Here's the playbook:
1) A.G.s and private lawyers start filing lawsuits.
2) Defendants realized there is potentially catastrophic liability here and start negotiating a master settlement agreement ("MSA") whereby the states agree not to sue in the future in exchange for a set payment schedule to the plaintiffs.
3) States A.G.s realize this is a great publicity opportunity to leverage their career into other elected office and governors realize this a real revenue stream.
4) So, interests aligned and there is a settlement.
5) Lawyers make a TON of money on their fee schedule set forth in the MSA. So much so, the Tobacco MSA lawyers were securitizing their future fees in private markets.
6) Bankers swoop in and start pitching states on the securitization of MSA payments for states to cover current deficit shortfalls.
7) Bankers make a point or two on the securitization deal proceeds ($10s or $100s of millions).
8) States leverage their future payments under the MSA to fill budget gaps where ever possible. Some allocate a small portion of the proceeds to the victims of the malfeasance but many do not because there are better ways to get future votes.
Full disclosure: I was once a young public finance analyst working 80-100 hour weeks building financial models to securitize Tobacco MSA payments...slight grudge still held.
 Tobacco stocks jumped on news of the settlement because a large known liability is much better than an unknown one.
EDIT: slight clarification.
9) The states themselves, as well as a large interest group formed by the purchasers of whatever deals were securitized, are now financially interested in the continued financial health of the malfeasors.
In other words: the opioid producers now have the states and bondholders rooting for them to continue selling opioids.
(In fairness: if the pharmas are not pure plays this will not be as dismal as it was with tobacco. But in the tobacco case, it was pretty clearly laid out that the continued payment streams were secured only by MSA revenues based on continuing cigarette sales. So the states, or the bondholders, were rooting for continued cigarette sales.)
And to think of the bonds that will come from this that will be tied to tax revenue from such products that will probably decline as patients and doctors avoid using them, probably a way to get exposure to short positions on those as well.
Instead, I found a new perspective that helped me to see that this isn't about opiate abuse at all. It's about cashing checks.
This is why CU undermines Democracy.
Yes, and that's why you prefer perfect ;).
> Isn't pharma losing some of their ill gotten profits better than them losing one?
The problem here is that when such a thing occurs again and again, people start to treat it as a business model. Punishments are meant to deter, by giving only a slap on the wrist and calling it sufficient punishment, they'll be further legitimizing the whole strategy as a viable business model.
- User switches to heroin or some other generic opiate because it's too hard to get a legal prescription and dies.
- User mixes drug with alcohol or benzodiazepines and dies.
- User dies from APAP poisoning, which the government requires to be added.
There might be 50,000 opiate-related deaths per year or whatever, but the actual number of accidental opiate ODs on solely OxyContin is no more than the number of deaths from Tylenol or Ibuprofen.
The Supreme Court already ruled that drug manufacturers can't be held responsible for the safety of generics. So even if Purdue is held entirely responsible for the rise in opiate addiction, there are enough mitigating factors in terms of the actual harms of addiction that I think it will be hard to see a tobacco-style settlement.
The basic issue is that even if they purposely got millions of Americans addicted to opiates, being addicted to opiates isn't especially dangerous or harmful in and of itself. If most of the harms come from unrelated government policies then there's only so much damages you can pin on the Pharma companies.
However, you paint the whole thing as a corrupt failure. Hasn't smoking use dropped dramatically? Sure, lots of people got paid/power along the way, but we did make a large dent in the problem.
This would of course have immediately bankrupted every tobacco company.
This pretty much obligated the states to transfer their interests to investors of the securitizations in order to reduce the obvious conflict of interest.
I'm sure there were some good aspects of the MSA that I failed to mention. The restrictions on marketing is one that comes to mind without a lot of thought.
I think the biggest problem (that I remember) was money getting allocated to pay for things other than programs to help the original victims.
It would be politically hard to oppose the arrangement without looking pro-Tobacco, or at least without getting smeared that way by the beneficiaries...
I'm just spitballing here, but the fact is that until we meet some other similarly advanced species and get to know their psychology, we can but theorize.
This is just as dangerous as terrorists or any other think that goes bump in the night - it will destroy this country if not stopped.
Not sure what the solution is but this looks to be a good start to push for controls needed.
This is a fallacy. In the case of terrorism "past performance is not an indicator of future results".
An attack with e.g. a biological weapon could cause, on a single day, 1000x the cumulative number of deaths we had over the past decade.
There is no possibility of the number of crush deaths from vending machines rising like that.
Perhaps. But it's virtually a certainty that opioid overdoses will kill tens of thousands of people in the US this year. (The most reliable recent figure I can find was ~30k in 2015.) Meanwhile, a terrorist attack in the US that kills hundreds of people -- let alone tens of thousands -- is a relatively low-probability event...
Not saying we shouldn't do anything about this drug epidemic but your comparison is fundamentally unsound.
Moreover, addiction is fundamentally a disease which acts upon the sufferer's ability to make free, rational decisions. In a very real sense, the addiction itself is "infringing on the freedom" of the addict, even if it hasn't killed them yet.
No, the point of the lawsuit is that they don't (or didn't). The article makes that clear through quotes such as: "We believe that the evidence will show that these pharmaceutical companies purposely misled doctors about the dangers connected with pain meds that they produced."
> Nobody cares about smokers getting addicted although they do care about public smoking because it infringes on their right to clean air.
Public smoking is a focus of conversation today, but the analogous 1990s big tobacco lawsuits centered on the medical costs of treating smokers. See wikipedia: https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agre...
Apart from writing difference of books and publishing hundreds of papers on the subject (see Nassim Talib), the tl;dr is economists and sociologists still really have no way of truly accounting for them besides being cognizant of their existence.
A true black swan is something that's basically inconceivable before it occurs. It is outside the mental model used to evaluate outcome probabilities. Black swan events include things like:
---Your enemy in a war invents the nuclear bomb and drops it on your cities (this happened to Japan in 1945)
---You are a turkey. The farmer comes, as he does every day. Instead of feeding you, he slaughters you (something which you've got no experience or conception of).
---It's 1994 and you own Blockbuster Video, a solid earning company. Then someone invents the Internet...
Biological warfare attacks are quite well-known as a concept, making them gray swans. Also in the gray swan category are asteroid strikes, supervolcanoes, etc etc.
I try to spread this distinction because if we start calling gray swans black swans, that will hide from us the most important part of Taleb's argument, which is that true black swans are the most important events. The idea of the black swan is hard to keep in your mind (how do you keep in mind the inconceivable?) so it's very easy for a pretender concept to sneak in and steal the label.
Good to know!
It was also well-known that U.S. is the world leading scientific and industrial power, that it absorbed huge number of well-educated Jews fleeing Nazis, and it was least affected by ongoing WWII of all major powers.
So if anyone was to make a bomb it was U.S., every rational actor should have expected it to happen. Only 'if' was timing.
Wormholes, for example, have been theorized for decades. Nevertheless, "The earth is about to fall into a wormhole and end up in another dimension" would probably fall into the category of black-swan events.
This was known before it was dropped on a city. The Trinity test happened about three weeks prior to dropping the first bomb on Japan. The second bomb was dropped with full knowledge of the potential casualties after the devastation of the first.
We Americans always justify these bombs, but really, there is no justification.
So you'd have volunteered to be the first wave on the beach?
The best explanation for why the US wanted to have a swift end to the war with Japan was to deny the USSR the option of dividing Japan like was Germany.
There is no good way to justify killing civilians during the war, and it's impossible to say what would have happened if these bombs were not dropped and some other path was taken.
Arguably keeping the USSR out of the islands may well have caused less misery over time for the Japanese people, from the purely utilitarian perspective of looking at how populations under Soviet rule fared.
Earlier than that on the European front, there was Dresden, which killed about a third of as many that as the atomic bombing of Nagasaki.
Really, once the US established control of the air, they were capable of wiping out Japan's cities with conventional weapons.
The second, just by its gruesomeness factor remains a black swan, irrespective of the number of deaths.
In the same vein the nuke might not be as deadly as all the bombings before it, but at the same time it was one new weapon (ie. a singular drop from a single plane) that did something totally new and horrific, thereby making it a black swan.
And you're right, you basically can't predict things like this -- but a great many catastrophic risks that can be prevented are ignored because the event seems much less likely than it is due to the scale of the impact being so large as to be unimaginable by many. Climate change is a chief example; but there are plenty others throughout history in business, warfare, and science.
No way to predict, sure. But if my memory serves me correctly, the entire theme of Taleb's Black Swan was about accounting for such events. For example, financial hedging; you won't know what event might manifest itself and cause a huge financial disruption (the cause), but you can anticipate "it" happening, in some form, and preparing for it by buying long shot hedges (accounting for the effect).
We can be fairly certain that something unexpected will happen in the future, but predicting what that something is or with what likelihood it will occur is still the domain of fortune-tellers.
Large-scale, high-consequence, strongly systemic or correlated events are difficult to model and describe.
Death-by-asteroid is one of the more interesting cases. That would be a bad day for you (or your descendants), but also, quite likely, many others, when it happens. The days aren't frequent, but they're big.
More generally, there's a lot summary statistics don't tell you.
The point is that past performance gives a baseline that can used to judge both possibility and probability of such outcomes.
Civil wars did. Many of them have either been started by, or fueled by American foreign policy.
So, yes, your country being destabilized by a civil war is a real threat if you live in the global south. In America? It's not going to happen because of a few mouthbreathers decided to cook some bathtub C4.
Not unless some terrorist rogue scientist invents nano machines that turn everything into vending machines. Some bizarre gray goo scenario.
 - https://en.wikipedia.org/wiki/Opioid_crisis
 - https://arstechnica.com/science/2017/03/with-a-10-day-supply...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ title: "The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy"
How can you prevent crazy people?
I'm asking because I often wonder what price we're willing to pay to make to make the chances of killed by another person 0%. Is there anyway to acheive that without creating a police state with zero privacy and zero possibility of dissent? If we start editing people's genes so they aren't "crazy" who decides what the legalized normative behaviour is?
Lab experiments with rats might be pointing is towards what we have to do to mitigate this at least somewhat. Experiments showed that rats in a healthy social environment are much less prone to opioid addiction than ones living in isolation or having lived in isolation. See https://en.m.wikipedia.org/wiki/Rat_Park. I finds it easy to imagine that the same is true to some degree for humans. I wouldn't be surprised if the effect was even stronger on humans. We are very social animals after all.
I'm pretty sure the person you're replying to was using the word "crazy" in reference to terrorists, specifically the ones of a suicide variety, not your garden variety person who ends up addicted to prescription drugs.
Especially in the US the opioid addiction epidemic is caused mostly by doctor.
Last year less than 1% of the population tried heroin or opium poppy. A bit more than 5% of the population tried opioids.
'Opioids' are the prototype solution to human pain.
Have you never had surgery, a massive fever, or a broken bone?
Morphine and its analogs are probably up there with HVAC, internal combustion engines, and carbohydrates with respect to human progress.
And doctor prescription is caused mainly by drug company.
I have a hard time imagining anything except a real monoculture of individuals would emerge from such a possibility.
Source: I moved from the suburbs of DC in MD to Manhattan, I track my spending pretty religiously on Mint, and my spending only went up a few $K per year -- which is way, way less than my salary did from the move.
I see DC creeping up to $160K-$170K or so for senior devs that can negotiate.
What are you seeing in Manhattan?
Fear is the foreknowledge of (or of the risk of) something unpleasant happening to you. Foreknowledge of our inevitable death, over which we have no control (sure, we can try to prolong life a bit, or end it early, but the ultimate result is the same), induces fear, ranging from anxiety to terror, in large numbers of people - perhaps even the majority.
To me, it's irrational to fear events that are highly improbable, but in view of our survival instinct as humans, it's quite rational to fear something horrible that is absolutely going to happen to you, and there's nothing you can do about it - for example, being scheduled for judicial execution the next day.
B: People are not perfectly rational.
However, I totally agree with your main point.
For example, on a policy level, Japan never has them. They just don't immigrate any of the religious group who might commit terrorist attacks. So it's a non-issue.
And on a personal level, you can mitigate terror attack risks. Just avoid gatherings of people, basically. You can go as far as you want with this - living off-grid in the forest makes you pretty much fully insulated from terrorist attacks.
So the only question remaining on a personal and policy level is what the cost/benefit is for various things you could do to prevent terrorist attacks.
This is a common mistake. People like to think that some options are impossible, or some gains are free. Thinking this way makes decisions easier; it makes you feel more secure in your opinions. In reality, everything is possible, and everything costs.
This is regularly triggered by various disputes about commonly claimed territory and things such as politicians visiting shrines that house the Japanese war dead (including war criminals). It often leads to rioting and destruction of perceived Japanese things (cars, restaurants, etc) in China.
Still no terrorist attacks in Japan committed by Chinese though despite Japan allowing in large numbers of Chinese visitors, students and workers.
I have a Japanese friend that has been road-tripping Europe for some time in his vacations and has been unable to convince any (Japanese) friend to go with him. In the last one, he was almost coming with a guy, but at the last moment, that guys mother convinced him to cancel the trip, and this was before the Paris attacks.
I remember being a kid living in Japan, and watching the subway attacks on TV. It was scary.
But to your point, I agree, statistically, Japan is about the safest country there is in terms of human on human violence.
Terrorism killed 160 people/year in the US over the past two decades. 
Terrorism killed 33,000 people globally in 2014. 
Vending machines deaths in the US are 2-3/yr. 
There's hardly a comparison.
33,000 from opioid overdoses in 2015 .
That's like 11 9/11's every year. I'm not afraid of terrorists. I am worried if I take opioids after a root canal I'll become a drug addict .
 - https://www.cdc.gov/drugoverdose/
 - https://arstechnica.com/science/2017/03/with-a-10-day-supply...
Driving is not a good analogy either. A 2 week prescription gives you a 25% chance of becoming an addict. That is Russian roulette odds.
Driving everyday all year has about a 1 in 10,000 chance of death.
Driving is a necessity in most places. Opioids are not.
Oh? Drugs are not the source of their problems? Well, neither is terrorism. It doesn't happen in a vaccum. The kind of terrorism that destabilizes societies takes place in the middle of civil wars. If you are in the middle of a civil war, terrorism is not your problem.
If you do insist on spending billions of dollars to deal with terrorism, though, perhaps you could look at dealing with the root causes that breed dejected, anti-social, and radicalized young men (Who tend to either join terror cells, or an army.) As a bonus, you'll also probably save quite a lot of people from opiates.
Here you have to make the distinction between the steady problem and the unlimited-growth problem.
The steady problem is "homegrown" terrorism. While there is always some level of terrorism coming from all groups, that should be addressed with the usual deradicalization and politics programs. Those approaches solved the issue with, for example, IRA terrorism. Which is a good thing, because we have to live with our own people.
The real issue is the one that will grow without limit due to ongoing demographic replacement in the West by Muslims. That's what people are worried about, because people understand that unlike homegrown terrorism, the Islamic terrorism problem can become infinitely bad, and you can end up like the Christians in Egypt. No magical historical force prevents French or Germans or British from ending up living under such deadly tyranny. Sadly, the only real way to stop this is to cease Muslim immigration until some of these data  start looking a lot more promising (which will take a century at least). There's certainly no shortage of people wanting to move West from places like India and China, so I see no problem with choosing immigrants who will create better outcomes (and we do that anyway).
If we're willing to discriminate on age and education, we can discriminate on religion - especially when a religion's core beliefs, as interpreted in all its mainstream schools of thought, explicitly opposes the basic egalatarian democratic values of our society.
Practically all of the recent Muslim immigrants in Europe are running away from terrorists not becoming them. Fear of a Muslim majority is completely irrational.
Many (most?) have criminal punishment for blasphemy, apostasy and homosexuality. Capital punishment for any of the above is common, and legal in many majority-Muslim states.
There are clear examples of social regression to point to as well. Both Iran and Turkey used to be far more secular and liberal.
True, it's not terrorism. The oppression is usually legal, and at the behest of the majority of the population. But it's reasonable to fear it, especially if you happen to be kuffar, female, or gay.
But you're ignoring my point - almost every majority Muslim country has a rights-violating Sharia based Government.
So no. Europe certainly won't enact Sharia law, provided their Muslim population remains a minority.
Do you know many muslims? I happen to live in a muslim majority area of a major European city. No problems. They're people just like me and you and like most religious people they keep their views to themselves and get on with their lives.
Oh and the area I live in has a muslim politician in charge (and their closest competitor is a Imam) - both have very liberal policies.
Your reasoning seems to be: muslim majority == now they have the power to implement strict religious laws via the democratic process. Well that's absolute nonsense when it's only a tiny minority of them that have these extremist views. I could very easily look at some fundamentalist Christian groups and come to the same conclusions you have but I know that not all Christians believe the crazy crap that some fundamentalists do.
I'm actually terrified reading your comment because you've taken the uneducated bullshit arguments given by people and political parties on the verge of racism/sectarianism and polished it to look like it's intellectual and backed by evidence when that's clearly not the case.
You only have to take off your rose tinted blinders and look at the state of affairs in muslim majority countries to see what happens when they are significant in numbers. Even in a "moderate" muslim country like Indonesia gays get arrested. Do you think these societies are a result of their geographic location or the culture/religion? What do you think happens if you only change the location of the people and they keep their culture/religion?
It's far from a "tiny minority" that holds extremist views - there are plenty of polls (check out those from Pew Research Center) that attest to that. You are gravely mistaken if you believe all religions are the same and equally compatible with western ideals.
Plus, we'd save billions of dollars and countless hours of productivity.
Not that I'm expecting this to happen, but one can imagine...
However, I wonder if it's a little unfair to average out the probabilities and compare to something closer to an actual random event, like falling vending machines; surely, a terrorist attack is significantly more likely to occur in a place like New York than Middle America, no?
I'd really like to see something like what's the probability of being killed by a "falling vending machine" IN NEW YORK vs a terrorist attack IN NEW YORK, than something country wide.
So long as you never rock vending machines, and you shouldn't!!, you are way more likely to be killed by a terrorist, even though the odds of that are incredibly low (one in many, many millions).
I'm no expert but isn't China known for having suffered from opium for a long time? If so it's quite relevant here since we're precisely talking about opioids.
Opium addiction ravaged China (although by the point it really became a public health problem, domestic opium production had exploded). But the wild swings in the price of silver fucked the Qing economy, that had a bimetallic currency between silver taels and copper cash.
But, of course, multiple things can be bad at once.
The odds of a terrorist group detonating a dirty bomb are not, but the casualties from one will be much, much lower then what they can accomplish with an equivalent effort put into bathtub explosives.
The danger of nation-states using their arsenal of nuclear weapons against each-other is at least two orders of magnitude greater. If those two nation states are the US, and Russia, the death toll will also number in the hundreds of millions.
If you really want to optimize for 'not dying in a nuclear explosion', you should be clamoring for immediate, unconditional disarmament, instead of worrying about orcs from Mordor carrying out Hollywood suitcase nuke plots.
And honestly, the Iraq war is as related to terrorism as vending machine crush deaths. That was our dumb fault. That was a military industrial complex power grab.
This is just wrong. Iraq had nothing to do with 9/11, but 9/11 provided the political cover that the Bush administration needed to take the country to war. Absent that terrorist act, there's no way that the American public and the international community would have stood by and allowed the US invasion to take place the way that they did because of 9/11.
I think that's known as carefully picking your sample population to get the result you want.
That said, even if we include the whole of US history (that whole wiki article) it's still an average of roughly 1/100 as many people dying each year of terrorism compared to opioid deaths. Even if we include the whole of US history terrorism deaths, it's still about 1/10 the number of terrorism deaths than opioid deaths just in 2015.
Hospitals are ill-equipped to handle addicts and the tangled web of birth, opiates, and crime that comes with it. The result: kids die.
The mere aspect of caring for a child born with what they call neonatal abstinence syndrome e.g. babies addicted to opiates is too much for the current system. Lily's Place in West Virginia is one response, but it's a drop in the national bucket.
Now picture a school in a community overrun by this trying to contend with children born addicted to opiates, and parents who merely shrug when social services takes their children away. Portsmouth, Ohio is one that has been hard hit by the opioid epidemic. There is no safety net for this sort of thing, and it's crushing the institutions that it touches while wrecking the community.
I can feel the anger in this post but please know it's not directed at you or HN. I see this up close and the hopelessness of it all, makes me feel impotent to meaningfully help, and subsequently, angry.
Anyway, I have direct familial experience with relatives becoming addicted to prescription painkillers, so I don't need to be convinced, I grew up in the deep south, and have seen the impact first hand. Folks go from opiods to alcohol and meth. Their body is cooked by 40. It breaks families and is a quietly suffered epidemic. Terror is flashy and in your face. No one cares if your uncle died when you were 15 addicted to alcohol and meth. You get all sorts of patriotic platitudes about heroism if your relative is killed by a terrorist.
Edit: It informs life choices in interesting ways. When that tough on his luck guy comes over, smelling like a still at 11am, I can relate to where that guy is. So I let him pet my dog on our walk and treat him with kindness, because not many others will. It is about as hopeless a problem as you can find when a family member is in deep. Anyway, we do other things, but everyone has a hard go at it in life, some people just have it harder and deserve compassion. We do other things to help, but everyone loves petting dogs.
In the last /decade/, it depends on how you do the math, but it was less than 100 people. http://www.politifact.com/truth-o-meter/statements/2015/oct/...
edit: I see I was beaten to the punch here.
Humans have always wanted to use mind altering drugs. What makes that a problem is prohibition. What's nice is I think society is slowly realizing that and turning to harm reduction. The safe injection sites and prescribed heroin are a couple good examples of that.
Opioid pain prescriptions used to be very limited and carefully monitored because of the perceived risk of addiction. The prevailing wisdom on this danger was changed because of some low quality papers on the risk that were pushed by drug companies.
Another big driver has been a more effective opioid selling due to some Mexican drug sellers. Interestingly, these sellers are much less violent than previous opioid sellers.
These reasons are outlined in the excellent book 'Dreamland'
Long interview podcast (~1hr) with the author to listen to or read the transcript of here:
I don't think our government is humble enough to admit the mistake, so many more people will die.
So many of the worst tragedies in life seem to be caused by this. Arrogance, shame, saving face, covering your ass. Humans can be so cruel to each other when we try to do the right thing. We bow to peer pressure when we're 16 and end up wrapping mom's sports car around a tree. Ahhh, damn.
> “I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.”
No what makes it a problem is the debilitating addiction. It doesn't matter if you buy heroin from a dealer or from Walgreens, it's probably going to ruin your life.
It doesn't magically stop being dangerous, but prohibition clearly doesn't work for any substance.
Most things are. The main danger of terrorism is that we injure ourselves.
It's painfully obvious why it's been suppressed for so long. All you need to is look at who the top advertisers with news organisations are, then imagine why they very rarely cover negative stories about drug companies.
Hell just to name 1 big example, the elderly couple who were passed out in the car with their grandchild in the back. When it went viral, the claim was they were doing illegal opioids and days later when it settled down it was found out to be prescription meds.
Neither are going to destroy the country. These drugs are going to destroy a lot of lives though.
This is very relevant, from the article. This is the accusation. I have seen very generic comments in this thread that don't take this information into account.
And in the end what will happen is that people that legitimately need pain killers will be told "sorry, you might get addicted, just tough it out". Not a world I want to live in.
I am asking in good faith: I used to be prescribed cortisone, and managing the end of the treatment was a pain, I just decided to stop worrying treating my rashes altogether, because that was getting ridiculous. I am wondering if some doctors also threw the towel on that one.
Based on research canibis is promising http://jamanetwork.com/journals/jamainternalmedicine/fullart...
With a 25% reduction in opioid abuse by allowing patients access (not necessarily prescribing).
The people who got addicted, and the subject of the lawsuit, were prescribed opioids for long-term pain management. Of course you're going to get addicted if you take them every day for weeks or months. It's the nature of the drug, and the drug companies are being sued because the purposefully downplayed that.
If the teeth have come in enough though, they can be treated like regular extractions. They are still painful, but generally much less invasive / potentially complicated.
Instead of getting handed opiates like they are harmless because the doctors believed the drug companies who tried to pass them off as safe for unmonitored use.
120mg over 12 hours
80mg over 8 hours
People that take the 120mg over 12 hours realize it only lasts 8 hours thus they are taking 40mg more than they should be on the schedule that makes sense to them to avoid pain.
Rather than taking 40mg at the end of the day, the drugs companies caution doctors to prescribe more medication initially rather than give any indication that the drug only lasts for 8 hours.
They care more about their approach to marketing, than the efficacy of the prescription schedule.
It's this that creates addicts: the extreme high of the unneeded extra initial dosage, followed by a lower low when the drug runs out.
Once the prescribed regime is broken, and the psychological restraint is broken, too, there's little left to stop the usage from spiraling up, to an overdose.
Remember 9/11? Imagine that many people dying from a preventable tragedy every 4 weeks in the US. Because that's what happened in 2016 with opioid addiction.
It's a serious problem that is killing people, and it's worth taking a shot at without being shouted down every time by someone who thinks you're trying to take their pills away.
That's incredibly stupid and illegal in all but one other country in the world.
My apologies if I was wrong. I believe I got it from the nytimes article on the topic published a few months ago.
Would you care to update Wikipedia (and cite your source)? They only list the US, NZ, and Brazil.
The "war on drugs", and the racially motivated moral panic about crack cocaine and addiction created a social attitude that casts addiction as a moral failing
Inadequate safety net healthcare provisions lead people to the cheapest treatment option, generic opiates fit this bill
Here's some blog posts arguing the ACA actually increased the severity of the opioid crisis:
I'm (nevertheeless) pro-universal healthcare, but our idea of healthcare should probably not include these drugs in any but the most extreme and limited circumstances (like, I'm lying in a hospital bed). They're too dangerous.
Having doctors actively prescribe them, under incentives from pharma companies to sell them, seems to me predatory in the same way we think of street dealers stalking schoolyards as predatory.
Chris Arnade has done a great job documenting the crises at a personal level. I highly recommend checking out some of his articles and tweetstorms. It's gut-wrenching stuff (and obviously the problem goes way deeper than simple access).
But pharma/doctors/govt pushing drugs isn't helping, and is probably making it much worse.
And honestly, the correct answer (in my opinion) is that one should do both. As much as I'd like to believe better in society, the truth is that not everyone thinks things through. Not everyone gains information before they do stuff.
Some drugs should have restrictions. Age limits are prudent, for example. I don't trust folks to take most prescription drugs correctly. Antibiotics and most treatment-only drugs are like this.
I'd rather folks do opium than heroin or opiate pills. If there is still a market for them after legalisation, I'd rather the opiate pills that are available to the public be the mild variety. Push folks to do occasional cocaine rather than crack. Avoid meth if possible, mostly because it is hard on folks. Heroin or anything else that one injects are only available at a clinic, where you have to consume there.
And above all, drug addiction treated like a medical condition... and free of charge.
1. Crack has a lighter sentence than meth does despite meth being a "white" drug and crack being a "black" drug.
2. America has always casted failure as a moral failing. Its the basis of Calvinism. It has nothing to do with the war on drugs.
3. The epidemic is new. In the 40s, 50s, 60s, when healthcare was much worse, you didn't see this level of addiction to opiates. Easier access to opiates means better access to healthcare which is the problem.
Yes, this epidemic is new, but drug epidemics aren't. This one is likely more widespread because of widespread use.
But this is most pronounced in the US. Other countries with good-or-better access to healthcare don't have nearly the same problems as the US . I think it lies more in the way we treat folks when they are sick: Turning to opiods instead of other drugs (a combination of ibuprofin and paracet/tylenol is a pretty standard pain treatment here). Not actually giving folks time off when they are sick and injured. Sure, you have the FMLA, but that doesn't exactly let folks pay their bills. We (the US) could also do things like talk to patients and/or their families about ways to handle the pain, what to do if the pain relief wears off, prescribe differently so that it isn't wearing off. We could make sure to have realistic conversations about addiction. And the drug companies could be upfront about this. Lastly, we could provide addiction help, treating it with time off in a manner similar to simply being sick.
Sam ran the podcast circuit awhile back if you want to listen to his story. I found out about it via Russ Roberts' Econ Talk.
That is what makes the USA unique - it's almost impossible to be prescribed strong opiates anywhere else in the world, let alone to be told that they're safe.
You know something is prevalent when the drugs to treat its side effects are worthy of prime time advertising.
Well, we're one of only two countries in the world that allow direct to consumer advertising for drugs at all, so your statement is probably true.
(New Zealand is the other one for those curious, with Canada having some limited things they allow).
What the other poster is talking about is the reaction to someone being hooked, looking the other way and/or not treating it as a mental health issue and putting them in rehab instead of jail.
Then, imo, if you really want to get into it, destabilization in Mexico has created the actual heroin epidemic we see now, as the pill mills and doctors involved have had their operations closed.
"By 2002, death certificates listed opioid analgesic poisoning as a cause of death more commonly than heroin or cocaine."
If those people were on methadone instead, for example, hundreds of thousands of people who are now dead would still be alive.
Also if you read "Dreamland" 80% of heroin addicts started addiction with prescribed drugs.
He on other hand made a big deal out of whole thing.
We decided to trash all the medicines and lived happily without any issues.
My doctors have given me opioids so many times and I typically throw them out. Why take a substance like that if pain is bearable ?
You decided your didn't need anything extra for your pain. That is good. Many people have difficulty toughing it out, maybe they had it worse. Perhaps some got an infection from their wisdom teeth removal (or they failed to follow directions and got dry socket leading to extreme pain). Given the prior doctor instructions (and perhaps not understanding why they are currently in pain) patients take their drugs at the maximum (or in some cases, above) the prescribed rate.
This isn't too say your choice was wrong, but that many others aren't as fortunate to avoid addiction, add once they are: their choices can no longer be considered rational, but as those made by an addict in pain who had been told opioids will help.
I am glad they didn't bring in the big guns, I am a bit worried about morphine and heroin stuff we read on the internet.
I don't know a single person here in Europe who got a recipe for opioids by a GP or after leaving the hospital. That's not because pain is not treated but because doctors realise how dangerous opioids are.
I think it's quite common to get co-codamol or dihydrocodeine from a GP in the UK. However, this is really weak in comparison to the high-dose oxy or hydrocodone that US doctors seem to prescribe.
Will probably depend on the doctor but the GPs I have seen in the UK have preferred Ibuprofen if it can treat the pain.
FWIW you can also get 8mg/500mg dihydrocodone without a prescription OTC in the UK.
FWIW, I've found ibuprofen to be the absolute best for my post-surgical pain. The issue is that it's 600-800mg every 6 hours to remain effective, and that's pushing some limits on dosage. Doctors have always told me fine in the short term, but bad longer term.
I know I'm saying this with a clear mind and pain free body right now, but I'm entirely unwilling to fill an opioid prescription in the future. The small amounts I've taken in the past for surgery were just too memorable - nothing should stick in your brain like that years after and be considered safe.
Anecdotally, the biggest potheads I know can take a month off without impact to their lives.
Regarding anxiety and panic attacks, I'm sure that's possible, but people don't die from it. An extra cup of coffee would do something similar for a longer period of time.
I don't think we've studied cannabis enough to truly know the negatives, but even heavily discounted historical and anecdotal evidence would suggest it's less harmful than opioids. That potential for harm might be low enough that you simply try it first for pain management, before moving on to stronger things that carry their own sets of risks. I'm not a doctor (or a cannabis enthusiast), just what I think I think.
I agree that anxiety can be an issue especially with novice users, but those effects vary person to person and strain to strain.
Also, if they are any smarter they should lower the premiums of people who did not such painkillers.