
How the Epidemic of Drug Overdose Deaths Ripples Across America - tysone
http://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html
======
dchmiel
We share a lot in common with our neighbours to the south and it seems that
the drug overdose epidemic has been happening in Canada as well. With some
very alarming rates of increase due to Fentanyl overdoses. In the province of
Alberta, Fentanyl detected deaths have risen from six in 2011 to 120 in
2014.[1] Other provinces are showing double and higher rates of increases.

If you were to look at Alberta alone there is a correlation to the collapse in
oil prices, since it's an oil and gas producing economy, and increased
overdoses. But Fentanyl is just this monster of a drug 80 times as powerful as
morphine that is being laced into so many other drugs and sold to unsuspecting
customers as OxyContin or laced into it. As a response to the epidemic the
government is fast tracking Naloxone to become a non prescription drug since
it reverses the effects of an opioid overdose within minutes.[2] I don't
remember where I read that first responders (Paramedics, EMS) will be carrying
Naloxone to administer it during responses.

1.[http://www.theglobeandmail.com/news/british-
columbia/fentany...](http://www.theglobeandmail.com/news/british-
columbia/fentanyl-related-deaths-soar-across-canada-report-
says/article25920303/)
2.[http://www.theglobeandmail.com/news/national/government-
to-f...](http://www.theglobeandmail.com/news/national/government-to-fast-
tract-availability-of-overdose-reversing-drug/article28196221/)

~~~
tallerholler
This really hits home to me as one of my best friends and one of the most
brilliant people I have ever met died 6 months ago from a fentanyl overdose
alone in a motel room. I met him in the #django channel on irc about 10 years
ago when I was learning python an django and we ultimately later became great
friends and he came to live with me in California for a time and did
consulting work. He was always way ahead of the curve with technology - he
knew about technologies, platforms, and architectures before anyone else I
ever knew would know about them. He also suffered from the disease of
addiction and ultimately his life ended all by himself in a motel room in
Texas after taking a bad batch of fentanyl. It was a complete and total waste
and if pisses me off more than words can describe. He could have been working
at Google but instead all he got was a short obituary in some small town in
Texas. His death has motivated me in many ways in my personal life and in my
professional life and I really hope that we as a society can figure out a way
to prevent other people like him from losing their life at such a young age
and having such a horrific ripple effect through their friends and family that
is a total preventable waste. It sucks :/

~~~
rjbwork
Society knows how. We've figured it out. Unfortunately, government is a giant
roadblock to getting it done at the moment.

------
djb_hackernews
Has anyone come across coverage of the heroin epidemic as it relates to the
growth of heroin production in Afghanistan since the arrival of US forces?
Seems like no one is connecting these dots and I'm curious why? Not to imply
there is a conspiracy theory at all, it may just be that I'm more "fascinated"
by that relationship than the average reader?

~~~
yrLS1
Afghanistan hasn't been a significant source of US heroin in decades. The
majority of heroin in the US is either from Mexico or Colombia these days.
Source:
[http://www.washingtonpost.com/sf/national/2015/09/24/pellets...](http://www.washingtonpost.com/sf/national/2015/09/24/pellets-
planes-and-the-new-frontier/).

No question Afghanistan is a huge opium producer, it's just that the majority
of that product ends up in Europe, not in the US. PDF source:
[https://www.unodc.org/documents/wdr2014/Statistics/Opium_Her...](https://www.unodc.org/documents/wdr2014/Statistics/Opium_Heroin_cultivation_production_eradication.pdf)

~~~
cushychicken
I parsed the implications of the original statement as one of deployed troops
picking up the habit rather than increasing the home front supply. Do you
happen to have any stats about heroin abuse among Afghan vets?

~~~
yrLS1
The only thing I could really find is here:
[http://usatoday30.usatoday.com/news/military/story/2012-04-2...](http://usatoday30.usatoday.com/news/military/story/2012-04-21/afghanistan-
soldier-drug-use/54450906/1)

Long story short, the Army investigated 56 soldiers in Afghanistan between
2010 and 2011 for using / dealing.

As for the bigger question, the military really is a subset of society.
Veterans end up using the same things the rest of society does to escape their
problems.

Combine that with relatively easy access to pain meds and you get the same sad
story we're dealing with everywhere else. Here's more info on that angle:
[https://www.hrw.org/news/2014/06/30/us-half-million-drug-
dep...](https://www.hrw.org/news/2014/06/30/us-half-million-drug-dependent-
veterans)

------
armenarmen
They shut down the pill mills and the pain clinics, which were the one
reliable source of safe opiates, and now people are dying left and right. Go
figure.

~~~
yrLS1
Except, of course, that people were also overdosing "left and right" due to
the pill mills and illegitimate pain clinics...

Edit for source: [http://www.jhsph.edu/news/news-releases/2015/pill-mill-
crack...](http://www.jhsph.edu/news/news-releases/2015/pill-mill-crackdown-
linked-to-fewer-painkiller-overdose-deaths-in-florida.html)

~~~
armenarmen
Interesting, "researchers also found substantially fewer deaths in Florida
from overdoses involving either prescription painkillers or heroin during 2011
and 2012"

Thanks for the article.

"with less access to prescription painkillers, fewer people may be developing
an addiction"

So we are seeing less people getting hooked on opiates. This is of course a
good thing. But I still worry about those who got hooked in "the good old
days" and now no longer have access to opiates in standardized doses.

~~~
Alex3917
> So we are seeing less people getting hooked on opiates. This is of course a
> good thing.

Not necessarily. You want people in pain to be able to access opiates. And
some of those are going to die from them. So the ideal number of people dying
probably isn't zero.

~~~
yrLS1
Ideally the number IS zero. :)

The realistic number on the other hand will probably be higher, as you
identify.

I'd also argue there's a difference between being 'hooked' on opiates and
using them regularly for legitimate pain management.

------
sageabilly
I only have my one anecdote in response to this story, which does not
translate into data I know. I'm from one of the counties in western NC where
overdose deaths have gone from 4-8 in 100K to 20+ in 100K. I graduated from
high school in 2001 so I have grown up with the rise of drug use in my home
county and surrounding areas and the people affected are people that I've
known all my life. I no longer live in NC and, in fact, haven't lived in the
area since I was 16 (went to a live-in magnet high school and then went
elsewhere for college + career).

2001- my graduating class goes off into the world, half to college, maybe 1/4
to trade school, the rest go to join a family business or into an
apprenticeship into a trade. A few go into the military. A few have no idea
what to do and get low-level jobs wherever they can find them.

Pre-2008- The economy is booming, people who've gone to college are either 3
years post graduating, establishing themselves in their young careers, or just
graduating from grad school, or for those that have entered a trade they've
worked long enough to start having some standing in their chosen line of work.

2008-2010 economy explodes. Layoffs, bankruptcies, consolidations, offshoring.
Immensely decreased consumer spending hits trades particularly hard- welders,
mechanics, electricians, construction workers- all take massive hits to their
profits. Business is scarce. People who've graduated from college and who are
establishing their careers get laid off and have to move back into the county
because that's where their safety net is- grandma and grandpa can take care of
the kids while they hunt for work or work a low-paying job because that's all
they can get. Military service men and women get done with their tour and come
back to _nothing_ \- no job prospects, community college has closed, trade
schools have closed, the factories where their fathers and mothers worked have
all outsourced to 3rd world countries and closed.

In my rural county suddenly there's way more idle middle to late 20-somethings
with no job and no prospects. No jobs to be found, no money to move. What I
saw among the people I know/knew is that it only took a few people trying meth
before it was like a powder keg going off- idle hands are the Devil's
plathings, after all. People I went to high school with no hope for the future
were doing meth because it was 3 minutes of bliss in stark contrast to the
whirlpool of suck their lives had become. Grandma and grandpa were taking it
because they couldn't afford painkillers. Teenagers were taking it because
they were shithead teenagers and it was more accessible than pot. The
"smarter" of the people I knew were cooking it because it was the only way
they knew to make money. Once the door was open to meth then "fancier" stuff
like painkillers started coming in and it was a way to feel like you were
"better than" everyone else you knew who was doing meth. Oh yeah you were a
drug addict, but at least your pills had a brand name. Enough meth labs blow
up and the more enterprising of drug distributors can come in and sell addicts
anything and everything they want, so if heroin is cheap enough that's what
gets sold.

This article is written from a scholarly point of view and has a lot of
conjecture but I definitely don't think they had any boots on the ground to
make the conclusions that they did, particularly with regards to saying the
epidemic in Appalachia is a result of on the job injuries. _There are no jobs
to get injured on anymore_.

[Edit] I also absolutely agree with onetwotree's comment downthread, this is
another ENORMOUS contributor to increased and sustained drug use in my tiny
county: _" Recovery is hard in tiny communities. All your friends are doing
drugs, there are maybe 2 or 3 12-step meetings a week, no outpatient programs
that you can attend while working, no sober living facilities, and treatment
involves a trip to the big city."_ Also worth mentioning is that often those
12-step meetings are held in the basement of a church, which in my hometown
means it's either your church which your whole family goes to and you grew up
in (pretty damn hard to walk in there and admit to being an addict) or your
friend's church that his whole family goes to and he grew up in- in both cases
it's impossible to be anonymous.

~~~
fweespeech
I don't mean to detract from your anecdote but the Florida and the CDC clearly
sees a link in overprescription of pain killers and the death rate. The root
cause is the way we are handling opiates in general which changed in 2001 and
the prioritization of "comfort" of the patient when they are in pain.

Anecdotal, I've been in pain, multiple times in my life, where Doctors were
literally confused by the fact I wasn't taking pain medication and immediate
would prescribe opiates without a second thought. A couple even made comments
[one Doctor who used to treat soldiers assumed it was a macho thing and told
me I was being silly, just take the drugs].

The main reason I don't take pain killers is I've got medical allergies so I
reserve the handful of things I can take for emergencies but they'll casually
try to suggest/prescribe them for trivial things.

> People I went to high school with no hope for the future were doing meth
> because it was 3 minutes of bliss in stark contrast to the whirlpool of suck
> their lives had become.

Yeah, but would you agree they would turn to drinking if they
wouldn't/couldn't do illegal drugs?

[http://www.cdc.gov/media/releases/2014/p0701-opioid-
painkill...](http://www.cdc.gov/media/releases/2014/p0701-opioid-
painkiller.html)

> Health care providers in the highest prescribing state, Alabama, wrote
> almost three times as many of these prescriptions per person as those in the
> lowest prescribing state, Hawaii. Most of the highest prescribing states
> were in the South. Previous research has shown that regional variation in
> use of prescriptions cannot be explained by the underlying health status of
> the population.

> The Vital Signs report also contains a study highlighting the success of
> Florida in reversing prescription drug overdose trends. Results showed that
> after statewide legislative and enforcement actions in 2010 and 2011, the
> death rate from prescription drug overdose decreased 23 percent between 2010
> and 2012. Florida officials had taken these actions in response to a 28
> percent increase in the drug overdose death rate over the preceding years
> (2006-2010).

> Declines in death rates in Florida for specific prescription painkillers
> (oxycodone, methadone, and hydrocodone) and sedatives paralleled declines in
> prescribing rates for those drugs. This report was based on Florida Medical
> Examiners Commission data from 2006 to 2012 and IMS Health National
> Prescription Audit data from 2008 to 2012.

They do the same with antibiotics:

[http://www.cbsnews.com/news/doctors-urged-to-stop-
prescribin...](http://www.cbsnews.com/news/doctors-urged-to-stop-prescribing-
antibiotics-for-colds-and-flu/)

> Despite years of warnings, doctors still overprescribe antibiotics for acute
> respiratory infections even though most are caused by viruses that those
> drugs cannot help. The consequences are serious: overuse of antibiotics is
> fueling the rise of drug-resistant superbugs, and patients can suffer
> significant side effects from drugs they don't really need.

[http://www.newyorker.com/business/currency/who-is-
responsibl...](http://www.newyorker.com/business/currency/who-is-responsible-
for-the-pain-pill-epidemic)

> The Joint Commission, which accredits health facilities, issued pain-
> management standards in 2001 that instructed hospitals to measure pain—you
> may be familiar with the smiling-to-crying faces scale—and to prioritize its
> treatment. Elizabeth Zhani, a spokeswoman for the Joint Commission, told me
> that their standards “were based upon both the emerging and compelling
> science of that time, and upon the consensus of a broad array of
> professionals.” Yet Purdue, according to a report issued by the U. S.
> Government Accountability Office, helped fund a “pain-management educational
> program” organized by the Joint Commission; a related agreement allowed
> Purdue to disseminate educational materials on pain management, and this, in
> the words of the report, “may have facilitated its access to hospitals to
> promote OxyContin.”

> In a policy drafted by several people with ties to narcotics makers,
> including Haddox, the Federation of State Medical Boards called on the
> boards to punish doctors for inadequately treating pain, according to the
> Wall Street Journal. The Federation also reportedly accepted money from
> pharmaceutical firms to produce and distribute narcotics-prescribing
> guidelines. In an e-mail, the Federation maintained: “[Our] most recent
> policy reflects the considerable body of research and experience accrued
> since our last series of formal policies related to opioid prescribing and
> addiction were adopted in 2004. Our latest guidelines, adopted this year,
> acknowledge that evidence for the risk associated with opioids has surged,
> while evidence for the benefits of opioids for long-term use has remained
> controversial and insufficient.”

> In 2007, Purdue Pharma and three of its top executives pleaded guilty to
> criminal charges that they had misled the F.D.A., clinicians, and patients
> about the risks of OxyContin addiction and abuse by aggressively marketing
> the drug to providers and patients as a safe alternative to short-acting
> narcotics. (Doctors had been taught that because OxyContin was time-
> released, it wouldn’t cause a high that would lead to addiction.)

~~~
sageabilly
_"...overprescription of pain killers"_ Yup, definitely a problem. Not so much
in my county that I saw, but definitely a problem. And then the people who
have them prescribed to them are selling them to get money because they have
none. Another anecdote- I did a brief stint as an in-home healthcare aide in
college and the sweet old lady I took care of who was in the 1st stages of
dementia sold her painkillers to her neighbor at $3 a pill "Because he says he
will get them to people who can't afford to go to the doctor, poor dears."
Also, if you're able-bodied and out of work, you're definitely not able to
afford to go to the doctor or pay for prescription painkillers.

 _"...they would turn to drinking if they wouldn't/couldn't do illegal
drugs?"_ Probably/definitely not. There's one ABC store in my entire county
(population 50K now, closer to 25K in 2001) and again, really hard to be
anonymous with your drinking when you went to high school with everyone who
works at the ABC store and it's where everyone in the entire county goes to
get their booze so chances are you'll see your brother in law and your best
friend's grandmother and your ex-girlfriend's uncle while you're in there.
Drugs can be done in the shadows and hidden way more effectively than booze.

RE: overprescription: I have no idea why this is a thing. Profit margins on
painkillers mean salespeople give under the table kickbacks to underpaid rural
doctors in return for more prescriptions? Aging population on Medicaid becomes
only cash cow for rural doctors after so many people lose their jobs (and
health insurance) so they have to start prescribing more pills that they know
Medicaid will pay for? Lack of doctor education leads to overprescription
because they don't know any better? It's a big unknown, and not addressed in
the article at all.

~~~
vkou
For over-prescription, there's also the issue that if you don't prescribe
opiates to people that ask for them, they will find another doctor who will.

------
highCs
What conditions pushes a drug addict to overdose? Do they all reach that point
at some point or what? Is this illegal drugs or regulated ones?

~~~
joesmo
Varying potency. Dealers putting in fentanyl or stronger opiates to
intentionally cause an overdose as marketing hype for their product (very
common). Misjudging the dose of a known product. Tolerance. Using too much
after some time stopped. Mixing opiates with other substances. I'm sure there
are many more.

 __If you 're using street opiates, it's going to happen at some point,
guaranteed. __I 've yet to meet an opiate addict who has never overdosed and I
doubt I ever will. Sticking to prescription opiates helps, but even then
people overdose often.

~~~
buttcoinslol
I never overdosed in a year of heroin use, then again I wasn't an IV user.

~~~
highCs
Can I ask why you use heroin?

~~~
buttcoinslol
I don't use heroin any more.

------
joesmo
Naloxone and clean needles should be available cheaply and over the counter,
no questions asked. People who help overdose victims shouldn't be charged with
drug possession. Until those things happen, I have no doubt overdoses will
continue to needlessly kill people while our idiot politicians stand idly by
wondering what they can do because they're too fucking stupid to implement the
tried and true, tested solutions for fear of looking bad. This isn't a news
story about anything else than the failure of government to implement very
simple solutions (as most stories about problems in the US). Instead, these
idiots keep working on filling up more jails. After all, jailing people for
everyday activities is the American way.

------
awavering
Recommended reading if this interests you: Dreamland tells the story of
intersecting prescription pill and heroin use in America.

[http://www.samquinones.com/books/dreamland/](http://www.samquinones.com/books/dreamland/)

~~~
MicroBerto
It's maddening.

Prescription opiate use has gotten so bad that Big Pharma is now heavily
advertising an anti-constipation pill for all these addicts, with the most
ridiculous commercial I've ever seen: a woman walks around town with her
opioid "bff" that happens to have muscles.

[https://i.imgur.com/NMn59EC.jpg](https://i.imgur.com/NMn59EC.jpg)

Seriously, if this _alone_ doesn't spell doom for your country and its health
care system, I'm not sure what does.

~~~
phillipamann
What is the name of this anti-constipation drug and do you have a link to the
commercial?

~~~
refurb
I'm guessing it's Relistor? It was recently approved for constipation caused
by opioids.

To be honest, opioid constipation is a huge problem. It's a great drug to
have.

~~~
Healthyme15
I think for chronic constipation, you can also use this Digestic by Mimonis
which is very good in treating constipation problem. I have been save from my
long battle of constipation that is why I can say it has been proven by mine
to be effective.

------
bluedino
The maps on this page aren't similar to a standard population map, so that's
good in a way.

Has heroin simply taken the marketshare away from meth?

[https://xkcd.com/1138/](https://xkcd.com/1138/)

~~~
theseatoms
"Good" as in "good data presentation". Not "good" as in "good that heroin use
is growing proportionately across the American populace", I presume.

Any "rate of change" graphic should control for the issue that xkcd mentions.

~~~
tgb
It does control for that - the rates are per hundred thousand people.

------
brooklyndude
Living in NYC. What can I do tonite? 63 plays, 22 gallery openings, 18
meetups, 23 movies. 31,245 restaurants to choose from.

Northern New Hampshire: What are we going to do tonite? Nothing. Absolutely
nothing going on.

Lets do some heroin.

Cool. It's all we got.

WTF.

~~~
api
An old friend of mine who grew up in Middletown, Ohio said there was "nothing
to do but drugs and church." He also said there was a surprising amount of
double-dipping in those things, wrecking a few stereotypes.

~~~
puredemo
I grew up in an area like that. One of my goals if I ever get wealthy is to
simply open up something cheap and fun to do in small towns to combat this.
Like rock climbing gyms for $30 a month. Or small indoor water parks.

I wouldn't even care if that chain of businesses made much money, I'd consider
it a public service.

~~~
gregpilling
How much do you think VR and Oculus Rift will impact the experience of growing
up in a small town? A kid will be able to experience much of the world, no
matter where they are.

I hope it has a positive impact; I don't see how it couldn't.

~~~
puredemo
The internet has already been a massive boon to fighting boredom in general,
sure. If you are highly literate (~15%) it's difficult to be bored when all of
the world's knowledge is at your fingertips. Even if you aren't highly
literate, there are still X-box games. ;) And you're right, VR will just help
even more.

That being said, I do see some issues with our youth habitually living in
gaming ecosystems rather than in the real world. For instance, a couple
studies lately have noted empathetic behavior sharply dropping among
millennials, [1] which I would think comes from spending far less time
interacting face-to-face with anyone during their formative years -- their
emotional attachments are probably not as strongly imprinted when staring at a
screen all the time.

Internet and VR are still a huge net win imo. Real-life, positive social
outlets are crucial as well though.

[1]
[http://www.ipearlab.org/media/publications/Changes_in_Dispos...](http://www.ipearlab.org/media/publications/Changes_in_Dispositional_Empathy_-
_Sara_Konrath.pdf)

~~~
Nadya
I empathize and care more about my online friends than _anyone_ I know in real
life - including _most_ of my intermediate family. While I could be the
exception to the norm, the people with whom I interact seem to be similar. Of
course, we could all be exceptions to the norm...

The study you linked does mention other causes which seem more likely than
device use:

 _> As discussed previously, narcissism, which is negatively correlated with
empathy, has been rising in American college students over a similar time
period (Twenge et al., 2008). _

The current college generation are extreme narcissists. To a _disgusting_
degree. Even terrible tragedies (such as the terrorist attacks in France) are
met with "how can I make this about _me_?" attitudes. A brief browse through
Twitter shows this isn't an _uncommon_ thing.

I have no data on whether or not narcissism may or may not be correlated with
internet/electronic devices. (I haven't bothered to search this statement, so
if a study shows up on the first page of Google results - didn't bother
looking! :) )

Either way - I look forward to habitually living in a gaming ecosystem rather
than the real world.

------
ComputerGuru
Interesting that Chicago is so underrepresented in those charts. I wonder why.

~~~
linxoz
The drugs come from Chicago, but majority of the OD happens in the western
suburbs of Chicago; mainly DuPage county.

[http://wgntv.com/2013/11/19/heroine-epidemic-plaguing-
dupage...](http://wgntv.com/2013/11/19/heroine-epidemic-plaguing-dupage-
county/)

------
1024core
Has the legalization of cannabis made a difference in the number of overdoses?
I don't have access to the numbers, but it would be an interesting question to
ask from a public health perspective, if easy access to cannabis reduces OD
deaths from more powerful drugs.

Edited: I mean, if access to cannabis reduces the incidents of ODing from
_other_, harder drugs like heroin or fentanyl or meth.

~~~
peter303
No one has died directly of cannibus intoxication in Colorado yet. A couple
have people have gone paranoid and committed suicide. And there a several ER
room visits for emotional distress or catatonia every week. About of fifth of
DUI convictions are now for cannabis. I presume there is a proportional
fracton of drunk driving deaths.

~~~
1024core
No, I meant if the legalization of cannabis has had an affect on the OD deaths
from _other_ drugs like heroin and fentanyl, etc.

------
csense
It strikes me how this article uses the language of an "epidemic," as if this
is a disease that happens randomly to people. It's not. These drug users are
deliberately chose to inject a substance into their body, knowing full well
that this is a totally unregulated illegal industry, and there is a high risk
of addiction, overdose, impurities and death.

They teach kids in school that drugs are bad. Maybe they need to make the
education more horrifying, with pictures and videos of people showing in
gruesome detail how their minds and bodies have been permanently damaged, or
the cold corpses of dead addicts. Maybe they need to better explain the nature
of statistical risk, telling you that even if you're fine the first, second,
and third time, the fourth, fifth, or hundredth time can still kill you.

Why are people so dumb?

~~~
tbabb
Brains are machines, and drugs damage them in such a way that the damage
accelerates.

If you think you are not driven by your own reward system, or that you are
above it, you are laughably mistaken. By and large, you will do what your
reward system tells you to, and your reserves to defy it are limited and
finite.

Be happy that yours is intact and _mostly_ tells you to do things that are
good for you (which itself is only by the grace of millions of years of random
variation and selection on your ancestors, who more or less knew nothing of
the potent drugs that exist in our habitat today), because once that system is
damaged, you cannot simply will it to become fixed.

Moreover, it looks like the Appalachian outbreak is due to patients falling
into addiction as a result of _established medical care_ , and simply falling
through the cracks-- or perhaps even having dangerous addiction-risky
treatments foisted on them by a drug industry overstating the safety or
necessity of its products.

Have a little sympathy. If the rates shown here continue, you may one day find
yourself among the affected.

------
xyzzy4
What they should do is sell heroin legally along with cigarettes and alcohol,
and that way people won't overdose as much because they'd know exactly how
much to use.

~~~
boondoggler
That might help to some extent, but people still overdose with prescription
opioids, which are much more uniform in strength.

An effective dose, especially for someone with high tolerance, often just
isn't that far from a lethal one.

Supervised injection sites, with medical professionals equipped with naloxone
would help, at least for people willing to use them.

~~~
Alex3917
> people still overdose with prescription opioids

It's relatively rare though that someone accidentally fatally ODs on a
prescription opioid other than fentanyl and that's the only drug in their
system. (Especially since in the U.S. it's very difficult to buy prescription
opioids without acetaminophen, promethazine, etc.)

------
salmonet
Interestingly high rate of OD deaths in a county on the Hawaiian island of
Molokai. Access is pretty restricted and the whole island has a population of
less than 10,000.

~~~
onetwotree
Recovery is hard in tiny communities. All your friends are doing drugs, there
are maybe 2 or 3 12-step meetings a week, no outpatient programs that you can
attend while working, no sober living facilities, and treatment involves a
trip to the big city.

Contrast this with a modest sized city like my home of Madison, WI, where
there are two rehabs in town, the land of a thousand rehabs is just across the
state line, hundreds of meetings a week, and there is a thriving sober living
community. Small town folks make up the majority of the recovering heroin
addicts I meet here. They all took the quick trip up the road to Madison for
rehab, moved into sober living in town, and stayed for the recovery community.

Perhaps that's more difficult on an isolated island community?

If you think it's too hard to get the dope there, you haven't met an addict in
need...

------
onetwotree
Yep, the new face of heroin is white and affluent. While I'm all for the
evidence based, treatment focused approach to addiction that this has brought
about, isn't it a little telling that we only switched from punishment to
treatment when white people started shooting dope?

~~~
gozur88
>Yep, the new face of heroin is white and affluent.

Have another look at the maps. It's white and poor.

~~~
CPLX
And that is not a coincidence. People take heroin as a palliative for bleak
life prospects. After a few decades of globalization life sucks for rural poor
whites in much the same way it sucked for inner city blacks in the 70's.

~~~
IndianAstronaut
If not globalization, it would have been automation or something else. They
were just in general underprepared for a changing economy.

~~~
CPLX
Or maybe they have been mercilessly trampled underfoot by a corporatist
political system on a well funded and organized campaign to crush organized
labor, prevent national health insurance, and remove support systems for the
working class. There's nothing inevitable about this.

~~~
elenorelange
What's inevitable is that they were going to lose. Life is a struggle of all
against all. For some people to win, others have to lose.

~~~
eropple
In no way is it _nearly_ as settled as your sweeping generalization suggests.
Pareto-efficient outcomes exist for so many things, why should they not for
society?

