
Opioid Use Could Explain 20% of the Drop in American Men from Labor Force - mcone
https://www.bloomberg.com/news/articles/2017-09-07/opioid-use-explains-20-of-drop-in-american-men-from-labor-force
======
hownottowrite
From the actual study (p.36): [https://www.brookings.edu/wp-
content/uploads/2017/09/1_krueg...](https://www.brookings.edu/wp-
content/uploads/2017/09/1_krueger.pdf)

 _" These regressions are difficult to interpret for a number of reasons, but
if cross-county differences in opioid prescription rates can be taken as an
exogenous result of differences in medical practices and norms conditional on
personal characteristics and broad region dummies, the effect of the growth in
opioid prescriptions on labor force can be estimated. In particular, I assume
that the based opioid prescription rate coefficient reflects inherent
differences across regions, and the interaction between prescriptions and time
captures the effect of changes in prescriptions on labor force participation
over time. This is a big leap, and ideally I would have preferred to have a
baseline measure of prescriptions (country-level MME data are unavailable
before 2010), so this calculation is at best considered illustrative. These
caveats aside, opioid prescriptions per capita increased by a factor of 3.5
nationwide between 1999 and 2015, which is the equivalent of 0.55 log units.
Multiplying 0.55 by the coefficient on the interaction between opioids and the
second period (.011), suggests that the increase in opioid prescriptions could
account for perhaps a 0.6 percentage point decline in male labor force
participation, which is 20 percent of the observed decline in this period."_

~~~
nostromo
Scientist: "difficult to interpret... I assume... This is a big leap...
ideally I would have preferred... this calculation is at best considered
illustrative... caveats aside..."

Reporter: "Opioid Use Explains 20% of Drop in American Men From Labor Force"

~~~
meri_dian
While genuine 'Fake News' is a real problem, hyperbolic reporting that
disregards nuance to attract clicks from the lowest common denominator is much
more widespread and insidiously damaging. I'd argue that it plays a large role
in the polarization of society.

~~~
Florin_Andrei
> _hyperbolic reporting that disregards nuance to attract clicks from the
> lowest common denominator is much more widespread and insidiously damaging.
> I 'd argue that it plays a large role in the polarization of society._

So, which is better? That? Or accurate, nuanced reporting that the everyman
does not even attempt to read because his eyes glaze over before he's done
parsing the first sentence?

The problem is not with the news, the problem is that this is what human
nature is. The vast majority of people are amazingly bad at absorbing
information regarding things beyond their immediate interests and horizon.

~~~
Clubber
You assume that everyman doesn't attempt to read it. Everyman read it for
years. The news dumbed everything down when they chased the tabloid dollars.

~~~
washadjeffmad
Again. Remember an early symbol countering the yellow journals was the Old
Gray Lady.

And thorough, well researched, objective journalism has atrophied or gone
underground in the wake of the digital readership monetization crisis.

And AFK, how many reporters are there now versus news readers? When you can
buy your rhetoric and blurbs right from the think tanks in partnership with
SocialCo(TM) and have anyone who looks the part read off the script, it makes
sense not to spend the money on originality and depth.

It takes some mental acrobatics not to want to call that an ersatz
representation or a fools interpretation of what journalism is.

~~~
Clubber
The NYT just seems so one sided since Trump (and probably before). I mean
there are two sides to DACA and both have merit. There was an article the
other day that tried to explain away whites being killed by cops as suicide by
cop. That's not good reporting, that borders on propaganda. I mean I know
opinion pages are garbage, but damn.

EDIT: Suicide by cop article was Wapo, not NYT. I need to stop reading Wapo.

[https://www.washingtonpost.com/news/post-
nation/wp/2016/07/1...](https://www.washingtonpost.com/news/post-
nation/wp/2016/07/11/arent-more-white-people-than-black-people-killed-by-
police-yes-but-no/?utm_term=.ee9ffa098d0a)

I don't even mind that much that they pick a side if they do it at the end, I
just want them to present both arguments, and their merits so I can decide.

When the best out there does what the NYT is doing now, we're in trouble.

------
jefe_
I have an uncle who owns a factory in Northeast Ohio. I saw him over the
summer and this is easily the number one issue affecting his day to day
operations. He showed me a few security camera videos of people coming to work
high and literally going crazy, and then a video of someone who had arrived
for a job interview, but just sat in the lobby dazed and unresponsive to
commands to leave. The videos were shocking, people were like zombies. He
can't find people to hire, and he can't keep the people he has, if they don't
overdose at work, they overdose at home. I knew it was an issue, but didn't
know it was the main issue facing American industry.

~~~
drzaiusapelord
Yet somehow Jeff Sessions can't stop talking about "urban pot epidemic" and
how pot, including medical pot, needs to be cracked down upon.

Meanwhile opioids and meth are completely out of control, but because they are
largely white rural/suburban drug users, they have been getting a free pass
for decades.

~~~
jrs95
They haven't been getting a pass, criminalization is just totally ineffective
at dealing with the problem. As far as disproportionate enforcement goes,
rural and suburban Americans haven't been murdering anyone at nearly the rate
of inner city gangs, which is a big part of why there's more enforcement in
urban areas.

~~~
dragonwriter
> As far as disproportionate enforcement goes, rural and suburban Americans
> haven't been murdering anyone at nearly the rate of inner city gang

Certainly, more ruled-as-murders per population unit happen in urban areas,
but I'm aware of no statistics by urban/rural residence of killer (where a
crime happens doesn't tell you where the criminal is from, and people who live
in rural areas obviously can commit crimes in cities.)

And rural areas have higher death rates and it's at least plausible that the
decreased population density makes it easier for evidence of homicide to be
concealed and murders to be passed off as death by other causes, so the
relative rates of ruled-as-murders may not accurately reflect the relative
rate of actually-is-murder.

~~~
1123581321
Race is a proxy for urban/rural and income. Population density is correlated
with increased crime rates. Certainly that's not to say urban living _causes_
crime.

The idea that so many rural deaths could be covered-up murders is simply
fanciful.

------
dv_dt
The title implys the opposite of the last lines of the article...

> “I do think it is related to declining labor-force participation among
> prime-age workers,”Federal Reserve Chair Janet Yellen said in a July Senate
> hearing when asked about the crisis. “I don’t know if it’s causal or if it’s
> a symptom of long-running economic maladies that have affected these
> communities and particularly affected workers who have seen their job
> opportunities decline.”

Edit: added the full quote.

~~~
rainbowmverse
A business news organization seems like it would be biased toward explaining
unemployment as a symptom of drug use rather than the other way around. It may
be constitutionally incapable of considering that rising poverty and its ills
are a result of mindless outsourcing and automation leading to structural
unemployment.

~~~
pishpash
Another example of externality not priced into costs -- if businesses had to
bear retraining/unemployment costs to society, they may not outsource as much,
or they may still outsource, but be better community citizens.

It might also spur governments to do more to stay competitive in a
_sustainable_ way, e.g. investing more in education.

~~~
jstanley
Nonsense. Unemployed people in poverty is no more the fault of businesses who
don't need their skills than it is the fault of workers who fail to provide
skills that businesses need...

~~~
infogulch
This isn't about fault or blame. This is about keeping a healthy surviving
economy and society over the long term.

The fact that many people are becoming unemploy _able_ is no fault of their
own, and it's not the business' fault that don't need their labor. But as a
society we need to decide what to do about it, because covering our ears and
closing our eyes and yelling LALALALA and pretending it doesn't exist or will
go away on its own is only going to make the problem worse.

------
csense
I've heard a lot of people say the arrow of causality goes the other way --
between globalization and automation, our society's struggling to provide
enough jobs, so the unemployed turn to idleness, despair and drug use.

Low interest rates are supposed to help, but for the most part they've just
led to bidding wars for real estate and financial assets, instead of building
new businesses and increasing payrolls.

The 2016 US election is a sign of despair -- our politicians are seen as out-
of-touch, barely acknowledging there is even a problem. You know it's bad if
people are desperate enough that they're willing to vote for a guy like Donald
Trump.

~~~
disease
Here's a good counter-argument to your assertion that people voted for Trump
out of economic despair:

[https://www.theatlantic.com/magazine/archive/2017/10/the-
fir...](https://www.theatlantic.com/magazine/archive/2017/10/the-first-white-
president-ta-nehisi-coates/537909/)

------
michaelbuckbee
Several people are asking about the "why" of this, much of it stems from
legitimate prescriptions for Oxycontin which due to the "12 hour problem" [1]
balloons into a heroin (cheaper, easier to get) addiction [2]

1 - [http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

2 - [http://www.narconon.org/blog/heroin-addiction/5-reasons-
pres...](http://www.narconon.org/blog/heroin-addiction/5-reasons-prescription-
addiction-turns-to-heroin/)

~~~
otakucode
Yeah, much of the 'opioid crisis' is entirely manufactured by how we've dealt
with things. If doctors had recognized opioids as habit-forming and planned
ahead of time to wean patients off of them with a long period of gradual
tapering down in dosage (so if it takes 6 months or more, so what?) before
quitting. Instead, they decided 'addiction' was a moral failing and simply
stopping giving anyone prescriptions no matter how legitimate the need.

One thing that rarely gets mentioned is how abundantly SAFE opiates are. If
you know what you're getting, know what dosage it is, and know it's not
adulterated with other substances, you can use opiates for decades without
significant health complications (aside from constipation). Overdoses
primarily happen with people mixing medications, trying to use unfamiliar
medications recreationally (nothing can save a stupid person who wants to get
high but can't be bothered to figure out what the right dose for that is for
their body mass), or, most often now, having to get things from a black market
where the supply is unknown potency or contents.

Fundamentally there is one group of people who is angry that other people are
using a chemical to feel good because they feel that if other people aren't
suffering as much as they have then they were cheated somehow. And they've
been driving policy since the 80s, costing countless lives and monumental
amounts of resources. Just to make sure no one has an easier time of life than
they had.

~~~
DanBC
> One thing that rarely gets mentioned is how abundantly SAFE opiates are. If
> you know what you're getting, know what dosage it is, and know it's not
> adulterated with other substances, you can use opiates for decades without
> significant health complications (aside from constipation).

But there's little evidence that opioids are effective for treating long term
pain.

We know about 10% of people who take prescription opioids will become
addicted, and that tends to be the people using them for chronic (long term)
pain.

> Fundamentally there is one group of people who is angry that other people
> are using a chemical to feel good because they feel that if other people
> aren't suffering as much as they have then they were cheated somehow. And
> they've been driving policy since the 80s, costing countless lives and
> monumental amounts of resources. Just to make sure no one has an easier time
> of life than they had

No, that's wrong. There are people who see that opioids are massively over
prescribed in the US, which is causing untold harm and death. Trying to cut
back on that massive over-prescribing has to happen.

The problem lies with a fucked up health system that doesn't provide drug &
alcohol rehab; and just cuts people off from their meds cold turkey.

~~~
otakucode
My original comment was unclear, I can see that from both replies I got. I was
not claiming that opiates were effective for long-term pain relief. I wasn't
addressing their ability to relieve pain at all. I was referring only to the
toxicity and health consequences of long-term opiate use alone. I also do not
specifically consider 'dependence' to be a negative consequences in the
scenario I described because I specifically mentioned a reliable, known clean
supply. SSRI anti-depressants are similarly heavily prescribed and cause
tremendous dependence. That only becomes an issue if a substance has other
health consequences, or supply is disrupted.

There are a surprisingly large number of long-term wealthy opiate addicts who
are not suffering from any sort of physical pain they are trying to cure. They
are addicted, certainly, but manage their addiction like an alcoholic or
smoker manages theirs. Unlike the alcoholic or smoker, however, they are
unlikely to develop any cancers, cirrhosis, or other significant complications
other than the constipation I mentioned. Constipation is inevitable because
the gut has opioid receptors just like the brain does, only when those in the
gut meet a receptor agonist, they stop gut movement. That's how Immodium A-D
works. It's actually an opiate. But one formulated such that it will not cross
the blood-brain barrier.

Also, my later statement, about the people who want to make sure no one is
having it easier than they are, was in reference to the moralizers and the
original drives to make various substances illegal as well as the 1980s 'war
on drugs' push and similar. Drugs are not illegal because they're bad for you.
That was never the basis of any of the laws. Poisons are not illegal to
produce, possess, or ingest, generally speaking. Only chemicals which make
people happy are.

Those concerned with dealing with the current opiate crisis certainly are not
among that group of people simply angry that they didn't have the 'easy out'
of popping a pill to be happy. I count myself among those deeply concerned. I
live in West Virginia, a state with one of the highest rates of deaths from
heroin overdose due to the restriction of the availability of prescription
opiates with absolutely no attempt to provide any alternative to those
dependent upon prescription opiates other than turning to heroin.

Dependence is simply a fact of opiate use. It's not evil. And it's not
intractable. It CAN be dealt with by doctors, if they educate themselves
through sources other than lying pharma company reps and avoid the inane moral
stance that a patient should be able to stop taking them suddenly and any
failure to do so is a moral one. Taper their dosage down. Do it over 6 months
or a year if necessary. They're not blowing out their liver or kidneys or
anything, and opiates are among the cheapest drugs there are (the non-
synthetics at least), so there is no reason to hurry and try to force the
patient to bear the discomfort of withdrawal. There is a hidden big problem
behind that, though. It will only really work with patients who do not have
other issues in their life which make stopping the use of opiates untenable.
As we know from animal research, if you put mammals in a restrictive,
unstimulating environment, they will naturally turn to addiction. If put in a
stimulating, pleasant environment, they will avoid addiction and even wean
themselves off automatically... but that requires providing people with a
better life. The simple fact is that many people have terrible lives and
desperately want an escape. I'm not sure what can be done in those
situations... it almost seems immoral to ask them to drop the only thing that
makes them feel good and simply bear their situation because we don't like the
idea the pills are helping them.

------
danschumann
From listening to Jordan Peterson talk about psych, he says if men get
unemployed, they're going to develop depression and chronic pain(and he says
the two are almost one in the same), and then turn to opioids, especially if
they're conscientious.

~~~
timsayshey
I've noticed Jordan Peterson getting mentioned a lot around here lately. Do
you have a link to his lecture on this topic?

~~~
drdeadringer
Not the video, but found the quote:

"Partly what you need to do is decide what your highest value is. It's the
star. What are you aiming for? You can decide. But there are some criteria. It
should be good for you in a way that facilitates your moving forward. Maybe it
should be good for you in a way that's also good for your family, as well as
for the larger community. It should cover the domain of life. There's
constraints on what you should regard as a value, but within those constraints
you have the choice. You have choice. The thing is that people will carry a
heavy load if they get to pick the load. And they think, 'well, I won't carry
any load.' Ok, fine, but then you'll be like the sled dog that has nothing to
pull. You'll get bored. People are pack animals. They need to pull against a
wait. And that's not true for everyone. It's not true for conscientious
people. For the typical person, they'll eat themselves up unless they have a
load. This is why there's such an opiate epidemic among so many dispossessed
white, middle aged, unemployed men in the U.S. They lose their job, and then
they're done. They despise themselves. They develop chronic pain syndromes and
depression. And the chronic pain is treated with opiates. That's what we're
doing. And you should watch when you talk to young men about responsibility.
They're so thrilled about it. It just blows me away. Really?! That's what the
counter-culture is? Grow up and do something useful. Really? I can do that?
Oh, I'm so excited by that idea. No one ever mentioned that before. Rights,
rights, rights, rights. Jesus. It's appalling. People have had enough of that.
And they better have, because it's a non-productive mode of being.
Responsibility, man. That's where the meaning in life is." \--Jordan B
Peterson

~~~
geofft
This seems like something I'd hear from a mediocre pastor, not from an
academic.

------
pascalxus
Where do they get the money to afford all those opoids? Most people with jobs
can barely afford to make ends meat, so how are the growing ranks of
unemployed able to afford that, year after year after year?

Why wouldn't they rather spend the money on things that mattered? like
shelter/rent or food.

~~~
crispyambulance

        > Where do they get the money to afford all those opoids?
    

They can't afford them forever. When the money runs out, they switch to heroin
which is MUCH cheaper than the abused prescription drugs which got them
addicted in the first place.

"Shelter", when someone hits the bottom, consists of a flop-house or couch-
surfing.

~~~
KGIII
I should probably use a throwaway, but I am not scaed.

During the peak of my very long addiction, post retirement, I was spending
$250/day - not counting the habits of friends that I helped to feed.

The only difference between what people call a junkie and myself is that I can
afford it. That's also the reason why I was able to get adequate assistance to
minimize the harmful behaviors. Err... I am on Suboxone, and probably will be
for a very long time. I used for 35 years.

Anyhow, it can be expensive. Users equate use with life. Life always finds a
way.

~~~
wu_tang_chris
The only difference between you and what people call a junkie is people are
being polite to your face. If you're on subs and have used opiates for 35
years, it seems pretty clear to me.

~~~
KGIII
Pretty much. I can afford to maintain an air of functionality. I was a
functional addict, for much of that time. When I sold and retired, I no longer
needed to function. Things escalated quickly.

Nobody calls a guy a junkie, if said guy drives a new BMW and has a big house.

------
cubano
I'd like to turn this around somewhat and find a study that shows just how
many "productive", employed citizens are actually using prescribed opioids and
ADD medicines (methamphetamines) that _help_ them to work harder and longer
hours, because my bet is that it would be at least a significant fraction.

My point? Maybe just because someone is taking opioids, people shouldn't
automatically label them as unhireable.

People on suboxone and methadone would test positive for opioids as well...are
these people also considered unhireable?

------
gscott
With the offshoring of manufacturing jobs men with nothing to do end up taking
drugs. In poor areas drug use is very common, so it is easy to eventually give
in and try it, then you are hooked the first time and can't stop.

~~~
josefresco
That's, not how addiction works. Also, drug use is common ... everywhere. Rich
people can afford to hide their drug use, and can also afford legal protection
if they are caught.

~~~
gscott
So people don't get addicted because they have nothing better to do? I lived
in Lakeside California where so many people are addicted to meth, it is crazy.
If there was manufacturing people would have something to do, have something
to look forward to, an idea of a future and stay off drugs. Not everyone can
do white collar work and not everyone wants to work in fast food or 7/11\. The
outsourcing of work an average everyday person does leads to ideas of no
future, which leads to boredom & self-pity, which leads to drug use. For $10
you can get high, be happy and not worry about a thing. That high solves all
problems. Then the person just thinks about their next high and how to get it.

~~~
igravious
You misunderstand. It's not one hit and you're hooked.

~~~
themaninthedark
Does it matter if it is one hit and you are hooked or five hits and you are
hooked? The end result is that we still have people addicted because of how
good it makes them feel about their shitty circumstances.

------
BurningFrog
The book to read about the opioid crisis is Dreamland by Sam Quinones.

It is really well written and researched and lays out the several separate
events and trends that converged to make this perfect storm happen when and
where it did:

[https://www.amazon.com/Dreamland-True-Americas-Opiate-
Epidem...](https://www.amazon.com/Dreamland-True-Americas-Opiate-
Epidemic/dp/1620402521)

------
lsc
Interesting, because yeah, I think people who fall out of the workforce should
often be considered a social or psychological problem rather than an economic
problem.

You are 'unemployed' if you have looked for work in the last month. I'm only
exaggerating a little when I say I haven't gone more than a month without
looking for work... ever, past the age of fourteen or so. Even when I was
happy with my current gig.

You are a 'discouraged worker' if you've looked for work in the last year.
Year. A lot changes in a year. I personally do my best to interview at all of
the top-tier silicon valley companies every year, because there's a lot of
randomness in interviews, and I'm not completely unqualified, and getting a
fte job at, say, netflix would net me a lot more than what I get as a
contractor now, so I roll the dice. I can't imagine spending a year without
looking for work.

I mean, I'm not saying these people shouldn't be helped; it's just that if you
want to work, but you think there are no jobs for you, the rational thing to
do is to re-evaluate that belief periodically. My own perception is that
demand for my own labor varies sharply, opportunities come and go in a very
short period of time. If you find logging into dice and sending some emails
once a month too difficult, you have some other problem; I'm no shrink, but it
sounds like depression to me.... Which is actually reasonably treatable these
days; really, getting you treatment for depression so you can get a job is
probably an incredibly good return on my social-services tax dollar.

------
EternalData
There's been a lot of work done on the effects of long-term unemployment --
I'd wager that a lack of purpose drives opioid use rather than the other way
around...

~~~
cprayingmantis
It works both directions. I'll give you a pretty common example for my neck of
the woods. A good friend of mine worked in a machine shop and had a great job
for rural America ran his own small lawn-care business on his days off. One
day he hurt his back bad, he didn't have time or money for physical therapy
(who else would pay the bills) which would've probably been best instead the
doctor prescribed opioids and insurance paid. So he went for a few months and
it got worse, which was probably just him building up a tolerance, rinse and
repeat a few times and he was a fully burned out addict. Couldn't hold his job
because of how fried he was.

This isn't an isolated incident it's an all too common pattern I've seen. The
cycle works: you go to work and work as hard as you can, you get hurt, you
can't afford the best care option, you take the cheaper meds so you can
continue working, tolerance builds up, you can't perform, then you're let go.
In the end you're left broke, hurting, unemployed, and addicted.

------
bandrami
The rest of the world manages to get by on the 15% of the world's opioid
supply that's left after the US uses 85%.

Opioids have never been found effective at managing chronic pain.

------
bitL
Wow, didn't know that 1/5 of US guys IDGAFed on society. Must be quite hostile
society to men when they can't find anything keeping them interested. I think
that's close to rates in Soviet Union after collapse.

~~~
bagacrap
Male participation didn't drop by 20%. Rather, 20% of the drop that has been
experienced might be linked to opioids.

~~~
bitL
Ah OK, got it. How big was the overall drop? I assume a lot less than 20%.

~~~
wnissen
The overall drop was from 66% of the population to 63% in the last 15 years.
But really the drop was from 2007-2014.
[https://data.bls.gov/timeseries/LNS11300061](https://data.bls.gov/timeseries/LNS11300061)
Basically an entire major metro area of people who would have worked but
don't. The fraction of people on Social Security Disability is only up by 1%,
so the other 2/3rds aren't bringing in money. Another way of looking at it is
to say that in 2000 only 8% of "prime working age" males didn't have a job. By
2014 it was 11%. A relative increase of more than a third in less than a
generation.

The other interesting thing is that women's labor participation is also down.
There was pretty much an unbroken increase going back to the 50s, and then
around 2000 it started to drop. The thing is, the drop in percentage points
(the total number of non-working people) is about the same for men and for
women, as far as I can see. So I don't understand where the idea comes from
that it's men who are getting hit particularly hard.

------
emodendroket
I heard them talking about this on the radio and they were talking about how,
supposedly, one of their problems is young people would rather become drug
dealers than work in the factories because it pays so much better. But if that
is really true (nothing was offered as proof except a factory manager's
assertion, so it seems kind of dubious to me) it seems like the obvious
solution is to pay more so that isn't the case.

~~~
bjd2385
Most factories in my area will start you off at less than $14/hr. Granted it's
full time, but that's roughly less than $20k/yr after taxes, which is hardly
enough to live on, let alone raise a family on. I worked for 6 months putting
rolls of tape in a box for a smidgen over $10/hr. And at the end I walked out
the door because there were no prospects of moving up.

Most of the people I know have (single?) parents who are in the same boat,
making it almost impossible to move out on their own. Plus, you need reliable
transportation, and vehicles are expensive. For someone just getting out of
high school it's likely not an option.

Basically what I'm saying is, there are a lot of barriers that any employer
would need to help overcome (wage being perhaps the biggest part) before you
see any changes in this sector of society.

No kid my age wants to be a drug dealer. I don't care who you are or how poor
your home life was. I would much rather go to work, get a loan for a half-
decent (or even somewhat nice) vehicle that'll last me a decade if I take care
of it, have my own apartment so I can have a few friends or my girlfriend
over, etc.

I wouldn't say my generation is lazy. I just don't think factories or
employers in general should require stable state of mind or hard work without
paying enough to really make a difference in someone's life, i.e. enough to
support a stable, independent way of life.

~~~
emodendroket
I am perhaps not making it explicit, but that is more or less what I wanted to
say.

------
pasbesoin
Or, the _dropping of_ American men from the labor force (i.e. not by their
choice nor volition) could explain x% of opiod use...

Actually, this seems to be borne out be reporting of newer surveys and
studies. Those in stable employment and social settings are less vulnerable to
addiction. Even when they "experiment"; they have more reasons not to chase
the experience down the rabbit hole.

I've heard this specifically from several recent sources of reporting.
Different shows and segments, largely on public radio.

That's not to mention the growing media and public re-evaluation of addiction
and its causes, treatments, remediations, and possible solutions -- alongside
comparison with the increasingly obviously counter-productive _and expensive_
"tough on crime" practices with respect to it -- now taking place in the U.S.

------
pow_pp_-1_v
I just don't understand why politicians don't take this seriously[1]. A smart
and savvy politician could build presidency reaching career if they spent time
talking about this and trying to find solutions.

[1] I could be wrong.

------
s73ver_
I'm sure it's both A and B. If you're one of the people that have been left
behind in the economy, drugs look awfully good.

------
Mikeb85
Pretty sure the drop in the labour force is the cause, and the opioid use the
result.

------
RealityNow
What's causing the opioid use? I'd imagine the causation goes both ways.

Has anybody actually asked these people why they use opioids? Or is it just
economists running statistical regressions from their ivory towers?

------
brandonmenc
My hometown - located on the edge of the rust belt - is in the midst of a
national news-making opioid and heroin epidemic.

Anecdotally, I believe the converse is true.

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hueving
Where does the other 80% come from?

~~~
d--b
Don't know if that's true or not, but some people blame video games...

~~~
Clubber
If it were the 80s, they would blame heavy metal.

~~~
dv_dt
Don't forget D&D as well as Devil worship...

I wonder if "opioid addict" will replace the "welfare queen" stereotype for
blame-the-victim-and-gov't memes.

~~~
azernik
Opioid addicts tend to be white, so they seem to be getting more sympathy and
less blame in the memeosphere than black drug addicts and welfare dependents
did in the 80s.

~~~
Clubber
Ya but just barely. Based on deaths, blacks make up about 10% while the black
population is 12%.

[http://www.kff.org/other/state-indicator/opioid-overdose-
dea...](http://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-
raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D)

The biggest problem with the 80s is the same problem we have now, Americans
are easily scared shitless about every damn thing and the news just fuels it.
In the 80's it was crack epidemic, devil worship and super predators. In the
90s, it was ecstasy and raves. In the 2000s it was meth, terrorism and trailer
parks. Today it's opioids and ISIS.

As a country, we do irrational things because we always have an irrational
fear. Who plants that fear? News.

Did you know we turned away boatloads of Jews during the holocaust because we
were afraid German spies would be on the ships?

[https://www.theatlantic.com/politics/archive/2017/01/jewish-...](https://www.theatlantic.com/politics/archive/2017/01/jewish-
refugees-in-the-us/514742/)

Remember Ebola? Zika? Anthrax? That scared the shit out of everyone and it
ended up being a whole lot of not much.

When FDR said, "The only thing we have to fear is fear itself," he knew how
afraid Americans are.

------
mycosis
Funny how we've been protecting poppy fields in Afghanistan for 15 years.
Probably just a coincidence.

~~~
pizza
Oh honey America's role in Afghan poppy industry goes so much further back
than 15 years ago. America built a dam in Afghanistan in the 1950s. The dam
changed the soil conditions and what could grow in the region. It was found
that opium would grow well in the conditions, which meant that people would
grow it to provide food for their families. Then the Taliban started
controlling the trade, and profited tidily, and expanded it significantly.
Destroying the opium trade would likely just add to the misery, by now.

[http://articles.baltimoresun.com/1997-03-29/news/1997088009_...](http://articles.baltimoresun.com/1997-03-29/news/1997088009_1_opium-
poppy-helmand-river)

------
micheljones
The white male privilege.

------
realitymensa
There are a lot of assumptions at work here, (pardon the pun) the main basis
of this ASSumption is based on invalid surveys, conducted online without any
verification and or face to face interviews which are done in any valid
scientific determination. Much like the flawed polls of the 2016 election
cycle which proved to be problematic for the political predictions of the
political process we now see a illogical jump to conclusions not found in
valid scientific evidentiary procedures. Quote, "In the Paper published by
Alan B Kruger he states that the focus of the paper is focus on the role of
pain and pain medication in the lives of prime age men who are not in the
labor force and prime age women who are not in the labor force and not
primarily taking care of household responsibilities, because these groups
express the greatest degree of distress and dissatisfaction with their lives.
"

According to the paper, what follows is apparently what constitutes science
these days.

To better understand the role of pain and pain medication in the life of prime
age men who are neither working nor looking for work, I conducted a short
online panel survey of 571 NLF prime men age 25-54 using an internet panel
provided by Survey Sampling Inc, henceforth called the Princeton Pain Survey
(PPS).20

That did an online survey of 571 persons and somehow they believe that this is
real evidence?

Additionally they state that

Thus, on any given day, 31 percent of NLF prime age men take pain medication,
most likely an opioid-based medication. And these figures likely understate
the actual proportion of men taking prescription pain medication given the
stigma and legal risk associated with reporting taking narcotics.

Consider the statement contained in the quote above.

most likely an opioid-based medication.

Now excuse me but the word most likely does not belong in any kind of
scientific document.

Using an online form to gain information and then publish it as if it were
valid is just ridiculous.

I cannot begin to understand why a “Real Study” was not conducted.

This paper while well meaning is in effect meaningless because of the lack of
proper scientific investigation and procedures.

Additionally the number of Men surveyed, is in itself not a sufficient number
to accurately predict any type of medical evidence of prescription drug use as
a mediator for the so called, Opioid Crisis. In effect what has happened here
is that there has been no scientific distinction between deaths associated
with multiple drug use and prescription pain medication use. Even The CDC
admits that they did not separate prescription drug deaths from illegal IV
drug use, (Heroin) There is a need to call this what it is.

You can never expect to solve a problem when you are not willing to address
what the problem actually is.

The problem is multiple illegal drug use involving IV Heroin, street drugs
where the contents of those drugs is unknown.

Alcohol use along with multiple drug use most often is the common denominator
for drug overdose deaths. How can anyone be expected to take this kind of
nonsense seriously when the body of science as a whole "lumps" all conditions
and all manner of drug induced deaths together and then "Label" it as a
Crisis.

This is simply the War on Drugs 2.0

------
Zaskoda
correlation != causation

------
ikeboy
Title is somewhat confusing at first - it's saying that it explains 20% _of
the drop_ , not that it explains a drop of 20%.

~~~
sctb
Thanks, we added a "Could" and a "the" to help clarify.

------
eighthnate
Drug use is a symptom of lack of opportunities rather than the cause.

American men are using opioids because of the war on men waged by the elite
and business elite.

When women are favored for jobs while men are being discriminated against and
can't get jobs, then they turn to drugs.

Drug use is a result of lack of opportunities, it doesn't cause the lack of
opportunities.

Look at what happened to china in the 1800s with their opium crisis when their
society was attack by european powers.

Look at what happened to russia in the 1990s when lack of opportunities cause
their male population to resort to drugs and alcohol.

This is a problem caused by bloomberg and the media.

When men are systematically disadvantaged in job prospects, when men are
attacked as rapists in college campus and when the media wages a war against
men in america, you can't offload the blame to "opioids".

The problem in america isn't opioids. It's the media and the elite.

~~~
passivepinetree
Are you seriously suggesting that the decline of the acceptance of rape or the
increasing awareness of discrimination against women in America is causing men
to use opioids?

~~~
dallashoxton
To me, he's suggesting that the prevalence of general anti-men sentiment
within the culture at large is partly responsible for men dropping out of
society. College campuses declaring that all men are rapists until proven
otherwise is symptomatic of that culture.

------
miguelrochefort
Europe handles pain management a lot better than America...

------
tabeth
What I've never understood is why anyone does opiates to begin with, under any
circumstances. Why even try it? I feel in the media _everywhere_ it is said
how terrible it is.

~~~
garethsprice
Even though you don't drink, imagine you get into a minor accident on the way
home from work today. You seem alright but your knee hurts the next morning,
so you go to the doctor just to get it checked out. There's a strong chance
that in the event of a minor injury you'd be (over-)prescribed oxycontin,
percocet or another opiate. Doctors have been handing them out like candy in
the US thanks to heavy promotion by pharma companies & pressure to get
patients processed as quickly as possible (easier to give pills than really
get to know a patient). The doctor says it's safe and it's a medical
prescription so it's fine, right.

Your pain is gone and you're able to function normally. After a few weeks your
supply runs out and the doctor refuses to renew your prescription despite your
injury still causing you pain. The doctor provides no after-care or advice to
avoid addiction, writes on your chart that you've exhibited "drug seeking
behavior" and tells you to leave.

Your buddy says he has a friend, who hooks you up with a few Oxies (at least
you think they're Oxy, the writing is in Chinese), and you're back to feeling
"normal" again. After a while you run out of money, but your friend can supply
you heroin at a lower price. Congrats you're a junkie, despite being a tee-
totaler just a few months before.

Kinda condensed and I'm sure many people on HN will say "but that wouldn't be
me". But it is the slope for many, many people in this country.

~~~
syshum
WOW there is a lot of incorrect crap in your comment.

Yes the US proscribes opiate based pain killers at a higher level then
Socialized Medicine nations, mainly because American Patients do not accept
the "live with the pain" treatment you get from Government run care where they
refuse to provide pain killers unless you are screaming in pain, and even then
they give you a Advil and tell you to "suck it up butter cup"

Screw that.

There are all kinds of people that cant not get the medication they have a
legitimate medical need for because the these new crack downs on Opiate based
pain killers, now these people are having to live with chronic pain because
the doctor fear being sent to prison by the DEA, because the DEA knows more
about medicine than a doctor does clearly

In your Hypothetical from Prescription to Heroin you blame the doctor, I blame
the DEA. The artificial limits and constraints the DEA is placing on medical
professionals is interfering with patient care, and causing some patients to
turn on street drugs instead of proper medication

Contrary to what the DEA thinks, combating Drug abuse is not a police matter,
it is a medical matter and should be left in the hand of medical doctors not
the legal system

~~~
DanBC
You've made a few mistakes in this post.

The first, and perhaps most important, is that you think opioids are a
suitable treatment for long term pain. They aren't. There is little evidence
of efficacy of opioids for treatment of long term pain. Your suggestion - that
we treat pain using opioids - i) doesn't treat pain, and ii) creates addicts.

More information here: [https://www.fpm.ac.uk/faculty-of-pain-
medicine/opioids-aware](https://www.fpm.ac.uk/faculty-of-pain-
medicine/opioids-aware)

> "live with the pain" treatment you get from Government run care where they
> refuse to provide pain killers unless you are screaming in pain

Quite clearly nonsense.

> The artificial limits

No, these are evidence based restrictions.

~~~
syshum
Umm, Number 1 in your link contradicts number 2, first they claim it is not
helpful for long term relief, then go on to say it is helpful for long term
relief.

Further in typical UK practice they claim it is not helpful but offer no
alternative treatments, claiming it should be discontinued even if there are
no alternative.

basically what I said "Suck it up buttercup" but they state it in a more PC
and nanny government terminology

>Quite clearly nonsense.

hmmm

[http://www.nhs.uk/Livewell/Pain/Pages/Longtermpain.aspx](http://www.nhs.uk/Livewell/Pain/Pages/Longtermpain.aspx)

"You may also be referred for complementary therapy to see if that helps with
the pain. You should be offered advice on how to better manage your pain on a
day-to-day basis, such as by using self-help techniques."

Again, No pain Killer, just walk it off or deal with it. That is the UK policy
on long term chronic Pain. Suck it up and learn to live with it.

>No, these are evidence based restrictions.

No infact they are not, not in the case of the DEA/US Drug Control Policy
anyway

There is not a single drug control policy in the US that is "evidence based"
most of is not even about the actual drugs, it is about power, control, money,
and about 100 other things but not public safety or drugs

~~~
DanBC
> Further in typical UK practice they claim it is not helpful but offer no
> alternative treatments, claiming it should be discontinued even if there are
> no alternative.

Untrue.

[https://www.nice.org.uk/search?q=pain](https://www.nice.org.uk/search?q=pain)

