
What Science Says to Do If Your Loved One Has an Opioid Addiction - anythingnonidin
https://fivethirtyeight.com/features/what-science-says-to-do-if-your-loved-one-has-an-opioid-addiction/
======
anythingnonidin
OP here.

An interesting takeaway I had was the importance of community. Does anyone
know any non-profits or startups working to increase people's sense of
community at a mass scale? It seems this is missing from large parts of the
western world and has many consequences.

~~~
otakucode
It reminds me of things Mother Teresa (who was at times a horrendous person,
her Nobel acceptance speech is pretty disturbing and cruel) said about
American/western society. She remarked that although a person in India might
be radically more poor, even if they were starving in the street, they knew
people would reach out to them and cared for them. In America, no matter how
rich you are, you feel far more alone than that.

~~~
gedy
> (who was at times a horrendous person, her Nobel acceptance speech is pretty
> disturbing and cruel)

Wait what? Because she brought up abortion?
[https://www.nobelprize.org/nobel_prizes/peace/laureates/1979...](https://www.nobelprize.org/nobel_prizes/peace/laureates/1979/teresa-
acceptance_en.html)

~~~
emodendroket
I don't know about the speech particularly, but I think Catholic notions about
poverty and suffering bringing people closer to Christ rub some people the
wrong way. At least that seems to be a lot of the motivation behind "Mother
Teresa was awful" stuff I see.

------
emodendroket
> Consequently, do not try to use legal consequences as a way to help people
> you love, and if possible, bail them out if they get arrested for drug
> crimes. This doesn’t mean you shouldn’t hold them accountable, but do so in
> ways that are less likely to lead to lifelong problems. Meaningful
> employment is an important factor in recovery — and few things are more
> harmful to the chances of getting a good job than having a criminal record.

This is one area that's crying out for some kind of reform.

~~~
criddell
I've been thinking about similar things in the context of a basic income. If
we were to just pass a law and guarantee a significant basic income I think it
would have disastrous effects and fail miserably. A guaranteed income is a
good goal, but before we do that we need to figure out how to replace
meaningful employment with other meaningful activities. People need a purpose.

If we can alter our culture and separate a person's purpose from their
employment, then we might be able to get to a Star Trek future. If I can get
anything I want from a replicator in the wall, what are my incentives to still
better myself and work towards something?

~~~
emodendroket
> I've been thinking about similar things in the context of a basic income. If
> we were to just pass a law and guarantee a significant basic income I think
> it would have disastrous effects and fail miserably. A guaranteed income is
> a good goal, but before we do that we need to figure out how to replace
> meaningful employment with other meaningful activities. People need a
> purpose.

I don't think so. I think people can find a purpose without us imposing one on
them.

> If I can get anything I want from a replicator in the wall, what are my
> incentives to still better myself and work towards something?

Why do people get really good at chess when there is little extrinsic
motivation in it? If some people just want to hang around, is that really a
"problem" we need to address?

~~~
criddell
> I don't think so. I think people can find a purpose without us imposing one
> on them.

I didn't mean to say a purpose should be imposed. Today it kind of is. A
purpose is often closely tied to a job and a job is pretty much required to
survive.

I was trying to convey that we should look for more ways to help people _find_
a purpose or whatever you want to call some activity that is meaningful and
fulfilling to that individual and socially healthy.

> If some people just want to hang around, is that really a "problem" we need
> to address?

Maybe, maybe not. If they are hanging around because it's what they want to do
and they are happy and healthy doing so, then I don't see a problem.

~~~
emodendroket
Well you said there shouldn't be a universal basic income because people
wouldn't have a purpose without the job being imposed on them, which seems to
take as its premise that people need to have some kind of purpose imposed on
them. The big reason unemployed people feel purposeless is because we live in
a society where everyone is supposed to have a job or else is a drain on
society/shamefully failing to support their families/whatever else. In a world
where there's no need to have a job to support yourself who's to say that's
still the case? That's not to say there aren't other potential problems, but
I'm not sure "purpose" is the real one.

~~~
criddell
> I'm not sure "purpose" is the real one

 _Purpose_ might not be the right word. I think people need meaningful lives.

~~~
emodendroket
Well, no, I think that's the right word to convey that. I don't see life as
meaningful because of the amount of time I spent at my job really.

------
sharpercoder
An addiction tries to replace a void in someone's life. Chances are big the
environment of the addicted played a role in cerating the void.

~~~
betenoire
That's not helpful at all. Yes, addiction is "filling" "something" "broken".
Now what?

~~~
otakucode
It is extremely helpful. It is very incovenient, to be sure, but it is very
helpful. If you want people to not use drugs, then you have to provide them
with a fulfilling life or the opportunity for such. If your desire is to
operate a society that grinds people down, restricts them in ways that feel
burdensome to them, insults them, and also does not have people using drugs?
You might as well wish to fly. Because your wish is as realistic, and as
worthy of ridicule.

It comes down to whether you want to stop people using drugs because you don't
like that they get happy so easy, or whether you want people to stop using
drugs of their own accord and have happy lives. If it's the second - help.

~~~
ubernostrum
Never mind people who get addicted after being prescribed medication for an
injury, then? Never mind that the new generations of opioids were marketed as
safer/less addicting when they probably were _more_ addicting, and thus
prescribed even more out of perception of their safety?

~~~
zaroth
Althogh this has certainly become the narrative of late, TFA seems to discount
this fairly strongly;

"To that point, pain treatment is not the most significant risk factor for
addiction. Far greater risk comes from simply being young and from using
alcohol and other recreational drugs heavily. Ninety percent of all drug
addictions start in the teens — and 75 percent of prescription opioid misuse
begins when (mainly young) people get pills from friends, family or dealers —
not doctors. Opioids are rarely the first drug people misuse."

~~~
betenoire
And whether or not it is the most, least, or somewhere in the middle, risk
factor, makes no difference in treatment. The article is about effective
treatment for that addict and TFA suggests medication. It does not suggest
addressing addiction issues, except as mean to getting the addict into actual
treatment.

Filling voids and seeking happiness aren't mentioned in TFA.

------
taylorswift_
I read this, as a recovering addict that went through my own hell mostly from
alcoholism, and wondered where the "science" part was?

For instance this sentence "More than 13 percent of its participants died
after treatment,1 mainly of overdoses that could potentially have been
prevented with evidence-based care." The argument is that they "could" have
been prevented but how do they really know that? How many people in general
die of an overdose after X number of stays in a rehab? Through my own
experiences going to rehab, I have known of many people who die. The fact is
you can't predict which people will "get" it any better than you can predict
if it will rain next month.

I also disagree with this notion that being on suboxone or methadone
indefinitely is a legitimate solution. Like what? You're advocating to stay on
a drug the rest of your life? That isn't recovery at all, it's a band-aid that
will likely lead to relapse and promotes a perpetual notion of being sick.

I also disagree that their supposed evidence that CRAFT gets twice as many
people into rehab has much relevance. How many of those people relapsed? How
many of the people that didn't go to rehab ended up overdosing OR recovering?
We don't get the whole picture so the "evidence" is mute.

They knock 12-step which is fine but it turns out that it works for millions
of people.

There is no silver bullet here.

While I have mixed feeling about the "tough love" approach, I can tell you
from personal experience that the only reason I'm not buried right now is
because at a certain point the floor dropped out too low, my family and
friends abandoned me, I lost everything for a moment, and the pain and horror
reached a level that finally I had a change of psyche on my OWN and realized I
wanted to get better.

In my own humble opinion the only "science" that matters on this subject are
the opinions of those whom have lived it and recovered. Go survey the opiate
addicts that didn't end up dead and find out what worked for them.

~~~
setrofim_
First of all, thank you for sharing your experience. It was insightful, and I
completely agree with your criticism of the article.

I would like to make a small, and perhaps somewhat pedantic comment regarding
your last statement:

>In my own humble opinion the only "science" that matters on this subject are
the opinions of those whom have lived it and recovered. Go survey the opiate
addicts that didn't end up dead and find out what worked for them.

There is a problem of silent evidence and survivor bias here. What is
important is not what they did that led to their recovery, but what they did
_differently_ (or, more generally, what was different in their circumstances)
from those that tried to recover, but didn't.

So, IMHO, what is needed is not _just_ the opinions of those that recovered,
but a longitudinal study to identify which, out the many factors that were
involved in the recovery process, have been the most instrumental.

~~~
CodeWriter23
While I agree with your points about collecting empirical and unbiased data, I
want to point out that when it comes to opioids, "Science" is moving the goal
posts. They are measuring social acceptability of a subject while under the
influence of doctor-prescribed dope, while ignoring the numerous addicts who
maintain similar levels of social acceptability while using Street dope, then
declaring their method a "success".

~~~
setrofim_
Yes, fair point. This is a common problem for social studies. One must keep in
mind and be explicit about the population the study sample is drawn from; and
very cautious about extrapolating the findings to other populations.

------
biggerfisch
I think the saddest part of this article is perhaps the glancing statement it
makes about how prison isn't a place of recovery and rehabilitation. The
prison system here really is too focused on punishment and locking people up
forever rather than helping them get back on their feet and being productive
members of society

~~~
buxtehude
Unfortunately, the drug war and punishing users of non-sanctioned drugs is
embedded deep in America's political and social DNA - but seeing how much has
changed in some areas of drug policy especially with variations from state to
state - I hold out some hope that we might see some changes there too - but I
just wouldn't hold my breath.

~~~
billmalarky
It's not just America's DNA. Many countries around the world base their drug
policy off of US drug policy.

------
anythingnonidin
Also interesting and related:
[https://news.ycombinator.com/item?id=15241874](https://news.ycombinator.com/item?id=15241874)

"Psychedelics Help Reduce Opioid Addiction, According to New Study"

~~~
taylorswift_
Have you also read "Abstinence Helps Reduce Opioid Addiction, According to New
Study"?

~~~
pjc50
Oh, is this like the "abstinence based sex education" that increases teenage
pregnancy and STD rates?

------
kchoudhu
Now that the opioid crisis is a problem for white people, science makes an
appearance in the policy discussion.

Contrast to the crack epidemic in the 80s: fuck'em, throw them all in prison.

Edit to add: I wish the best of luck to those who have been caught up in this
crisis: I'm rooting for you, and I hope every last one of you find the
treatment you need. For those of us who aren't affected, it's time for some
deep introspection about what we allow our politicians and (yes) our neighbors
to get away with.

~~~
gozur88
>Contrast to the crack cocaine epidemic in the 80s: fuck'em, throw them all in
prison.

That's overly reductive to the point of being wrong. There was never a
particularly strong feeling that crack addicts should be thrown in prison any
more than other types of addicts. People were strongly in favor of throwing
crack _dealers_ in prison because they were turning neighborhoods into war
zones as they fought for lucrative turf.

And it wasn't just white people, either. The strongest advocates you'll find
of drug criminalization are black people who lived through the crack epidemic
in the '80s.

~~~
liveoneggs
crack vs cocaine sentencing doesn't agree with you. It was clearly making the
"black" crime of crack possession worse than the "white" crime of coke
possession.

Obama got a whole law passed in _2010_ to address it!

~~~
dogruck
Y'all realize that black legislators and community organizers pushed for and
voted for those "racist" crack sentences? They were trying to save their own
communities.

Edit: for the uninformed down voters:
[https://www.google.com/amp/amp.slate.com/articles/news_and_p...](https://www.google.com/amp/amp.slate.com/articles/news_and_politics/crime/2016/02/why_many_black_politicians_backed_the_1994_crime_bill_championed_by_the.html)

~~~
glibgil
Have you heard the theory that racism might be institutionalized?

~~~
sremani
I do not recollect with precision, but there is an article posted on HN few
years ago, showing the 80s archives of New York Times, in it NYT was squarely
arguing for harsher sentencing and so were African American civic leaders.

May be there is racism that is institutional, but the point is most people
even those who are against harsher sentences today thought it was a remedy. We
will be failing ourselves if we cannot examine that fact and simply hitch and
re-assign every "fucked up" decision to racism.

~~~
rexpop
> May be there is racism that is institutional, but the point is most people
> even those who are against harsher sentences today thought it was a remedy.

That's exactly the irony of institutional racism: it's so rarely _consciously_
racist. It is often "colorblind".

------
intopieces
If there were one article this year I could force my family to process
adequately, it's this one. Addiction is still seen in our group as a failure
of character -- not raised right, not religious enough, not following the
right path. This kind of advice is seen as 'soft', and that's a shame.

~~~
buxtehude
I would also recommend listening to an NPR podcast "The Fix" by RadioLab:
[http://www.radiolab.org/story/addiction/](http://www.radiolab.org/story/addiction/)

While the description talks about taking a pill to solve your addiction
problems (some very interesting insights into the latest research at that time
2015 and also many absurd regulatory hurdles), it's the interviews with
researchers and addicts that are truly eye opening - and address many of the
issues you mention. After listening to it I personally will never reduce
someone who has an addiction to failure of character.

~~~
leggomylibro
In the words of Neal Stephenson, they are '[opiate]-seeky.' They have a
tendency dug in at the neurological level to seek opiates, even if they aren't
doing so at the moment. The distinction offered by Stephenson is that
'*-seeky' is an adjective that modifies an individual, rather than a noun such
as 'addict' which overshadows and eclipses an individual.

------
wjossey
I do not agree with much of what is stated in this article, nor do I feel that
this article represents "what science says" should be done if a loved one has
opioid addiction (although it really goes into addiction as a general topic).
Treating someone with addiction is a remarkably nuanced and challenging
situation, and the author tries to present certain treatment options as not
worth doing based on science, when their own citations do not back up those
claims.

As someone who has had a loved one go through addiction, and ultimately die
from that addiction, I find the binary nature of a lot of this self-described
"evidence based guide" dangerously black and white. Proclaiming that
abstinence based programs "have not been found to be effective" is total
nonsense. What the study found in GB was that psychological only based
treatment is less effective at preventing death than replacement therapy, on
average. For many, replacement therapy may very well be the best option. For
other, abstinence programs may give them an opportunity to fully reclaim their
life. How about we empower medical professionals with the ability to treat the
disease with a number of weapons, rather than creating this false dichotomy,
which is _not_ represented in the data. This guide would potentially
discourage someone, or a family member, from choosing a very viable option for
treatment, by overstating results.

While I'm not a medical professional, the best example I can think of is with
how we treat depression. For some people, active psychotherapy is the best
treatment option. For others, a regime of anti-depressants is sufficient
treatment. For others, a combination of both is the optimum treatment option.
What we don't do, as scientists, is say, "Option 2 has a 30% better outcome,
thus we _only_ will treat depression with option 2." That's just absolute
junk. What it means is that we will look at what cohorts tend to respond best
to option 1, 2, and 3, and understand _why_ , so we can choose a treatment
option that makes sense for that individual, without having to try 1, 2, and
3. It doesn't mean that we just toss out the other options wholesale.

The 538 politics podcast does a, "Good use of polling" and "bad use of
polling" intro during many of their podcasts. This article would clearly fall
under the category of "bad use of polling". I hope to see better out of 538 in
the future on these topics.

------
logfromblammo
In short, the published science says to addict the patient to methadone or
suboxone instead of whatever they are on, for a lifetime of perpetual
treatment.

Actual drug users are likely to recommend using kratom to alleviate withdrawal
symptoms and ibogaine (or another powerful hallucinogen) to permanently remove
the addiction.

"Science" does not recommend this, because politics has made the hallucinogens
--and research into their therapeutic uses--at least as illegal as the opioids
that cause all the problems. As someone with an opioid addiction is likely
already routinely breaking some rather serious laws, and frequently courting
sudden death by overdoses or adulterants, it may be worth trying the single
dose of ibogaine before choosing the lifelong maintenance therapy.

------
Justsignedup
Interesting question: The replacing opioid addiction with maintenance drugs...
I could understand that drug being an okay interim solution, but in the end
the person still needs to go through withdrawal, the drug just replaces
withdrawal with another drug.

Withdrawal is hard. Yes. But at least the person is in the right mindset to go
through it once they are off the compulsory addiction, even if it takes a year
to get to that point.

As kchoudhu points out and many have pointed out to me before this article,
certainly once a bunch of white kids have this problem, suddenly they are
"victims" not "criminals". Yet we have destroyed so many lives between the 80s
and now, especially with the mandatory minimums and such.

~~~
wbl
I'm physically dependent on caffeine. Why bother fixing that when it is cheap
legal and available?

~~~
spraak
In case you're looking for a sincere answer: being physically dependent on any
otherwise unnecessary drug is a drag. You constantly have to seek it out to
feel better. Even though caffeine is easily obtainable, I still have found it
to be inconvenient when I've been at high levels of consumption. Plus, it does
have health effects. It may not be so, but you'll likely feel a lot better
without it.

~~~
pbhjpbhj
I've gone cold turkey on caffeine a couple of times (takes me about a week of
headaches, I'm not an especially heavy user), mainly because I was making hot
drinks to avoid work out of boredom, so switched to ginger teas and such like.

Anyway, there doesn't appear to be consensus on whether coffee/tea drinking in
moderate amounts is good or bad, but I've seen more suggestions that it's
beneficial than otherwise. Any input to that?

------
dogruck
Annoying how this 538 article immediately bemoans the lack of regulation -- as
if the only solution is to grow the government and pass more laws.

------
btmorex
What science says nothing about because of the DEA's inane scheduling:
hallucinogens.

~~~
elchief
Yes, Ibogaine is literally 10x more effective than Methadone. It's risky if
you've weakened your heart with stimulants though.

~~~
martinald
Source?

------
sizzle
Hands down, Naltrexone is the only thing that helped my loved ones with
alcohol addiction. Please look into it and watch "one pill" documentary. You
have a choice other than AA meetings.

------
otakucode
Great article, but if your loved one has an opioid addiction and wants to quit
without suffering the devastating withdrawal, I would strongly recommend
investigating kratom. It is a non-opiate tree which grows primarily in
Thailand and similar regions. It contains an alkaloid called mitragynine. This
alkaloid is a selective opioid receptor agonist. Specifically, research shows
that it is an agonist to several opioid receptors but particularly an
antagonist of the receptor which causes respiratory system depression, and is
thought responsible for the primary addictive nature of most opiates and
synthetic opioids.

It is legal in most of the US (I believe there are 1 or 2 states which have
banned it, it has a long history by now in US law. A year or so ago the DEA
announced to Congress the intention to schedule it (ban it) under their
'emergency' powers (which is bullshit since there are no deaths from it, and
it remains mostly unknown, those 'emergency' powers are simply abused). After
that announcement, they were required to consult research and doctors, along
with opening a public comment period. Afterward they withdrew their intent to
schedule it. So, for now, it remains legal.

Its effect upon a person with no opioid dependence is at low doses similar to
caffeine without the 'jittery' part and without the crash afterward. In larger
doses it has mild analgesic and sedative properties. I've taken Vicodin after
I had my wisdom teeth removed, and have also tried kratom, and not even in
large amounts have I ever experienced it giving any sort of similar 'high'. It
is mildly habit-forming of itself, but very mildly compared to opiates.
Withdrawal after extensive use might consist of having the sniffles and
feeling a bit restless for a day or two. With tapering dosages down rather
than sudden cessation, nothing is likely to be noticed.

Reportedly, kratom ameliorates most, if not all, withdrawal symptoms from
things like Oxycontin, heroin, etc. Expecting people to go through withdrawal
is inhumane and stupid. We can deal with it without the suffering. Kratom can
be gotten online from multitudes of vendors. Please steer clear of the "legal
high" and 'weed shop' variety of places. In addition to being radically
overpriced, their association does active harm to the community of people who
use kratom reasonably. Stay away from extracts and concentrated forms
(although those seem to have mostly gone away from most outlets, they were big
for awhile and were bordering on dangerous) and just get simple crushed
leaves. If you or a loved one wants to quit, kratom will let you do so without
ruining your life.

If your loved one does not want to quit, because doing so would expose them to
the full pain (emotional, physical, OR psychological) of a life they hate and
which they feel traps them... your problem and theirs is not the drug.

~~~
spraak
Thank you for your detailed and educating post. I came into the comments here
after Ctrl+F "kratom" on the article and finding no results. Kratom is life
saving for opioid/opiate addictions, but as well as for chronic pain. My wife
has been in constant chronic pain for the past few years, to the point of
mostly being bedridden the entire day and not working. But doctors haven't
found anything wrong with her. Perhaps it is a rare autoimmune disorder, but
it remains yet undiagnosed. In the meanwhile, we're grateful to have
discovered kratom, where with it she can actually get through the day nearly
normally.

~~~
otakucode
I am very lucky myself, as I have mostly watched kratoms story from the
sidelines. I've never had an opiate addiction and I don't have any chronic
pain or anything like that. I tried it originally just out of curiosity after
reading some of the research, and still occasionally use it in small doses for
the energizing effect. I don't find larger doses useful to me personally. But
I've encountered many people that have had their lives saved due to kratom,
and witnessing the way some politicians and authoritarians just so rabidly
pursue anything because it's LIKE something else is disturbing. Milk has
opioid receptor agonists in it. And we give milk to babies. The opioid
receptors in our brains are not there as some sort of evolutionary boobytrap
to enslave us to poppy plants. And there are a variety of different receptors
to boot, with them not being equal.

I often do not mention kratom in public forums intentionally. It's odd. I do
not hold my tongue about hardly anything, I am very talkative. But I am always
afraid that one message about kratom will get read by a busybody with an axe
to grind and they'll spearhead a movement to have it banned. I am glad to have
seen the multiple places around the country where states tried to ban it but
were met with both doctors and police stepping up and telling them "this is
not a problem. Stop trying to make it one for your own aggrandizement."

But when I come across someone who deals with addicts, I always try to explain
it as best I can.

~~~
spraak
Yeah, you do make a great point about when to mention something or not.

------
ringaroundthetx
> evidence-based medicine

non-evidence based medicine that uses the made-up-on-the-spot holistic
approach is upheld by the idea that there is no scientific method available
because it is about the body as a whole.

I think that rebuttal is reductionist and that there could be a method that is
applicable to that form of treatment.

does anybody have thoughts on that?

~~~
taylorswift_
posting my response above but I am with you...

------
stmfreak
Sympathetic support I'd fine for people interested in kicking a habit. But
when the addict doesn't want to quit? What then?

------
narrator
Nothing about NAD therapy? Sadly, it's an underutilized treatment for opioid
addiction.

------
CodeWriter23
"Science"'s answer to opioid addiction: prescribe opioids, declare addict
cured.

PS I'm not an advocate of treatment because they also employ shortcuts to
"recovery".

------
grzm
(2016)

------
warcher
Fun fact: The current standard within the US is AA/NA.

AA and NA are not only wholly unscientific, being invented of whole cloth by a
layperson in the early 20th century (for context, lobotomy was a _totally
accepted psychological treatment_ for decades after 1935). There was no
science whatsoever involved in AA, and indeed Alcoholics Anonymous _actively
resists any data collection about the efficacy of its techniques whatsoever_.

It's main advantages from a US perspective are a) it's free. The costs are
borne mostly in the form of churches providing basements and meeting rooms.
and b) it's super churchy. We love churchy stuff around here.

So basically we kicked addiction under the rug for the entire 20th century in
favor of religious hokum that refuses any objective evaluation of its
efficacy, or changing its methods.

I should say, for the record, that there's a lot of people that have been
helped by AA and NA, and there's indisputably good work being done there. But
it's not perfect and categorically refuses to get better, and its longevity is
IMHO more a result of our collective refusal to take the problem of addiction
seriously in the US than anything else.

~~~
rajacombinator
Got any better suggestions? Genuinely interested, not sarcasm. (Mostly.)

~~~
warcher
It's happening, it's just happening slowly.

Point of fact, addiction is a disease and must be treated like a disease. This
is pretty mainstream and not really all that controversial. The issue we're
working through, glacially, is that in the US healthcare is for-profit and
junkies are not profitable. So we just.... throw those people in the garbage.
I think that's both immoral and economically wasteful. I know former junkies.
Personally. And they're not garbage-- they have value and if you can get them
well, they want to live a productive life.

The plain fact of the matter is that there's no business case for treating
these folks-- the government is going to do it or nobody is going to do it.
And the status quo is "Fuck it, send them to church. I'm not paying for a
bunch of crackheads to get clean. They need to find jesus." Which is another
way of saying "Let them eat thoughts and prayers."

~~~
rajacombinator
While I appreciate the "US healthcare sux!!" sentiment, that's a pretty naive
viewpoint that underestimates the difficulty of the situation imo. Are there
other non "for profit" healthcare countries that have substantially better
results in this area?

------
mirimir
> When a family member, spouse or other loved one develops an opioid addiction
> — whether to pain relievers like Vicodin or to heroin — few people know what
> to do. Faced with someone who appears to be driving heedlessly into the
> abyss, families often fight, freeze or flee, unable to figure out how to
> help.

OK, if someone wants to be an opioid addict, why not just let them? The
"driving heedlessly into the abyss" aspect seems mainly due to opioids being
illegal and expensive. I mean, do we use such language about diabetics? Do we
expect them to manage their diabetes through diet alone?

I'm not aware of solid evidence for health risks associated with chronic
opioid use alone. Excluding opioid addiction, I mean. But please do share.

~~~
mattmanser
A lot of people are dying from overdoses.

[https://www.asam.org/docs/default-source/advocacy/opioid-
add...](https://www.asam.org/docs/default-source/advocacy/opioid-addiction-
disease-facts-figures.pdf)

~~~
mirimir
People are dying of overdoses because opioids aren't available legally, with
regulated strength and purity, and at reasonable prices. If opiods with
regulated strength and purity were as readily available as liquor, few people
would be overdosing. In parts of the Middle East, where alcohol isn't
available legally, methanol poisoning isn't uncommon.

