Addiction has a huge situational component. 20% of US GIs in Vietnam were addicted to heroin. When they returned home 90% of them stopped using heroin overnight, indefinitely [2].
We're doing this all wrong.
[1] https://www.theguardian.com/news/2017/dec/05/portugals-radic...
>Addiction has a huge situational component.
Yes, this is exactly what I'm getting at.
>20% of US GIs in Vietnam were addicted to heroin. When they returned home 90% of them stopped using heroin overnight, indefinitely [2].
This seems to contradict your previous point, no? In Vietnam there was of course zero enforcement, outside of the military (I'm being charitable here for reasons that should be obvious), and they returned home to a country where the drug was illegal.
Edit: very interesting, the negative reaction to this comment. What I said is true, so I can only assume that people who are reacting negatively are doing so because they are projecting a view on me that I do not hold.
(1) We have data from 1971 onward, just shy of 50 years, that shows that the "war on drugs" approach used in most of the world has been an abject and total failure. Drug usage remains pervasive, social harms are clear, and we keep throwing people in jail. No progress is made.
(2) A country was doing terribly on every metric, then they made a bold decision that was the opposite of the failed approach everyone else is using.
(3) The results were spectacular.
(4) Your response is "well that'll never work here." This is an implicit endorsement of the failed status quo, and an explicit rejection of evidence in support of an alternative.
> This seems to contradict your previous point, no?
No, it doesn't. It's not at all related to availability or legality of drugs -- drugs are equally available literally everywhere. Nobody in the US who wants to do heroin has any trouble getting heroin, or any other opioids. Accessibility is not the issue. And nobody addicted to heroin goes "oh, well, it's illegal in America, guess I'll stop."
It's evidence to support that we need to end the abject failure of an approach we've squandered 50 years on, and start a new, public health and community support approach to managing addiction. As evidenced by a place it's been overwhelmingly successful.
We literally can't do worse than what we have now, unless you wanted to make drugs mandatory.
They also returned to their families and loved ones, trying re-introduce themselves to civil society and many figured out that heroin was not helping (illegal or not)
Everyone gets the point you’re making, you’re just not following it through to something meaningful and instead supposing it implies something it doesn’t.
Fits nicely to me.
We have? Can we get a citation on that?
How would you know who suffers more on average?
The cases I've mostly heard about seemed to be that people hot addicted to opioids and the only way to keep it going was to break the law. That eventually got them in trouble. For some drugs it does seem like the government trying to protect you from the drugs do more harm than what the drugs themselves do. Are opioids among them?
A recent article which contextualises the work is here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/
Obviously it’s lossy to reduce something with this much complexity down to a single dimension but it’s still a helpful tool nonetheless.
As far as I remember, only 10% of people who ever used heroin get addicted to it. But that still leaves 10% at a very high risk, because of their neurochemistry and life circumstances.
So I don't think ALL drugs should be legal.
> people with chronic pain.
Chronic refers to the length of time the pain exists, it doesn't refer to severity.
Here's what the Royal College of Anaesthetists says about opioids
https://fpm.ac.uk/opioids-aware
> Key Messages
> 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain.
> 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).
> 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit: tapering or stopping high dose opioids needs careful planning and collaboration.
> 4. If a patient has pain that remains severe despite opioid treatment it means they are not working and should be stopped, even if no other treatment is available.
> 5. Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detailed assessment of the many emotional influences on their pain experience is essential.
Especially as it is prescribed in the US, where drugs get preferred instead of other interventions. "Back pain? Opioids. No PT, no losing weight, just opioids. No, not even NSAIDS, just go for opioids"
Remember that some drug companies pushed for their medication to be in 12h regimens which increased their dependency potential, as opposed to a shorter interval preferred by doctors?
As a personal experience, opioids don't seem to work much for me on many types of pain.
For chronic cases, I think chronic makes a lot of sense.
Pain helps you get moving. Opioid's don't. Too much pain is debilitating. Surely we can find a formula here (a very very large one).
Cannabis never removes all the pain. I think that's the main feature here.
He states, "The opposite of addiction is not sobriety, the opposite of addiction is connection." (18:08)
The former U.S. surgeon general, Vivek Murthy, declared loneliness an epidemic, and just wrote a book on it [2].
I believe the biggest challenge we face in the United States centers on emotional health. How do we feel? Whom do we trust? Who do we think loves us? How do we rebuild trust? How do we apologize and forgive? How do we grieve?
I watched a 60 Minutes episode talking about some of the pharma reps trying to convince doctors to prescribe more opioids [3]. One rep, Alec Burlakoff, had this interchange with the interviewer:
> Bill Whitaker: You're preying on these people-- > Alec Burlakoff: Yeah, because they're desperate. They'll try anything. And they may get relief from Subsys initially, But we all know what's gonna happen. We know. We've been doin' this long enough. We know how it ends. > Bill Whitaker: And that is? > Alec Burlakoff: It ends in addiction, withdrawal, pain, suffering, and even death. > Bill Whitaker: And you didn't care about that? > Alec Burlakoff: Back then, I was numb to that.
This reminds me that while I often think that the people who feel disconnected are the ones using the opioids, very often the ones selling them also feel disconnected. How did this man get so numb to selling products that he knew were causing so much pain and suffering to others? How did he get so numb in life in general? More importantly, how do we help him feel more alive?
I agree, I don't think the Department of Justice, especially with a focus on punishment rather than rehabilitation, can lift us out of this hole. I believe it will require a focus on emotional health, on repairing relationships, on helping us feel less distant, more close, to our friends, family, neighbors, and fellow Americans.
[1]: https://www.youtube.com/watch?v=CDpjvFn4wgM [2]: https://www.amazon.com/Together-Connection-Performance-Great... [3]: https://www.cbsnews.com/news/opioid-epidemic-pharmaceutical-...
A man whose professional experience is journalist and has no science, medical, public health, or psychotherapy background... and he’s trying to sell a book.
Is this too harsh a take? Is there a reason I should be taking his opinion seriously?
[1] https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism
[2] https://www.theguardian.com/science/brain-flapping/2018/jan/...
On the second point, I think it would be hard to find a book talking about mental health/healthcare that weren't challenged, but I could be wildly wrong on this. I just get the impression that there are many many takes on mental health, especially coming from a variety of fields—psychology, psychiatry, neuroscience, social work, sociology, criminology, etc.—and that I personally believe we still have a lot to learn in this space.
I agree the opinion is probably too sweeping, as I like to qualify most of my statements and some people, especially authors and politicians, often exaggerate theirs.
> Your comment reminds me of an episode of Joe Rogan with Johann Hari [1], talking about what really causes addiction and the failures of the "war on drugs."
I guess I'm a bit confused at such pushback on Hari, but maybe by putting "really" in my statement, with such confidence in the statement, I invited such a challenge.
I personally don't think that just because he's a journalist without those backgrounds, that he's not capable of learning and presenting truth in those spaces—I see a lot of value in journalistic skills of investigation and interdisciplinary exploration. That being said, it doesn't necessarily mean he's right or that he's not exaggerating or oversimplifying.
I found the podcast episode to be quite compelling to get me more interested in looking up other sources to see whether they agree with him, or if they differ, and in which ways. Even you posting this, questioning his credibility, inspired me to search a bit of what people with more experience in directly related scientific fields have said. Some have questioned whether the studies done with rats extrapolate to humans, some have questioned his seeming disapproval of antidepressants, and more.
I guess it just depends on who and what you trust to give you the truth about this issue. I found the interview illuminating, but that doesn't mean you would or should.
What is science, if not a never-ending quest to learn more about the universe?
Bold claim, or tortured use of often.
> I wonder how many of our scientific discoveries have come from suggestions (or bold statements) from people in other fields.
A lot of academic fields are fairly siloed from others. One example is presentations at a conference from a subfield that is just slightly oblique from yours is hard to follow because they use different jargon than you. It is getting a little better with some emphasis on interdisciplinary research.
> Sure, many may prove to be false, but I like how you've framed it as a novel opinion that could spur further research into a topic.
From my experience with being blasted by spam ideas just because my contact information is in a university's physics directory, a lot of/most 'novel opinion' is noise.
Fair point, it may not be that often.
> A lot of academic fields are fairly siloed from others. One example is presentations at a conference from a subfield that is just slightly oblique from yours is hard to follow because they use different jargon than you. It is getting a little better with some emphasis on interdisciplinary research.
True, jargon and other aspects can draw divisions really fast. I left the electrical and computer engineering department at my university to pursue international studies because it was interdisciplinary and I could basically build my own major from economics, intl business, anthropology, political science, and other areas. So I'm probably biased towards interdisciplinary stuff and maybe see more of it than there may be.
> From my experience with being blasted by spam ideas just because my contact information is in a university's physics directory, a lot of/most 'novel opinion' is noise.
I can only imagine how many novel theories of the universe you receive and how few have relevance. I still think sometimes we can see patterns in the odd/wrong suggestions they provide and come to hypotheses about things, but maybe more so in some fields than others, and maybe much less directly than I had postulated.
Anyway, really appreciate the back and forth dialogue :-)
I wonder how frequently those opinions come from journalists trying to hawk books on fairly facile premisses tho
What do you mean by it?
If I had to take a guess, his income as the vice president of sales probably helped with that.
I guess I still see it as an issue of how connected he felt to himself and other people. I know plenty of people right now, who, if they were offered his salary to do the same job, would never do it. And others who were probably in a field like that and quit because it was getting too much, or maybe even became whistleblowers.
Makes me also think about how some of us can become workaholics to avoid pain in our lives, or crave lots of money to cover up for fears of not having or being enough.
I guess with sociopathy, even if they are behaviors that are very difficult or impossible for a person to change (something I strongly doubt in most cases), I'm still curious as to what brought a person to that stage.
This reminds me of one of the speeches that has touched my heart the most—"Love Your Enemies" by Martin Luther King, Jr.[1]—where he discusses how he strives to love a person, even if he doesn't like how they behave. I see sociopathy similarly—if the person can't change, I may remove myself as much as I can from their behaviors, but still wish them well. I don't know if it will help them change, but it sure helps me feel better :-)
[1]: https://www.youtube.com/watch?v=522wcqUlS0Y
edit added link
You laden them with paralysing amounts of debt in their late teens, force them into capitalistic servitude for the rest of the life. Make sure they earn only just enough to survive. Make sure they work until they are totally exhausted and you can’t squeeze another dollar of productivity out of them.
Make sure they think the only alternative to this is homelessness/total destitution.
Then don’t give them a legal or ethical option that shows them any future other than the above until they are dead, while their bosses boss gets rich.
Then wonder why they act unethically
Having seen opioid addiction up close, I have a hard time not condoning DOJ actions. It’s not perfect, but nothing is.
Genuinely curious: this doesn't really mesh with my understanding. I think opioids are extremely addictive (more so than tobacco or even cocaine or amphetamine) and as a result it's nearly impossible to be a "casual" user (and therefore I don't ever intend to try any opioids). Is there evidence that opioids can be "moderately" used?
The actual drugs here - I’m talking pure, regulated pharmaceutical versions - are pretty benign physiologically. Constipation is about the worst of it.
The combination products (opioid plus something else) are a bit worse - but in those cases it’s the other thing (usually Tylenol) that’s actually hard on your body, especially the liver.
Although it’s much less common these days due to all the regulation, many doctors kept a up successful practices for decades while self medicating heavily.
What gets people killed are either things sold as other things (e.g. heroin laced with fentanyl, which is much stronger) or propel who quit for a while and then go right back to their old dose and OF because their tolerance is gone.
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443....
This paper is a great read on the topic. Some suggest more than 50% of heroin users are casual users.
I wonder about the truth of this. I've done a lot of reading at places like Bluelight (for research and curiosity), and it seems there really are a lot of people who set strict guidelines for their drug use and are able to use opioids periodically without addiction.