many cities have used it as a way to entirely ignore the issue.
Instead of building the facilities, they're just throwing up their hands and allowing the kind of "public camping" that quickly turns into public open-air drug markets. Unsurprisingly, the population and markets grew.
> A lot more empowering than just "submit to a higher power" which is clearly not working for the majority of users.
The twelve steps are about quite a bit more than "just" that. They're also targeted towards a person that is at a specific stage of addiction _and_ willingness to address it. It's not general purpose and you can't force people into it, particularly when their drug of choice is so easily available and socially acceptable.
You have to reduce the inflow of drugs. You have to stop drug markets from forming. You have to convince addicts to seek treatment.
On the last point, I think the most effective strategy would be confiscation. If you are caught with drugs for personal use, they should be taken and destroyed, and you should be given information and transportation to a treatment center if you desire. Otherwise, you should be free to go. If the state doesn't interject itself at some level then I don't think you stand a chance.
And this is how we get fentanyl. Why import 2 tons of drugs when you can import 2 ounces with the same power.
Attempting to reduce the inflow has just created a violent black market and a dangerous police state.
For example: The more people are depressive, the more pills can be sold. If people kill themselves due to depression, that's too bad, but they didn't buy any pills to begin with.
Diabetes is great, because people depend on insulin. A never-ending money maker! Fat people are great! They eat more, thus spend more! Some of them get their fat surgically sucked out of their bodies, which also pays! When they get more and more sick, they need more and more medicine, which pays even more!
The transhumanism movement is awesome, because transitioned people require pills! Every day!
Sadness? There's a pill for that!
Drug addicts? Lets invent a vaccine for that!
Fantastic!
Society isn't getting fixed, because nobody actually has any interest in that. Those in power/money certainly don't give a fuck and rather want more money, while the actual people are mostly too stupid to figure out that the whole system needs changing.
Instead they whine, complain and protest and go voting, without realizing that it does basically nothing. Yes, voting actually does nothing. We didn't get to this point because voting helps anything. We got here, because voting doesn't matter.
Decades of evidence lay in front of everyone out there to see, yet for some reason every couple years people actually believe their button-pressing/their X-making actually gives them power over what's going to happen!
There's no vote allowing you to change who pays all the money to the politicians, law makers and judges. There's no vote that allows you to change the underlying corruption that's going on. There's no vote that enables you to decide what actually happens with your money.
You're fucking hilarious. You're not wrong per se, but also hilarious.
"Society needs fixing!!!111" well then get together with enough people and fucking fix it.
Politicians won't do it for you.
Better get your guns ready, btw, because it's definitely not going to happen peacefully.
Given how many lives this destroys, how many people it takes out of the potential workforce, how many social problems this causes (crime, homelessness, exasperated mental health issues) - why isn't there the political will to change this?
The abridged version is: there too much money to be made.
Fentanyl has gone from direct primary import (which was blocked) to banning of exporting precursor drugs from bulk suppliers in China (to slow down | stop Mexican drug labs from mixing them to make Fentanyl) to where things are today ...
relatively mobile "popup" drug lab networks that start with bulk pre precursor drugs to make the precursor drugs that are funneled to final product labs.
It's a hell of a whack a mole game across Mexico, the USofA and Canada with a process that's tough to break, the initial drugs used are too useful for too many things to ban outright and the production aspect is broken down into many replaceable parts.
( I had references to most of those stages in the original comment, apologies for not having them to hand ).
My assessment is that if even people at that level of wealth and success can get addicted to opioids and die, pretty much anyone can.
Addiction, whether alcohol, drugs, cigarettes, etc., is something that is a genuine medical issue needing treatment. Thankfully, the medical community seems to be shaking off the social stigma about addiction and treating it properly now, but progress has been very slow.
Painkillers can provide relief for emotional pain as well as physical pain.
Even something like Tylenol can help people going through painful breakups.
Unfortunately opioids are addictive and users build up tolerance, which is bad for people with chronic pain of any variety.
Do you have any evidence that that works better than (say) buprenorphine or naloxone, which target the underlying neurological problem?
I doubt that it's always a "choice". But it wouldn't surprise if there was many main causes.
Also, this: https://www.dailymotion.com/video/x305n83
People here want you to
- Be in a gang (or a prostitute, thief, ex-con and so forth) - Be on drugs (or in rehab for drugs) - Have a mental illness (so you can go to therapy) - Be disabled - Find religion
There isn't a position for "I ran out of money and my family wouldn't support me, and at some point finding web development work became too hard as the technology became more complicated." People want you to "get better." I don't do drugs, I don't smoke, I don't drink, I don't steal or assault anyone.
I just don't have any money.
But people here are morons. They need to have a reason for why someone is poor other than "I'm a person of average intelligence that doesn't know how to find a paying job in this society." I don't want to be psychoanalyzed, be put into rehab, go to church or join any number of the lonely people who have to have a support group because society is awful. I don't have problems other than being poor - if you managed to buy into the crypto ponzi scheme at the right time then no one is asking you to "find god" or "get better".
People are social animals. If you put them in a position where those are the options (jail, crime, drugs, psychoanalysis, religion, disability) they'll take the least unpalatable. There's a whole lot of people who walk around here with canes they don't need because otherwise the San Francisco General Assistance office won't spring for them to have housing. Also known as an apartment with a bed and a door that locks.
If I make more than 1500 dollars I lose my health insurance through Medi-cal.
And I'm no defender of a lot of these people. The bastards that set up tents on the sidewalk and smoke meth are just awful. But on the other hand, I have absolutely no idea how to get a job. None. I've done construction before and all I ended up with was bad memories and scarred hands. I could work "security" by putting on a t-shirt and standing outside a soup kitchen, but that's just bullshit make work the charities give out so the poor can buy shoes and feel special about themselves. Real security jobs outside of bars are a good way to get killed. And that's about it. I'm staying at a homeless shelter and have the clothes on my back so how am I supposed to get a job?
There's your why.
So let me give you a when. When, not if, your industry is automated or the code becomes too complicated for you to understand anymore you'd better have enough savings or a social network so you don't become homeless. Or you'll have to crawl into one of the buckets that allows society to make sense of you.
And today I'm sitting in the San Francisco library looking to make a contribution to a software project for free and I just don't know that I care anymore. And if you tell me it'll get better, then I have to ask if you're about to be laid off or not and what your plans are.
Skip the web dev and be a writer. Surely other HNers can hire patientplatypus for this?
I had a very strict rule when I was homeless. Stay away from other homeless people. Camp on the edge of town. Ride the bus into rural areas.
How did I get a job with just the clothes on my back? I hitch-hiked to north dakota in the oil fields where a man is a man and they don't give a fuck what you look like. They hired me to do day labor, and once you have enough money for a van or a short stay airbnb it only gets easier from there.
Get the fuck out of tenderloin, and san francisco at all costs. Hitch-hike if you must. If you want guaranteed housing you can also look into doing seasonal harvesting work for fisheries in alaska. They'll pay your flight from seattle and then cover your food/shelter while you're working.
We do have a once a month injection of naltrexone that can block all opioids, which can be effective in the right person. A targeted approach to fentanyl alone would probably work in people who don't have an opioid use disorder (and therefore wouldn't be as prone to substitution with an alternative opioid). This is an interesting step, but our understanding of immunology is far too limited to make this realistic in the near term.
One of my last conversations with this individual: they were excited to go to some convention in Minneapolis that was all about mushrooms and psychedelics. What struck me was how excited they were, how into that community they were. I couldn't relate. I thought to myself, isn't there anything in your life more exciting than this? Rewind 12 years, and I also have a memory of his fascination with tagging buildings on YouTube. The art of it aside, I was so struck by his ignorance to the fact that you're damaging someone else's personal property without their consent.
To deepen the mystery: I grew up in an unstable household, suffered emotional abuse and physical abuse on one occasion. I remember sleeping at a friend's house for a week and begging them not to call the police. When I look at this deceased person's life, whatever grievances they had, it really pales in comparison to my experience. And yet I never touched drugs. It makes me think some choices are not our own - and if it is predestined in some way at birth, well then yes, more compassion is necessary.
Whatever your personal views, it is objectively true that a vaccine would prevent some people from dying, so it's likely a good on balance.
I'm sorry for those impacted by this.
1. It's unclear what your family member was going through. Your own experience is much more salient to you, but battles are more and more invisible to external viewers, so it makes sense that you would characterize your experience as more difficult. It can be true that you had a horrible experience, and so did this person. There's a reason the "walk to school uphill both ways" meme exists.
2. Your sample size here is very small. Even if it is true that your experience was worse (we can't know for sure), your actions in that circumstance shouldn't be generalized to people-in-general, and the same applies for your family member.
> It makes me think some choices are not our own - and if it is predestined in some way at birth, well then yes, more compassion is necessary.
I'd encourage you to challenge whether predestination / loss of control is the qualifier for compassion. How can we know, for certain, why people make the choices they do? If you were predestined or not, we don't currently have a way to know.
Would people deserve compassion if everything they go through is a direct and pure result of their choices and nothing else?
Are you always this judgmental of others’ interests? Do you have these feelings towards someone excited about e.g. a new video game or a programming conference?
Good to hear, but at its worst, my pain was only relieved by fentanyl (administered by a professional in a hospital). Noticeably better than Dilaudid (hydromorphone).
Is morphine a reliable replacement for fentanyl? Fentanyl is used quite often in palliative care because it lacks the side effects of morphine, is this correct?
To summarize, yes, this vaccine prevents overdose, as well as the other drug effects.
"Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys. Thus, the individual will not feel the euphoric effects and can ‘get back on the wagon’ to sobriety,” said the study’s lead author Colin Haile"
They clarify that this causes a user to not feel the positive effects of the drug, but I would assume that if the drug was also able to prevent overall mortality, they would be excited enough to mention it.
It claims to block the ability to get high -- does it also block overdose potential? Or is this just going to lead to lots of people OD'ing as they try to take enough to get high?
One way or another, it seems likely to lead to even greater harm as addicted people look for something else that does work.
Honestly seems like a bad idea overall, based on wrong and unuseful ideas about the nature of addiction.
This is answered in the article.
>“The anti-fentanyl antibodies were specific to fentanyl and a fentanyl derivative and did not cross-react with other opioids, such as morphine. That means a vaccinated person would still be able to be treated for pain relief with other opioids,” said Haile.
>Problems either way; if just fentanyl, then, duh, that's not the only way to get high.
Yes, but fentanyl is considerably more dangerous than most of those other methods. Mis-judging your poorly-cut heroin dose by a milligram at least doesn't kill you. That's part of the point of targeting fentanyl itself with a vaccine - it would be accepted by the drug-taking public, because most of them don't want to be taking fentanyl in the first place: there are other ways to get high.
I had rather major surgery. Once I was sent home, the opioids just weren't worth it. (I was surprised.) Ibuprofen actually worked a lot better.
Granted, I don't think I'd want to undergo surgery without opioids during the first few days of recovery.
"Once feared, illicit fentanyl is now a drug of choice for many opioid users: People with opioid-use disorder are increasingly seeking out illicit fentanyl, often smoking it."
https://www.nbcnews.com/health/health-news/feared-illicit-fe...
(I really do know that everything you read in popular media about drug use in general, and opioid use specifically, cannot necesssarily be trusted. But my understanding from several sources is that this is so. The fact that fentanyl is cheaper for the effect is a reason a user might choose it too, or it may simply be what is available, or affordable)
Whether users are intentionally seeking and/or aware of getting fentanyl or not, I am saying that the consequences of making someone's dose not have the effect they are looking for can often be that they take more (getting more of all of the substances that were in the dose, known or unknown), or that they switch to an alternate supply/substance. Either of which can have very dangerous outcomes.
I won't tell you what you need to familiarize yourself with, or assume I know what you are or are not familiar with.
Not really clear if it prevents ODing but the article says:
> Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys.
An opioid that's more potent, more addictive, and more deadly than heroin should never have gone to market in the first place. It speaks of enormous corruption and a complete lack of ethics when regulators didn't see an issue with fentanyl and let it move forward.
The "but people are in pain" argument doesn't hold up very well when heroin is safer and has less potential for abuse but they already made illegal in the US.
The drug is extremely useful and saves lives in a clinical setting; chances are it will save your life or someone you know and love. It's literally used _every hour_ around the clock in ERs.
Nearly all problematic Fentanyl in the US is illegally imported and created by third parties overseas. It is not manufactured by those big bad US Pharma companies.
It's naive to think we could make "super heroin" and it would stay restricted to safe, controlled medical environments. I'm not convinced the good it does in certain cases outweighs the enormous harm it's also responsible for.
This is a little misplaced. Fentanyl is a medically useful drug. Fentanyl had years of use as an anesthetic agent (and still does - it is an essential ICU medication) before the idea of marketing it for other purposes occurred.
And without defending the pharma industry and their role one bit. The vast majority of fentanyl these days is not from big pharma, and it's arguable what relative role fentanyl played vs all the other drugs
Specifically, the demand for illegitimate fentanyl today was mostly driven due to addictions from other medications that were NOT fentanyl - such as oxy, hydrocodone and even the "safe" tramadol.
Having said that, it's going to be a hard sell that all opioids should be banned. There is some middle ground between reserving for palliative and acute critical illness and having PCPs prescribe for simple back pain.
> heroin is safer
It is a smidge more complex. Fentanyl has some pharmacologic properties that make it safer for controlled use in sick patients. Heroin has similar metabolite related side effects as morphine.
I completely agree that there's a ton of recklessness in the history of opioid prescription. It's been a horrible plague on society that will have generations of lasting impact. But there's uses for it. I dunno, maybe heroin patches could have become a thing?
However, as my condition becomes more severe, a time will come when I will have to "graduate" to something stronger. The end of that choo-choo train looks like fentanyl or something very much like it, assuming I don't just up and die first. I'm glad that there is something there.
A friend of mine, his mother died of the same thing many years ago, when it was poorly understood and largely untreated. She was kept in a distant corner of the house so that the screams were less bothersome. Raving in pain, she would curse his name for not helping her to die. That's what it looks like at the end when there's not enough painkillers.
So I guess if you get your way, can I bunk at your place?
I joke, but only a little. You don't have a lot of skin in this particular game. Consequences are far away, third-order at best. I dunno, maybe listening to someone howling away might bring it home, maybe not.
To someone like me, it looks like someone who won't really be affected at all just trying to yank one of the few solutions I have left away, and for no good reason at all.
Personally, I refuse all pain killers except OTC and local anesthetics like novocaine. I rather risk biting through my tongue than getting addicted to that shit.
Do you think there would be a meaningful difference in the volume of illicit fentanyl if it was never approved by the FDA?
They should have known that an opioid 50 times more potent, deadlier, and more addictive than heroin would be responsible for the worst drug epidemic the world has ever seen.
That's gotta describe like 75% of US healthcare budget, right?
Red Dye #40, BPA, preservatives, emulsifiers, PFAS -> ADHD, Anxiety, Depression -> Adderall, Xanax, Prozac
Sugar, seed oils, preservatives, endocrine-disrupting chemicals in food, water & air -> Obesity, hypertension, diabetes -> Lipitor, Insulin
Alcohol, smoked/grilled meat, tobacco, microplastics, pesticide residues, air pollution from cars & factories -> cancer
Further, are you claiming meat, tobacco, and alcohol are products of the US pharmaceutical industry?
* You could identify fentanyl passed off as heroin, cocaine, etc because they don't work as well.
* "Damn this cocaine is weak. Maybe I need to take more" - I could imagine this leading to more fentanyl overdoses.
* Something like this happened in neuromancer.
Right, and Case bought betaphenethylamine instead of speed which was way harsher. That's exactly what is going to happen, some more potent drug that escapes the vaccine is going to get more popular. It's a bandaid solution that ignores the root cause (drug prohibition)
fentanyl is scary stuff.
You just reminded me that I want to re-read it soon.