Apparently the poor are most at-risk from this crisis according to a large study [1] - so maybe the fix isn't just harm reduction, but alleviating the existential crisis we put people of lower income in the US - making them more susceptible to drug addiction & death

[1] https://www.nhlbi.nih.gov/news/2020/large-study-links-lower-...

By comparison, shipping heroin across the Pacific is costly risky business, because it's easier to detect and seize. Hence the need for fentanyl which is orders of magnitude stronger and can be created in impromptu labs.

This gets particularly dicey for every "party drug" users in the states, because a white powder that would be relatively harmless is subject to accidental cross-contamination. [edit based upon reading comments below: Yeah, if you live in the US and your friends take coke or ketamine, you should have Narcan.]

Opiate users are addicts but they're not stupid. Nearly all greatly prefer reliable heroin to the risk of OD'ing. Hence why fentanyl hasn't become a thing in Europe. A reputation for killing your customers is bad for business.

Bonus question: Why does Europe not have a methaphetamine crisis?

Because it has an amphetamine crisis?

I'm assuming most of crystal meth in the US comes from mexico and they don't bother to ship that much of it overseas as stuff like cocaine has higher profits and a bigger market.

Not enough free space. It takes a lot of room to make meth because anyone nearby can easily tell.

It is going to change soon because Afghanistan is starting to make it.

I've always thought that it was because all the precursors for meth get used to make MDMA.Though it's probably more of a culture/economic thing. Europe definitely has some meth in it.

And opioid overdoses are similar to the US per capita.

British Colombia had 2,306 deaths in 2022, and adjusted by population that's 132,000, so more than the US.

I think there would be a lot of benefit to legalizing at least one molecule in each drug class for OTC recreational use, chosen based on harm reduction standards like toxicity, therapeutic index, and duration. I think so much of the drug war's ills could be headed off by making codeine and vyvanse OTC - destroying demand for dirtier more dangerous drugs would do enough good to offset the increased abuse rate for these particular chemicals.

My wife and I recently went to a Walmart near a “not good area” and it was depressing. Just about everyone was overweight. Many were hobbling or needed the use of the electric scooters. Looking into their eyes often resulted in a near zombie stare that went right through you. People looked at Walmart’s relatively low prices in desperation and despair as they mentally tried to grasp how they’d be able to handle the bill for the mass produced garbage they were trying to buy to save money (compared to fresh meat and produce). My wife and I paid for our stuff and headed to our basic SUV (one of the nicest cars in the parking lot) and you could see rundown cars on the edge of the parking lot with blankets up to block the sunlight (aka homeless people).

Things are not good over here.

Edit: I didn’t directly address your question, but it’s all tied together. People are drugged up and just trying to get by. For many Americans, day-to-day life is nothing short of a nightmare.

Complaining about mass produced garbage instead of fresh meat and produce is just silly. Walmart has plenty of all three.

Yes there are people without kitchens. But don’t tell me you think that’s most of the poor people at Walmart.

I do think that most poor people at Walmart are so worn down and tired that cooking a healthy meal can be difficult. Especially when there’s a box that only needs water and a few zaps from the microwave.

I went on Walmart's website. Per ounce, name brand fish sticks were cheaper than the cheapest fresh fish, tilapia. Pre made, microwavable burgers were the same price as just 80/20 ground beef. Jurassic Park white meat dino nuggets are the same price as Perdue chicken breast.

Those kids that didn't grow up with cooked meals are very unlikely to cook for themselves or their own eventual children. They're going to stick to 90 second rice pouches, ramen packs, mac n cheese, "salad kits". I can tell you right now a Kraft Mac n cheese cup is cheaper than what I would spend on pasta & the cheeses to make a roux. Easier to prepare, too.

I don't see people in Walmart buying produce. If they wanted that they'd go to one of the Latino grocery stores or the farmer market. If they wanted pantry staples (flour, bread, eggs, milk) they generally go to Costco. Who goes to Walmart to buy anything fresh?

All I'm saying is just that buying the components separately would probably be cheaper and result in a healthier meal.

But yeah you're right about many people not liking to cook due to lack of time or other reasons.

> I don't see people in Walmart buying produce

Well they wouldn't sell if people didn't buy it. I do see your point of course.

I no longer shop there and I know of many people who feel the same way. It’s the only store I avoid because of “the feeling of human suffering.” Walmart’s stores are cold and uninviting, the employees don’t look happy to be there, and the shoppers don’t either.

I don’t believe the people inside a Walmart are a representative sample of Americans, the store self selects for people who are willing to shop at a Walmart.

I shop at walmart all the time, in all area's poor, rich, middle class, are there fat people, sure. Are they "Dead zombies looking hobbled to their mobility scooters" .... I think the OP fancies themselves a fiction writer..

One is clean and the other looks like a bomb went off. Dirty floors, merchandise laying all over, employees nowhere to be found...

Doesn't even seem like the nice one is a Walmart.

Literally 95% of the US shops at Walmart, so... you might be in a very small bubble

That or a Dollar General with its bountiful selection of bananas and limes.

Walmart is rarely the Only option. Where there is a Walmart, 90% of the time there is a Kroger (or Kroger Brand) Store, or Mejier (if in the Midwest), or some other store close by...

Not sure why you're minimizing this reality. 1 in 6 Americans don't know where their next meal is coming from. https://www.ers.usda.gov/webdocs/publications/42711/12716_ap...

So if you have a source to back that actual claim I would be happy to look at it, and likely refute why it is cherry picking data

>>A solid chunk of the US population lives in a food desert.

Food Deserts are a political term, largely attributed to urban not rural area's and ever every study you find talking about Food Deserts I can find at least 1 if not more refuting that actual data.

Possibly. But your statistic tells me nothing about the foot traffic in a Walmart. 95% shop at Walmart, of that cohort how many shop there regularly? How many shop there for occasional purchases vs treating it as their primary store for staple items? On a random sample of days, how representative of that 95% is the foot traffic you’ll find there?

Personally I share OPs view of Walmarts, I don’t go in them because they make me feel bad about the world. I don’t get that feeling other places.

Very, since the more likely someone is to be a regular shopper there, the more likely you are to run into them on any given visit. That is simply an artifact of statistics.

> Personally I share OPs view of Walmarts, I don’t go in them because they make me feel bad about the world. I don’t get that feeling other places.

Do you get that feeling at the DMV? Maybe at the doctor's office or pharmacy? You are bumping into a true cross-section of the US population. Take note of the feelings you get and why, and understand that this is what the US is, not just what you see in the bubble

Exactly. "Do you shop at Walmart?" answers a different question than "How frequently do you show at Walmart?"

I don't think you encounter a uniform sample of 95% of Americans on random visits to Walmart, you encounter a disproportionate number of frequent shoppers.

> Do you get that feeling at the DMV? Maybe at the doctor's office or pharmacy? You are bumping into a true cross-section of the US population.

This is exactly it. I've never felt that way in a DMV or doctors office. I've shopped at bodegas in the Bronx, County Markets in the Midwest, Frys, Safeway, head shops, gas stations at the corner of trailer parks (actually shopped, like for staple items on a regular basis and daily breakfast), gas stations in East St. Louis, dollar generals, etc. Public transit was my only form of transportation for 2 years in NYC, same with Seattle, and I went all over NYC.

You keep referencing my bubble. I'm not low income. But I wasn't born this way. Software engineering pulled me out of poverty in my mid-20s. I've been down and up the socioeconomic ladder (outside of addiction fueled poverty and true wealth) - and I have friends who've experience many dimensions of that ladder.

America is beautiful and diverse. There are a lot of people trying to find their way through this life here and you find amazing people everywhere you look.

The only place I've sworn off is Walmart. I can try to articulate why I think Walmart is the way it is, but that's tangential to it not being a representative of America.

I'm going to push back and say you might be in a bubble if you think Walmart is representative of the population here and suggest it might have a similar effect as the DMV. Either you frequent nicer Walmarts, you spend less time in them, or you have a very skewed view of the diversity of America.

This is one of the biggest lies in social "justice" circles.

Buying fresh meat and produce is NOT in anyway more expensive than buying premade crap. at most the cost is the same, but in reality it is often cheaper to make it fresh.

For example I can make a better lasagna, with better beef for about 25% lower price than I could buy the same size Stouffers Lasagna.

People buy garbage premade food because either they cant, or choose not to cook for themselves.

This "ohh the poor people at the walmart just dont have options" is frankly disinformation.

>>Just about everyone was overweight.

And how many of those were buying cases of soda?

you can do that in a Instapot with no fuss in the same amount of time it would take to make a store meal

There are plently of Quick and Easy ways to make your own healthy meals. For me I do Meal Prep Sundays, and make my own freezer meals. Far cheaper and better than the store bought.

Further I doubt many of them are "working multiple jobs" the vast majority of that junk food it likely coming from government assistance money, disability, etc because if as you said they are "hobbled to their mobility scooter" then chances are they found a doctor to put them on disability

Edit: I remember watching my mom ration her insulin. I sure wish we could have been “welfare leeches” because that would have been super neat.

but no, I dont know anything about being poor....

If you are working two jobs to make ends meet, I imagine it becomes much more difficult to squeeze in the time to make a nice fresh lasagne.

I think the “food desert” issue can sometimes be overblown, but equally this nonsense idea that anybody who isn’t cooking from scratch is just stupid or lazy needs to die. It’s an absolutely perennial pet argument from some quarters and it just skips over so many complexities.

I have worked with and spoken to people dealing with these challenges over in the UK. A constant problem is the challenges people face in getting access to time, equipment and resources aside from food itself. How do you cook a lasagne if you work 14 hours? If you don’t have an oven? If you don’t have a refrigerator?

It really saddens me to see such surface-level, knee-jerk dismissal of complex problems.

>> If you don’t have an oven? If you don’t have a refrigerator?

Is that really a problem for most people. Most of my family is on some kind of government assistance or in government housing, all of them have Ovens and Fridges.

Compare that to boiling water, throwing macaroni noodles in for 8 minutes, and stirring in a "cheese" packet. I can tell you which one I'm going with after a work day at two separate blue-collar jobs.

I have literally no doubt whatsoever that there are people out there with all the time, knowledge, energy and equipment to cook themselves nice food, but who survive on ready-made or other more expensive food sources.

The problem is that every single discussion about this topic ends up with responses ignoring that it’s way more complex than “people who don’t make lasagne are lazy”. It’s a particular kind of facile that seeks simplistic solutions of complex issues.

This comes up as a public conversation at least once a year in the UK, when some politician inevitably says “I can feed a family of 12 for two pounds a day on fresh produce I collect from the bargain bin!” Meanwhile there are two million people in the UK living without a cooker.

In 2012 the Opioid dispensing rate was 81 per 100 people.

https://www.cdc.gov/drugoverdose/rxrate-maps/index.html

This doesn't even include antidepressants/ssri and such.

Some states were 107< per 100 for the opioids. How does that impact the movement of the Overton window over the last decade+ I wonder?

>For the calculation of dispensing rates, numerators are the projected total number of opioid prescriptions dispensed annually at the state, county, or national level. Annual resident population denominators were obtained from the U.S. Census Bureau.

Am I reading this right? They're counting scripts and then dividing that over the population? So if we imagine a state with a population of 12 people, one of whom is a chronic pain patient or cancer patient with an opioid prescription, that would show as 100 dispenses per 100 population? That seems almost worthless as a metric.

How?

"The clustering of the deaths from overdose in the group of patients who had successfully completed treatment is counterintuitive and illogical—unless it derives from loss of tolerance and consequent unpredictability of resumed heroin use."

[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153851/

Isn't this what "the wall" and securing the borders was supposed to be for?

https://twitter.com/BillFOXLA/status/1625936055047426048

> So far in FY23, we have seized over 476 lbs. of Fentanyl between the ports of entry along our southwest border. That's enough to kill 100 million people.

"The Wall" as envisioned by the proponents was never completed

The whole thing doesn’t need to exist for political theater, in fact I’d say its lack of actual completion makes it even more a theatrical construction than if it actually was done!

There’s even been a rash of fentanyl overdoses in nyc from marijuana (as reported by the victims). It’s thought that mass produced weed is being grown with plant growth regulators. These make the plant grow big, dense buds. It also makes the plant produce less thc. It’s believe that the plants are then being dusted with fentanyl to replace the lost thc.

Bah, apocryphal.

fentanyl has generally speaking only made it's way into the supply of non-opioids like cocaine as the result of contamination, not intentional adulteration. When we talk about fentanyl, in reality what's out there is perhaps some true fentanyl but a lot of fentanyl analogues that are much more potent (lethal dose in the mcg range). Often the people moving heroin are also moving cocaine and other drugs, and using shared surfaces to weigh and cut the product for street use. They aren't properly cleaning surfaces and instruments and thus fentanyl is ending up in all sorts of powdered drugs

fentanyl on weed has probably happened in some instances of intentional poisoning of an individual but I'd file this under similar in risk to your child being given an edible, or candy with a razor blade on halloween

https://www.vox.com/2020/4/15/21214734/deaths-of-despair-cor...

"You've Run Out"

with a graphic of a person's arm trapped in an elevator door

https://i.imgur.com/fZp2eaG.png

that said, 15-20 years ago prescribers in the U.S. were in various ways made to believe that painkillers such as oxycodone were not addictive and were these magical drugs that helped pain patients regain their lives in ways we had never seen before. Ended up in so many homes, lots of excess prescription opioids hanging around and as a result a lot of people ended up abusing them. For a significant number of people that led to heroin use, and then fentanyl came into the picture in 2015ish; so that's how we got here. heroin on its own when injected isn't actually that easy to accidentally overdose on- fentanyl however, is.

About a year ago I had an infected tooth... Nothing more than 600mg advil was on the table... take that at suffer through the rest of the pain...

I’m glad they gave me the percocet as a precautionary though because I absolutely would not want to have to go fill the prescription after the fact with mouth pain intense enough to then need the prescription.

When a surgeon does dozens of these procedures a month and most cases require a certain painkiller, it makes a lot of sense to plan ahead and prepare the patient when the alternative is intense pain.

https://www.nhs.uk/conditions/wisdom-tooth-removal/recovery/...

Not to be a dick, but I find it very interesting that people expect to go through life without experiencing pain.

They gave me 10 or 20 Vicodin pills and, despite some pain, my choice was to take no more than one or two. So it's not just crappy dentists that gave those out. On the other end, someone else might have taken the whole bottle, so perhaps individual behavior is still the key factor.

I strongly disagree given that we're talking about addictive substances and the power of doctors coupled with the DOJ finding manufacturers guilty of kickback schemes.

Of course, cue someone responding with something along the lines of “my sister once took an opiate and she immediately started shooting heroin and had withdrawals for 2 years.”

I don't think what I am sayin here is that you will get addicted after taking 10 Vicodins, of course not.

But what about 30? 45? There is a point when it becomes dangerous. And here is where this mentality becomes problematic. If you need to take opiates for 3 days after a root canal, surely you'll need to take them after you broke your arm, or after any other procedure and for longer. And you didn't have a problem after taking it for 3 days, so what's the harm?

It is orders of magnitude less invasive than an extraction.

The biggest issue is the lack of hope. Most people turn to these because they're tired of their shitty life and don't see any realilistic hope for improvement.

I mean, I got good grades, I worked hard, I'm an employed (not highly paid) software dev and I'm so disillusioned I completely get why some people turn to these things. I'm supposed to be at least in the top 25% of the current generation/my age group. Yet I feel like I'm barely making it to the same level that my parents were able to. Don't get me wrong, we aren't on assistance, we have good groceries, we have private/employer healthcare. But it's tough trying to save for retirement, healthcare, and stuff. There's no way 50% of the population will be able to retire at all, pay for Healthcare, etc as they get older or aren't able to work.

Being unfamiliar with the actual practice, how much are you typically prescribed, days or weeks worth, maybe even more?

For comparison NHTSA recorded just under 43,000 car accident deaths in the US in 2021. That’s also very close to the 2020 death by suicide number of 45,000.

That’s 25% more opioid deaths per year than our both cars and suicides COMBINED.

In fact we could add in the 19,000 Americans who were killed with guns in homicides in 2020. That’s 19,000 people.

Cars + Gun Homicides + Suicides = 107,000. Still less than opioid deaths by a few thousand.

It’s bad out there.

So yeah, it's *really* bad out there.

Is the just in case there's any problems with drugs you take voluntarily? (no judgement, been there)

or to have it on hand in case someone else ODs?

or for the worst case scenario of someone drugging you (spiking a drink, etc).?

I see people OD pretty frequently at music festivals, and while there is medical around, minutes matter when it comes to fentanyl overdoses, and it can take a while for someone to get out, notify medical, and get medical back into the middle of a 10 thousand person crowd.

I wish the US would follow Canada's lead and allow for drug testing tents to legally exist :/

So all of it.

I'm sure the likelihood of opioid ODs happening at shows and festivals is very high in some places, wouldn't be too surprised if some shows have dozens. Very good-samaritan kind of thing to carry if you go to crowded places.

Narcan/Naloxone won't help drink spiking, that's usually done with other substances as far as I'm aware.

So providing drug testing kits or providing a drug testing station in any official capacity would put the venue / festival officially on the hook for a potentially obscene amount of money because of that pesky darn "knowingly".

Given the current state of the opioid epidemic, I honestly can't understand how this draconian piece of legislation is still law. It is the exact opposite of harm reduction and literally kills people.

Nothing more classic than government overreach sneaking into legislation marketed as protecting kids.

how many people have been killed in the usa by its prescription-only status over the last 52 years

for that matter, how many opiate overdose deaths would be avoided if you could buy pure, safe heroin of known concentration over the counter instead of depending on organized crime not to put too much fentanyl in it

I remember seeing someone else on HN use a five digit date years ago, giving the reasoning that it gives us a bigger perspective on our timeline and society.

I like the idea, but it muddies the message since we use standards for a reason. For example, if someone writes "In 13 I tried..." it's a bit confusing, but if they write "In '13 I tried..." it makes immediate sense since we have expectations about communicating dates.

Since 2000, 75% of US opiate users started with prescription drugs[1]. So my guess is overdoses would be substantially worse if any opiate was freely available over the counter.

[1] - https://nida.nih.gov/publications/research-reports/prescript...

but the rate of overdoses from prescription opiates is, as i understand it, very low, because the dosage is predictable

a lot more old people needing regular enemas would be kind of shitty but not nearly as bad as millions of people dying from overdoses

Over time, addicts do not get the same high from the same dose of opiates. They require higher dosages, until such a point where they have to turn to illicit narcotics (which are also cheaper). Prescription drug abusers are 40x more likely of becoming heroin abusers.

This is all in the article I linked above (click on the subheadings).

this would increase the risk of suicide, but it would have to rise a lot to exceed the current usa rate of accidental overdose deaths