
The Poison We Pick - matt4077
https://nymag.com/daily/intelligencer/2018/02/americas-opioid-epidemic.html
======
noahdesu
The first thing I did when I opened this article was search for "rat", and was
happy to see it there. From the comments I saw I had a hunch it might be: I
recently finished a really powerful chapter in the book "Chasing the Scream:
The First and Last Days of the War on Drugs" which describes an experiment
involving rats that ostensibly shows that addiction isn't about the chemical,
but rather it's about the environment and feeling alone.

But that chapter also discussed the broader challenge of escaping the view
point entrenched in a generation that has only known addiction as a direct
result of chemical action. And a huge part of this article, at least the first
half or so I got through, painted this chemical action picture:

"The molecules derived from it have effectively conquered contemporary
America." and it kept going on and on, to describe all the effects in wondrous
terms, which seems to just reinforce what the book I've been reading claims
are already a societal level view points.

I'm by no means qualified to speak about addiction from a public health stand
point, nor do I really understand the pharmacological action of any drugs. But
this book highlights many experiments or studies that indicate our current
thinking is ass backwards, only to have the work squashed and funding ripped
away. Now, I cannot stop but seeing these threads in most content produced
regarding the drug war or opioid crisis. It'd be nice to know for sure, but it
has become very difficult to even entertain the bullshit that politicians are
still peddling w.r.t. to the drug war and realistic solutions.

~~~
foxbarrington
In addition to rat park[0], there's also been an amazing study wrt to Viet Nam
vets[1]. Only 5% of soldiers relapsed to heroin use in the first year of
returning home. Compared to a traditional 90% relapse rate when addicts
treated in the US return to their homes.

[0]
[https://en.wikipedia.org/wiki/Rat_Park](https://en.wikipedia.org/wiki/Rat_Park)

[1] [https://www.npr.org/sections/health-
shots/2015/01/05/3718949...](https://www.npr.org/sections/health-
shots/2015/01/05/371894919/what-heroin-addiction-tells-us-about-changing-bad-
habits)

~~~
andrewjl
I find the rat park experiment intriguing, but have there been any further
studies or attempts to replicate the results?

~~~
emiliobumachar
From [http://slatestarcodex.com/2017/10/25/against-rat-
park/](http://slatestarcodex.com/2017/10/25/against-rat-park/), slightly
paraphrased to disambiguate the references. I do highly recommend this blog
post if you're interested in the topic.

"Two studies (1, 2) tried and failed to replicate the results. Another two (3,
4) tried and mostly succeeded. There’s some concern that the rat strain
involved might have various substrains that the different experiments didn’t
control for. But a result that can’t survive a change in rat substrains has
pretty dismal prospects for applicability to humans."

[1] [http://sci-hub.io/10.2466/pr0.1996.78.2.391](http://sci-
hub.io/10.2466/pr0.1996.78.2.391)

[2]
[https://www.ncbi.nlm.nih.gov/pubmed/2616610](https://www.ncbi.nlm.nih.gov/pubmed/2616610)

[3]
[https://www.ncbi.nlm.nih.gov/pubmed/3696469](https://www.ncbi.nlm.nih.gov/pubmed/3696469)

[4]
[https://www.ncbi.nlm.nih.gov/pubmed/18463628](https://www.ncbi.nlm.nih.gov/pubmed/18463628)

~~~
andrewjl
Exactly what I was looking for, thanks!

------
sgentle
Rather than place the blame on a lack of structure, community or spirituality,
I see this as just a natural consequence of a system optimised at every turn
for economic output.

I've heard a lot about a singularity doomsday scenario where a paperclip-
maximising AI realises people are much less useful as paperclip constructors
than they are as paperclip ingredients. Surely it can't be so hard to see that
the productivity-maximising AI that we've cobbled together out of economic
rather than electromechanical components is slowly realising it doesn't need
us anymore either?

The truth is the economy soon won't have any use for poor whites other than
consuming the output of rich whites. The last bastions of unskilled and semi-
skilled labour are being automated or sent overseas (to be automated there).
I'm really curious to see what America's 3.5 million truck drivers do when
they lose their jobs over the next ten years. I guess we'll teach them to
code?

But don't feel too sorry for them; the rising tide of productivity caught poor
blacks before that, and all the hamster-wheeling busywork of the middle class
is up next. Managers and decision-makers will stay above it right up until
they realise abstraction cuts both ways. It'll just be the quants at the end,
tweaking the last few parameters and getting the lights on the way out.

I think most of the world at least tries to keep the economic AI from being in
charge of everything. It's hard because it keeps buying our politicians, but
even so there's a sense that it should be serving our values, not the other
way around. We might work with it, respect it even, but we don't trust it.

The USA is pretty strange in this sense, because somewhere along the line a
huge chunk of the population got convinced that if they just leave everything
to the paperclip AI it'll take care of them. And, for a time, it will, and the
people who work hard to make paperclips get rewarded, and the people who start
paperclip factories get rewarded more still. But, inevitably, you're not a
paperclip, and your value is incidental in this system.

Faced with that, then, your only options are to find a system where people
have value independent of their productivity, make being valueless palatable,
or just go die quietly somewhere. It's probably not so surprising that, in the
absence of the former option, the latter two are becoming increasingly
popular.

And, I guess, not so surprising that the paperclip worshippers are
particularly unconcerned with mental health and sensible drug policy. Still
pretty gross though.

~~~
panarky
The global economy already produces enough for every man, woman and child.

The surplus increases every year.

Every year, fewer and fewer people need to work full-time in mind-numbingly
boring jobs to produce what the population needs.

So why do we keep up the fiction that everyone needs to waste their lives
doing unnecessary work?

It's time to imagine how we could achieve a post-work society where more
people could realize their potential, instead of being tied down to
meaningless, mindless and unnecessary drudgery.

~~~
andrewjl
Easy answer, the narrative embedded into our worldview (and in the worldview
of many if not most decision makers) is that without work and the kind of
structure it brings, people cannot be functional members of society. It plays
itself out both externally and internally.

~~~
ryandrake
I’m reminded of Ursula Le Guin: “We live in capitalism, its power seems
inescapable – but then, so did the divine right of kings. Any human power can
be resisted and changed by human beings.“

------
dmreedy
I've been talking with my brother a lot about this recently, especially as a
function of the overall decrease of 'meaning' in the world. I think it goes
back even further, to the advent of postmodernism in the throes of World War
I. They were the first lost generation, but I don't think they were the last.
The death of modernism and the accompanying assault on the bastions of
objective meaning (as discussed in the article, Religion, Jingoism, and
Community by way of Tribalism) is in some sense a healthy thing, as
'objective' meaning is too often used as false justification to do battle with
other, contradicting 'objective' meaning. But it hasn't been replaced with
anything. And the intervening years have only weakened it further. Maybe we
had a brief sputter of national identity again with World War II, but the
atomic bomb saw to that, and Vietnam finished the job (in America, at any
rate). And now we're drifting in a world without objectivity. And what do you
work for when the only objective truth is death, and the end of your
accomplishments? Some people seem to be able to answer this question for
themselves, some cannot.

We thought as well that this may be why there are so many people engaged
rabidly in the consumption of fiction these days; it seems to me just as much
a symptom of a broader crisis of meaning as opiods may be. A fictional world
is readily graspable; you can wrap your whole head around the whole thing. And
meaning is easily found in the simplified moral space that these simulations
are often constructed under. It seems to me just as much a salve for the meta-
crisis of meaninglessness as a drug, in some sense.

I don't mean to ascribe any moral right or wrong to any of this; in fact,
that's the whole thrust of it. It's harder and harder to know what moral right
and wrong _are_.

\---

EDIT: it's been pointed out that I should probably be less careless throwing a
word like "objective" around: I mean it only in the sense of mass perceived
objectivity. If a society agrees on it, it's as close to objectivity as we
seem to be able to get. Substitute it for "Societal Consensus", if it pleases
you, but I think the brain treats them as one and the same.

~~~
dnomad
Only a very disingenuous reading of history would lead to the conclusion that
our society is less "objective" than the past.

What has been lost is widespread confidence and faith in those institutions
that previously served as the pillars of society -- the church, the king and
the nobility. Now people are completely on their own for their worldview.
What's become abundantly clear is that people are very, very bad at
constructing useful or reliable models of the world. Left to their own devices
the people will readily embrace all sorts of nonsense, the more extreme the
better. Some will turn to drugs and some will turn to ranting about crisis
actors and some will turn to video games.

None of this is a cause for concern. These people's lives are still orders of
magnitude better than those enjoyed by people just a century ago. A life
wasted playing video games for 12 hours a day still beats one wasted slaving
away for 12 hours a day on the farm.

What is disconcerting is that the "poison" is seeping into the vital and core
institutions and systems that contribute to our extraordinary quality of life.
The author is concerned about the suicide rate (which impressively continues
to break new records every year) but what should really be frightening is the
extraordinary poor governance that Americans have enjoyed for the past 20
years. (Seriously, _trillions_ of dollars flushed down the drain on completely
pointless wars.) When the real engine of American prosperity sputters out we
will have much more significant and difficult problems than a bunch of dumb,
bored kids getting high on dope.

~~~
jimbokun
"A life wasted playing video games for 12 hours a day still beats one wasted
slaving away for 12 hours a day on the farm."

This is not at all self evident, can you back up this statement?

"orders of magnitude"

So people living today are literally 100x or 1000x happier than a century ago?
Again, do you have any basis for this claim? How do you measure it?

~~~
pdonis
_> So people living today are literally 100x or 1000x happier than a century
ago? Again, do you have any basis for this claim? How do you measure it?_

You can't put an exact number to it, but you could argue that in some ways
people living today are infinitely more fortunate than people living a century
ago. I recently got in an airplane and flew 700 miles in two hours to visit my
mother. The richest person in the world a century ago did not have that
option. That's just one of many, many examples.

We could argue about whether having all these new options makes people
"happier". But more options means more people are able to do more things,
which gives more people more ways to figure out how to be happy. Another
example of options that the richest person in the world did not have a century
ago is this very conversation. Presumably we are both getting some
satisfaction out of it, or we wouldn't be here at HN. Nobody living a century
ago had any such option. Multiply that by all of the myriad things that we
have available that people then did not. That huge expansion of possibilities
is basically what the grandparent is talking about.

~~~
ggg9990
People a century ago rarely lived more than ten miles from their mothers.

~~~
pdonis
If that is true (I'm not so sure it is--lots of people emigrated between
countries a century ago, and many of them left their mothers when they did
so), it means that people were drastically reduced in their options, since
they never ventured far from their places of birth. The ability to travel
further in shorter time has greatly expanded those options.

------
chrisgd
I think almost all problems we discuss every day: political divide, millennial
job prospects, student loan debt, drug crises can be traced to wealth
inequality. At it's core, all these problems evolve from unfettered
capitalistic pursuits. The middle man taking their cut of student loans and
having no means to resolve that debt through bakruptcy. No growth jobs that
offer no safety net. For profit schools, prisons and healthcare allowing those
at the top to accumulate wealth by depriving more people of what was once
considered a community benefit. We yell that the other side has it wrong while
owners of gun manufacturers escape any civil liability and providers of
medicare admin routinely overbill, then pay fines less than the wealth
accumulated. Opiates provide an opportunity to escape what seems unescapable.
I am not sure the answer but the framing is continually wrong.

~~~
naeemtee
Singapore has one of the world's highest income inequalities and faces
virtually none of those problems. Distilling it down to "income inequality" is
reductionist, political scapegoating.

~~~
iamcasen
Singapore is also an extremely authoritarian state. Possession of drugs can
get you the death penalty, or state sanctioned torture and beatings.

Kinda apples to oranges when you compare to the US.

~~~
refurb
You can get decades in prison in the US for small-time drug dealing. What has
that accomplished in terms of reducing the drug problem?

~~~
iamcasen
I don't disagree with you. The US has an outrageous drug policy as well.

------
ArcticUnicorn
"It’s been several decades since Daniel Bell wrote The Cultural Contradictions
of Capitalism, but his insights have proven prescient. Ever-more-powerful
market forces actually undermine the foundations of social stability, wreaking
havoc on tradition, religion, and robust civil associations, destroying what
conservatives value the most. They create a less human world. They make us
less happy. They generate pain."

This articulates the feelings/observations I've been mulling over recently.
Also the idea of opiate abusers being a self-selecting group of the "failed"
areas of society was something I hadn't thoroughly considered. Very
interesting. If opiates caused a more distinct rise in violet crime, would
public policy be forced to respond similar to the other drug epidemics?
(Though I might argue that those epidemics were just replaced with this one,
yielding quieter and more easily ignored victims.)

~~~
maratd
> ever-more-powerful market forces actually undermine the foundations of
> social stability, wreaking havoc on tradition, religion, and robust civil
> associations

Is there an actual example of this? I can't think of a single one.

~~~
mistermann
Society splitting into haves and have nots due to technology, globalization,
and a myriad of other things most definitely changes social cohesion. That's
just one example, when (if?)people finally start paying attention there will
be many more obvious effects.

------
pwaivers
> "And so we wait to see what amount of death will be tolerable in America as
> the price of retaining prohibition. Is it 100,000 deaths a year? More? At
> what point does a medical emergency actually provoke a government response
> that takes mass death seriously? Imagine a terror attack that killed over
> 40,000 people. Imagine a new virus that threatened to kill 52,000 Americans
> this year. Wouldn’t any government make it the top priority before any
> other?"

This is a very good point and really puts it into perspective. Overall this is
an excellent essay. I also really like how he addresses the physical affects
of opioids, rather than just saying it gets you "high".

~~~
meri_dian
It's actually a foolish quote. What can the government do in the face of tens
of thousands of people essentially choosing to kill themselves? It could jail
them, but our culture is moving towards one where doing that to drug users is
frowned upon. So what option does it have?

Putting the onus on the government to solve this problem goes against the very
essence of this piece. If social fragmentation is truly the cause of the
opioid crisis, then government intervention will by like putting a mud wall in
front of a raging river.

~~~
Arnt
Do you intend to say that the Scandinavian countries' deliberate policies
against social fragmentation since about 1950 haven't had any effect? Or that
they wouldn't have any effect elsewhere? Or that they don't exist?

~~~
meri_dian
Scandinavian countries don't have social fragmentation on the scale of the US
because they are not the US. Not nearly as diverse, or large. They have much
more history and common ancestry and culture and community. There is very
little of use that can be gained from comparing Scandinavian countries to the
US.

~~~
mattnewton
It’s not clear to me that’s true. What is clear is that I don’t know any US
governments willing to test it, because they think they already know what
addiction is.

~~~
sokoloff
Which parts of GP aren't clearly true? That those countries are smaller, more
homogenous, have much more history and common ancestry and culture and
community than the US, which is often literally called the "melting pot" [of
immigrants from varied backgrounds]?

~~~
mattnewton
Not referring to that (which is true), but referring to the next idea that
being a melting pot precludes social intervention strategies that treat
addiction as a mental health problem instead of a crime, implied by “There is
very little of use that can be gained from comparing Scandinavian countries to
the US”

That I’m not sure is true, in fact I’m pretty sure it’s false.

Edit: I mean, further up the chain we are saying this method is partly
inspired by studying rats! Because Scandinavia has a more homogenous culture
we’re too different to learn anything? But Scandinavia can learn from rats?

------
scottlegrand2
This is bad, really bad, but just wait til our roads are filled with self-
driving trucks and the remaining factories with robots then the fentanyl party
will really begin unfortunately.

It is fantastic that OpenAI is attempting to address the more dire threats of
a rogue AI, but there's a big near term threat already staring us in the face
and seemingly zero leadership here in the United States aware of the crisis
that will arrive in the next decade or so. And what passes for leadership has
absolutely no concrete plan to get us past it.

------
tcj_phx
When I met the friend who taught me about heroin, I figured she was "high as a
kite" because she chattered from topic to topic like a butterfly. She called
back a few days later, and started to invite me into her world. I didn't know
anything about the street pharmacy, except that cannabis had been helpful for
another friend to get her alcohol use under control.

She said she'd relapsed on cocaine because of severe depression, then shortly
later on heroin -- supposedly to treat her high blood pressure (from smoking
cocaine). I think really she was just lonely. A chapter in Gabor Maté's book
is titled _Through a Needle, a Soft, Warm Hug_ [0].

She was going to the methadone clinic daily when we met. If she couldn't get
to the clinic by the 11am closing, she'd have to order heroin from her street
pharmacist. It was almost as if the clinic had contempt for its clients --
their business was to be their clients' legal dealer.

Four months after she'd begun to teach me about her world, I decided she
didn't actually like it that much, and began to express disapproval at her
self-medication strategies. She tried sticking with her old drug world, but
she liked me more than the drugs. At about six months we had a nice time
frying donuts (coconut oil is a treatment for compulsive alcohol use, and
makes for tasty donuts). Two days later she called to say that she "wished
[she] wasn't a drug addict". The next day, "I SHOULD ONLY USE SUBSTANCES WHICH
ARE LEGAL! Alcohol is legal, [tcj_phx]..." (me: doh! progress, I'll take it),
the following day, "I hate methadone, I hate everything about it..."
Essentially what I did was a months-long pace... then lead (hypnotic
technique).

The most important interventions to end the present "opioid epidemic"
(artificial) is to provide a legal supply of clean heroin, safe injection
sites, and protecting addicts from the criminal justice system.

[0]
[https://news.ycombinator.com/item?id=16023802](https://news.ycombinator.com/item?id=16023802)

(Yesterday's post about adoption-trauma is relevant too:
[https://news.ycombinator.com/item?id=16443667](https://news.ycombinator.com/item?id=16443667)
)

------
philipkglass
Sullivan starts out highlighting how America is exceptionally afflicted by
opioid abuse, but goes on to unconvincingly weave a bunch of unexceptional
factors into his explanation.

Smartphones, TV, video games, online porn: they're in every developed country.
They can't be the explanation for what's different about America. Decline of
religiously-derived meaning? Most developed countries' populations place less
importance on religion than Americans. Factory jobs squeezed by automation and
cheap offshore labor? Canadian manufacturers have access to the same robots as
American firms, and Canada has been a member of the World Trade Organization
as long as the US has.

Inter-temporal comparisons also show that it doesn't make sense to blame the
American opioid crisis on the decline of manufacturing jobs. The number of
American manufacturing jobs peaked in the 1970s. "Rust belt" became a common
term in the 1980s. But the opioid crisis is much more recent.

~~~
arprocter
Sullivan is a conservative, gay, catholic, British expat; so his conclusions
come through that lens

------
gt_
At least we are moving past the scape goats and taking a thoughtful,
considerate look at what is actually happening.

I regularly have long conversations about this with my mother, a nurse in
Louisville, KY and steadfast American patriot. She is at a loss of any
explanation these days. I am torn when we talk about it because I know her
pride in our country is a big part of her, but it doesn’t rest with what she
is seeing. Watching her spirit shift into curiosity then skepticism has been
difficult to witness. She wants to blame someone but she no longer believes
that someone is out there.

~~~
jacobush
This sounds like a good development?

~~~
dmreedy
The loss of a source of meaning in life is a dangerous thing, especially if it
isn't replaced by something else. That way lies nihilism, and, if the thesis
of the article is to be believed, opiod addiction.

~~~
the-dude
> That way lies nihilism

Sounds exhausting.

~~~
onychomys
How long have you waited with that username to make that reference? <3

~~~
the-dude
1598 days.

------
thecheops
I was the first to blame the drug companies (they certainly warrant blame) but
there are other factors to consider that are addressed in this article that I
failed to previous realize. Worth the 15-20 minutes to read.

------
JudasGoat
As a Heroin addict that hasn't used in over 5 years, I believe the emptiness
of Materialism was as instrumental in my addiction as the richness of
spirituality has been in my recovery.

------
jdtang13
Really brilliant and well-written article. The analysis of the uniqueness of
American society is really well-done as well. American hyper-individualism,
work ethic, and atomic self-oriented lifestyle leads people to seek their own
meanings, which leads to tremendous suffering when community network is
destroyed and when there's no available work to do.

------
DyslexicAtheist
_> We consume 99 percent of the world’s hydrocodone and 81 percent of its
oxycodone._

this is quite a mouthful and horrid if true. would like to see some sources
for this claim

~~~
paganel
Don't have any sources available, but as an European it's strange how
prevalent opioids are in the States for what are seen as "regular" medical
interventions. I remember having a discussion with a US redditor, telling
him/her that even though I had 3 or 4 teeth extracted during the last 10 or so
years I've never been prescribed opioids (the extractions were done by
different doctors, in different clinics), I've always managed the post-
extraction pains with Nurofen-like drugs and I was quite ok (and I don't think
of myself as a particular "pain-resistant" guy, quite the contrary). There
were other redditors in the same thread (I remember one from Germany) who had
had the same experiences as me. So, all things considered, these numbers don't
surprise me at all.

~~~
PuffinBlue
The NYT actually ran another story on exactly this topic - difference in
European/US approach to pain management, but more from the patients
perspective, it's really good reading too:

[https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-
ge...](https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-
vicodin.html)

Title was: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

It made the top spot on HackerNews too:

[https://news.ycombinator.com/item?id=16252372](https://news.ycombinator.com/item?id=16252372)

------
mikevp
Personally, I just don't "get" the high of opiods. My experience has been
entirely medical -- morphine after surgery, and the usual
vicodin/percocet/whatever pills after injury or tooth extraction.

Different people react to them differently. Some people, like me, they make
physical pain recede, but nothing else. Some people, they make feel groggy or
sick, and they don't like them. (My grandmother was like this -- she disliked
the grogginess from the Brompton's Mixture more than she disliked the pain of
her terminal cancer. She only took it once or twice.)

And some people, one dose and it's "Where have you _BEEN_ all my life!!!!"

An interesting line of research might be -- why the difference in reaction to
opiods? Why do some people get the "WOW! I _LIKE_ that!!" reaction, while
others don't?

------
jatsign
Loved the way the article was written. I read a lot of long-form articles and
have a few favorite writers. Is anyone aware of a service that will track
individual writers and give an alert when they post something new? Sort of
like an RSS feed for an individual writer, regardless of where their new
article is posted.

~~~
maxerickson
Twitter.

No, I'm serious.

If you don't want the tweets, just filter links out of tweets. But the part
where writers promote themselves on Twitter is true enough.

~~~
jatsign
Not a bad idea, but the first writer I checked, Dexter Filkins, doesn't seem
to use it. :\

The most reliable method might be to grab RSS feeds from a lot of online
magazines like the New Yorker and parse the Author field. But that'd be a lot
of manual work since the feeds change format sometimes...

------
lewis500
This whole piece is a good example of how fine writing can hoodwink you.
Garbage analysis from start to finish.

"Unlike in Europe, where cities and towns existed long before
industrialization, much of America’s heartland has no remaining preindustrial
history, given the destruction of Native American societies. The gutting of
that industrial backbone — especially as globalization intensified in a
country where market forces are least restrained — has been not just an
economic fact but a cultural, even spiritual devastation."

From time immemorial, people---especially cultural critics and journalists---
have blamed social phenomena on culture, the era's degradation, political
changes or something else they are interested in anyway. It flatters you for
your command of politics and history: turns out all that stuff you read about
because it interests you is actually solidly causative in explaining something
important. What a nice coincidence.

I am pretty sure that when the history of this era is written by real social
scientists, what they will decide is much more technical and boring...having
little to do with the topics that capture our attention for other reasons
(manufacturing jobs and trump's election in this case). For example: a bunch
of new opioids had been invented, which insurance paid for and doctors
prescribed. Large amounts of heroin were available at low prices from
increasingly competent and seamless sellers. In what world would these
phenomena take place and the amount of addiction not increase?

I used to live in England. There is not as much of a crisis there although
there is plenty of economic hardship, loss of manufacturing jobs, etc. The
difference is that the NHS won't pay for everybody to load up on a thousand
pills, and England is an island where you can't easily smuggle in tons of
heroin.

Sometimes the article really veers into the absurd. Consider this passage:

"A huge boom was kick-started by the Civil War, when many states cultivated
poppies in order to treat not only the excruciating pain of horrific injuries
but endemic dysentery. Booth notes that 10 million opium pills and 2 million
ounces of opiates in powder or tinctures were distributed by Union forces.
Subsequently, vast numbers of veterans became addicted — the condition became
known as “Soldier’s Disease” — and their high became more intense with the
developments of morphine and the hypodermic needle. They were joined by
millions of wives, sisters, and mothers who, consumed by postwar grief, sought
refuge in the obliviating joy that opiates offered."

Right here Sullivan offers a total explanation for why everyone got addicted
to painkillers: the government was literally manufacturing them and giving
them in massive quantities. But that's not literary enough, so he turns around
and fabricates something out of whole cloth:

"the epidemic of the late 1860s and 1870s was probably more widespread, if far
less intense, than today’s — a response to the way in which the war tore up
settled ways of life, as industrialization transformed the landscape, and as
huge social change generated acute emotional distress. This aspect of the
epidemic — as a response to mass social and cultural dislocation — was also
clear among the working classes in the earlier part of the 19th century in
Britain. As small armies of human beings were lured from their accustomed
rural environments, with traditions and seasons and community, and thrown into
vast new industrialized cities, the psychic stress gave opium an allure not
even alcohol could match."

Ah so it was the "psychic stress" of industrialization. So losing
manufacturing jobs causes addiction, but also so does gaining them.
Interesting that manufacturing jobs are such a powerful explanation in an era
when our president is constantly banging on about manufacturing jobs. Suppose
we hadn't industrialized at that time; I'm pretty sure people still would have
gotten addicted given how many free opiates they were getting. In that case
Sullivan probably would have said, "The rural isolation of Americans...the
soul-crushing vicissitudes of farming born alone...caused Amercians to take
refuge in opiates."

Also worth remembering Andrew Sullivan is serially wrong.

~~~
refurb
I took the same thing away. Basically taking the preconceived notion that
capitalism is bad and using poetic writing to tie every social ill back to it.

I hope that people don't look to this article as a serious review of history.

------
microcolonel
I read this article the other day, and it presents a convincing possible
avenue for explaining the current uptick in opioid abuse.

[https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-
you-...](https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-you-screw-
next-meth-back-12574)

------
Angostura
Well written and insightful, thank you. Useful fodder as I answer my kids'
questions about drugs.

~~~
shaki-dora
This article, especially the end, is actually more about the fundamental ills
of American society, rather than just drugs.

It’s about the breakdown of the social glue in the face of relentless market
pressure and individualism, and the diminish end of trust and solidarity,
along with institutions like organized religion, unions,families, or even
sports clubs.

------
bandrami
Unfortunately Sullivan ignores one huge factor: the deliberate and deceitful
marketing of opioids to doctors by pharma companies as effective and safe for
chronic pain management despite the fact that studies have repeatedly failed
to show it is either.

------
filipsch
> It is a story of how the most ancient painkiller known to humanity has
> emerged to numb the agonies of the world’s most highly evolved liberal
> democracy.

Pretty strong statement

------
rl3
As an aside, the cover illustration would serve as perfect art for a proper
_Cannon Fodder_ remake.

------
diogenescynic
Considering how overpopulated the planet is, this is probably a necessary
evil.

------
meri_dian
There is sadness in every corner of the world, but that only overlaps with
opiate availability in certain places.

In America, like every nation, there is sadness. However in America, unlike
many other nations, we have widespread opiate availability.

This combinations leads to opiate deaths on the scale we see. It's not
complex.

What is the answer? China knows the evils of opiate addiction, perhaps in the
future, after enough of our own society is ravaged by it we will adopt the
Chinese attitude towards opiates and look back at the naive past as our future
selves tend to do.

~~~
gt_
I think this conclusion is premature. Obviously it’s a hard question but I
will share a few reasons why I hesitate here:

\- The last 2 major drug-use epidemics in the US erupted in communities
afflicted by major financial hardship and growing socioeconomic disparities.
Both were victims of the poppy. I hesitate to discard the correlation.

-I have taken hydrocodone. Personally, I hate it. I can’t think or function, but yeah other than that nothing seems like it matters. For me, it feels deadening, like suicide, the other epidemic that happens to be afflicting the same communities as the opioid epidemic. There is no recorded rise in suicide availability. I hesitate to discard the correlation.

-Although much of the world has been outlawing opioid availability, opioids _are_ available and prescribed throughout. We do not/cannot know how many people would be using opioids if they lacked availability to them but this drug has a nature worth considering, which I think the article gets at very well.

-Let’s say the pharmaceutical cowboys’ are privy to ‘supply and demand’. No we aren’t talking about a fluid market but let’s also say, hypothetically, that not every society in the world is feening to collapse itself for opioid highs. And let’s assume US pharmaceutical suppliers have ways of identifying and responding to demands with supply despite being a regulated industry. I personally find none of these to be even a stretch, and to conclude, I have no problem imagining how it would play out exactly like we have observed.

------
dkural
The article keeps repeating how America is the "most highly evolved liberal
democracy", most advanced / modern country etc. This is simply not true. Many
European countries have free / low cost education, including higher education,
free healthcare where it is rationed by need as opposed to $, maternal and
paternal leave, paid vacations, some have free childcare, access to mental
healthcare, decriminalization of drug addiction accompanied with treatment,
higher gender and social equality, and more importantly, higher social
mobility (since access to education and healthcare is more equal); affordable
and high quality public transportation, and walkable cities. Property tax %s
are lower in most of Europe as well.

Their effective tax rate is lower too, since once you don't need to pay as
much for education and healthcare, your take-home pay is higher. You have
extra time to sleep, spend with your family and friends, or go out for a walk
/ read. Your mind doesn't constantly worry about the future of your children
or healthcare access due to the social net. This means you're more productive
at work and in society.

What's described above is the most evolved liberal democracy. Not the white
collar rat race we got here, where we worship billionaires and tax cuts for
corporations, where it is still a debate if weapons of mass carnage can be
sold to children, where the police force murders its own citizens every day on
the streets, where politicians are bought and sold to the highest bidder, in
the country with the highest incarceration rate in the world.

~~~
tomp
on the other hand, US has been a democracy for by far the longest. Other
European countries pale in comparision, with the possible exception of the UK.

~~~
dkural
If black people don't count, sure.

I would argue that the US has not been a full democracy until Civil Rights.

Jim Crow laws were in effect until 1965. Also, black people could not exercise
their vote, were not allowed to attend university, eat in the same
restaurants, or even sit on the same section of the bus. As far as black
people were concerned, the US was not a democracy.

~~~
Retric
Even then 4 million Americans don't get a vote because they don't live in
states. Residents of DC, Puerto Rico, U.S. Virgin Islands, Guam, Northern
Mariana Islands and American Samoa all get Taxes without representation.

Thus, America is still not an actual Democracy.

~~~
Jesus_Jones
Those people are free to move to the us, free to petition to join as states.
How do you think Hawaii and Alaska did it? I can move to those places. A
better argument might be that poor people are actively disenfranchised by
people they don't politically support.

~~~
Retric
These people live inside the United States. This is not some far off land
these are people living in our nations capital we are talking about. They
simply don't have voting rights due to politics so an area can be part of the
United _States_ but not a _State._

------
ilackarms
all this talk about opioids and no mention of ibogaine

~~~
kylek
Wanted to say this too. Unfortunate. It’s awful that it is illegal (and for
the most part unknown) in the states.

------
mmjaa
The way to treat the opioid crisis is that it is a battlefield, and America is
losing. Drugs have long been seen as a way of usurping the will of ones'
enemies; it is no different now. America has been under pharmacological attack
for decades; its people are too addicted to see that this is by design.

Drugs have weakened America, and that is by design of its enemies.

~~~
sevensor
Which enemies are we talking about here? Are they domestic or foreign? What is
their goal? I see where you're going with this argument, there are certainly
historical precedents, but you haven't said enough to make it plausible.

~~~
odMFJFHBvn2zyR2
From the article, "Fentanyl comes from labs in China".

Also:

The Opium Wars still shape China’s view of the West

[https://www.economist.com/news/christmas-
specials/21732706-b...](https://www.economist.com/news/christmas-
specials/21732706-britain-and-china-see-each-other-through-narcotic-haze-
opium-wars-still-shape)

