This is a medical crisis that will never get solved because our medical system doesn't want to handle people with these addictions. No one does of course. But that's the only way to solve it in my opinion.

I'm not sure of the price tag. But i had another friend who was told to go to another hospital when his wife's pregnancy took a bad turn. They spent two weeks and it was several hundred thousand. The insurance said, just beg the hospital to reduce it? It was ridiculous. I'm just sure my friend won't leave with that covered. Not the hospitals responsibility for sure but it's outrageous the cost and prevents people from seeking help.

“Also at the time of OxyContin’s approval, FDA product labeling warned of the danger of abuse of the drug and that crushing a controlled-release tablet followed by intravenous injection could result in a lethal overdose. There was no evidence to suggest at the time that crushing the controlled-release capsule followed by oral ingestion or snorting would become widespread and lead to a high level of abuse.”

https://www.fda.gov/drugs/information-drug-class/timeline-se...

I do share other people's skepticism of the medical industry as you might be able to tell. He should have done more research, agreed.

They'll stay up to date with what is standards of care, but even that is dictated to them by their EHR software or what they expect your insurance will cover.

When I've gotten prescribed a new medicine, I don't really recall a doctor ever even telling me what side effects to watch out for. At most, they've told me not to drink alcohol while on someone.

I’m convinced anyone who doesn’t do this is either too young to know better or too dumb to have been paying attention.

I thought I was world worn and tough.

Then came AI and I was again on the doom and gloom train. Then I had a moment, realized this just the new thing and dropped it down a few degrees.

What’s next?

You kind of have to be a monster to say something that callous.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/02...

Among other things, it says “Physical dependence and tolerance are not unusual during chronic opioid therapy.” I'm no expert, but I think that explains why warnings about dependence weren't more pronounced. The drug was supposed to be distributed in a tightly controlled fashion due to these risks, after all.

In retrospect, the warnings at the start, and the information for patients read like recipes for abuse, though.

For dealers, it gets people through the gateway. For the anti drugs crowd, it's the equivalent of preventing teenage sex by not telling them how it's done

The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release.

That turned out to be largely BS, but it wasn’t helped by the fact that addicts would crush the tablets, eliminating the slow release aspect.

A similar claim is now made about Vyvanse, a pro-drug for amphetamine. Like a slow release formulation, but needs to be metabolized first. The slower onset, less sharp peak, makes it less euphoric for a similar effective dose, which is supposedly one of the mechanisms involved with the reward-feedback addiction cycle. Less likely to experience (intentionally or accidentally) the intense euphoria of a bit too much instant-release amphetamine on an empty stomach, and so less likely to seek out the experience again. It also frustrates injection, since it needs to be metabolized first so injecting it doesn't make it work any faster. I'm not sure the premise is wrong, and it is probably fairly similar with opioids. But slightly less abuse risk is certainly not the same as non-addictive.

Two party from that party are now dead of overdoses.

I am sorry for your friend, but not for him losing out on his rent seeker plans.

Plenty of blame all around but central is the person who decides to use.

I didn’t fully appreciate why until I saw somebody go through it.

But then I got the entire picture. This man struggled. Hid it from his family. Finally confessed it to his wife who stuck by him and sent him to a rehab program to get clean. He was gone for about 4 months and got clean. Got his life back. Got his family back and got back to work.

And then his old dealer came back around. It took another family member telling the dealer he’d shoot him on sight if he ever came around again to get that predator to leave.

Do your own research. Get a second opinion. Etc. I rarely end up taking medication that's prescribed to me and overall I think I'm the better for it.

You mean modern medicine? That's what makes this problem so pernicious - so much of it was created by the people fictionalized in shows like House MD and Grey's Anatomy not The Wire and Breaking Bad.

If the only input into drug addiction was the modern medical industry over-prescribing opioids, the landscape of modern drug use would look very different.

There's plenty of alcohol, weed, cocaine, and hallucinogens, I'll give you that, but they're not gateways to opioid addiction. Breaking Bad glorifying the manufacture and sale of meth is the only except I can think of - Oxy, fentanyl, and p2p meth aren't exactly the drugs musicians and Hollywood turn to as a lyrical/plot device.

There's also a fine line between glorifying and entertaining. I struggle to find any such glorification in shows like Snowfall, for example, which mostly shows the very negative impacts of crack cocaine in cities. There's only a single character in the entire run that manages to overcome the drug and the main character is a tragic anti-hero at best.

Any time heroin or another opioid comes up in pop culture it's almost always in the context of horrifying drug dens.

The main thing it glorifies I think is that boys will be boys, not drugs per se. Those who criticize them just don't understand that boys have to find their own way, and it ain't always pretty.

Compare it with Snowfall: the main character's family has at least some history of drug dealing and he only succeeds because he discovers a cheap and ultra-addictive recipe for crack cocaine and because the CI-freaking-A is using him to fund the global war on communism. Recurring characters get killed off in dumb gang skirmishes all the time and the drug addict with the most screen time is literally a shell of her former self that can barely get through the day up until the latest season.

Or compare it with The Wire: all the people involved in the drug game are only in it because they have literally nothing else to live for except the glory of the game. Basically no one survives except the cops and Bubbles never really gets fully clean.

This is only partially accurate. There are two primary "pipelines" to opioid addiction; one of them is overreliance on painkillers, but the other one is fairly standard risk-seeking escalation through a socially deleterious lifestyle, often culminating in an OD or a prison sentence after a predictable years-long risk escalation path through social drug use.

I will agree that I don't think there's a lot of media showing meth or fentanyl use as cool and attractive, but my overall point is less that a specific drug needs to be shown to be cool, and more that the artistic construction of the drug lifestyle as alternative, exciting, rebellious etc. wears down the emotional barriers of a lot of people when they're young and malleable. I've done a good number of drugs in my day and I can assure you that in the case of most of the people I did drugs with, early exposure to "drugs are cool" art and music played a part in their ready acceptance of the lifestyle.

As one example, if you go to a high school party, often the riskiest, coolest kids will go off in private and do drugs. There's no feedback loop in the media to make this look pathetic or sketchy--on the contrary, most drug use is played for laughs, or it's added as another dimension to a lifestyle that's supposed to be tragic but instead looks awesome. "Oh my god, look at this guy's life, he's a mess, his apartment is so dirty, he's doing lines off the mirror... with a smoking hot supermodel-actress while we do a B-plot story about how his small-town parents are boring and stodgy... and he's a rock star..."

I don't really know whether or not you could seriously reduce drug use by not showing it in the media, but I do believe that showing it as positively as it is now increases drug use. And I haven't even mentioned the music surrounding drugs.

Oxy is hugely glamorized in rap music. Drinking "lean" / cough syrup and doing Percocet pills. Future song "Molly Percocet". The Weeknd's record label is called XO for Ecstasy / Oxy.

https://www.lionsroar.com/food-for-thought/#:~:text=I%20hear...

I still tend to disagree because I have a hard time finding balance and not going too far in restricting the media I consume, but it's a nice vision.

A lot of the religious right in the US, especially the part that is led by televangelists like the late Pat Robertson, just wants to suppress it out of ignorance and they have no plan except to throw more and more people in jail, creating more X to prison pipelines.

Edit: I searched a phrase in the PDF and found this: https://thubtenchodron.org/2017/11/non-harmful-consumption-n...

> The religious right in the US just wants to suppress it out of ignorance

I tend to agree that the religious right in the US is a legislative force that does more harm than good, and that many people who campaign against drugs don't have a solid understanding of drugs or drug culture. However, I don't think that it's ignorant to want to suppress drug culture (either in the media or in real life), and I think more religious conservatives have experience with addict family members than you think.

I can tell Thich Nhat Hanh appreciated the people you're talking about, having read about him traveling all around the world and meeting people from the US (where he lived for quite some time) and countless other countries.

One of the principles that I hold to pretty strongly is that the more performatively famous someone is surrounding a certain idea, the more likely it is that they don't have any real principles, and they're just beating whatever drum allows them to continue to hold influence over people. So someone like Pat Robertson doesn't actually believe what he's saying in private, but if he kept banging that drum he kept his lifestyle and acolytes. I think the majority of US politicians that people recognize by name are like that, and certainly most religious leaders like Pat or Joel Osteen.

[1] https://en.wikipedia.org/wiki/The_Presentation_of_Self_in_Ev...

After all this time a religious person of many different faiths over the recent centuries might have often said that for long-term use they were put on earth by god for people who can not be expected to recover.

Synthetic opioids are just the modern version which were developed because the natural product itself can not be patented.

Hence "patent medicine".

The habit-forming effect is what made the Sacklers the richest pharmaceutical barons so far.

Oh get off your high horse.

I've had two uncles die from alcoholism. In reality, it was the divorces and way more complex circumstances that really did them in. It really is the cage.

It's important that we avoid the twin extremes of, on the one hand, categorically blaming circumstance for everything, and on the other hand, categorically assuming 100% culpability. The proper view is that human beings operate at a nexus between circumstance and decision. Circumstances can create good or bad incentives, and statistically, people will follow incentives (hence the need to legislate properly, for example). These incentives can be strong or weak. They can create more or less pressure to follow through with the incentive. But we must ultimately make a choice and that rests with us (in the extreme case, something like extreme pain can blind a person and effectively rob him of the freedom to choose intentionally which is to say with the capacity to use reason). So how culpable we are for a decision varies on a variety of factors, but there is almost always some culpability.

In the case of your parent comment, it sounds like the person in question is very culpable, that he had the capacity to reason, to know he should have chosen otherwise, but did not. There's nothing wrong with the content of that claim as such.

It’s difficult to argue with the logic. The worse the problem gets, the more it seems like correct path.

I don't believe people get on addictive drugs and squander their lives when they truly have "every advantage in the world". I've been to rehab and recovery programs and I haven't a single person for whom this was the case.

Usually when people say this, they're talking about privileged people who outwardly seem like they have everything they need to succeed. But they have demons: depression, bipolar disorder, mental health, trauma, chronic pain. What's worse, other people are often unwilling acknowledge those demons, and say things like "you have every advantage in the world" which can just make them feel more isolated.

This can lead people to seek relief however they can get it.

I'm sorry for your family member and for you and your family; but for anyone reading this with a loved one struggling with similar issues, know that helping them can sometimes require willingness to understand them first.

That's what I'm hoping for here. I want a story that addiction from these horrible drugs isn't always the end. It would be amazing if he can recover from this. I'm scared but it's all I have for him right now.

Society will be much better off without it!

https://journals.sagepub.com/doi/abs/10.1177/026988110809967...

I think you should instead be angry at the government. Your friend should have been able to go to a facility that administers fentanyl or heroin safely while making available counseling and any other help that could be provided to him.

If there is a dosage for any substance where it can be administered without causing near-term death or irreparable physical damage, the government should either ignore it or intervene by implementing safe ways people can can consume these substances. You shouldn't need to go to a street dealer, even if you don't have a medical perscription they should let you get addicted and consume it if you choose to do so against all advice.

Millions die in the US every year because... I don't even know why? It sounds not right to treat people?