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Opioid Use Could Explain 20% of the Drop in American Men from Labor Force (bloomberg.com)
245 points by mcone on Sept 7, 2017 | hide | past | favorite | 268 comments



From the actual study (p.36): https://www.brookings.edu/wp-content/uploads/2017/09/1_krueg...

"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."


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"


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.


> 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.


By the time the everyman finishes reading the malarkey he doesn't know anything useful and now believes he has a handle on a complex and multifaceted issue. Ergo he actually knows less than when he started.


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.


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.


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...

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.


Things are not completely bad, however.

I tend to not go on Facebook too often. But when I do, there are two categories of news (or news and news-like, I should say) items on my feed:

- posts by Nautilus Magazine, Aeon Magazine, along with articles from more specialized journals like Sky & Telescope, etc

- reposts by Facebook friends from fringe blogs

The contrast is so huge, it's hilarious. I read one category for actual information; the other could be entertainment, except it tends to push me towards cynicism, so I end up just ignoring it.

Maybe I should restructure my Google News feed and just use that instead.


It definitely helps blur the lines so that full-on fake news can more easily exist and be accepted.


In the US at least, as the richest country in the world, there's really not very much pressure against anti-intellectualism. It'll work fine for people for a while.


There's too much money to be made to worry about long-term effects.


Totally agree. State of information is moving in a worrying direction. Example: verrit.com - "verifying" subjective political statements.


> is much more widespread and insidiously damaging.

Is that "is much more widespread and is also insidiously damaging" or "is much more widespread and is much more insidiously damaging"?


The former. I'm not sure how to determine the amount of damage so I won't rank them.


I'll take it a step further. I see no difference between this and fake news. One has somewhat less repugnant ends, but the means are equally repugnant.


Absolutely, yet we hesitate to call it "fake news," which it obviously is.


Fake news is an even bigger problem than opioid use?


No, he said hyperbolic reporting might be a bigger problem than fake news.


Now there's a headline idea!


I think that the whole fake-news is just a cry from news outlets clearly supporting democrats. Not that fake-news don't exist, it's the exact opposite: they're the norm and fake-news are the norm because is what mainstream media outlets actually do.

So now that someone is beating them at their own game, they came out for blood and you see facebook effectively filtering out whatever is considered fake news, which is ridiculous on so many levels.


Fortune has "1 in 5 Men Drop Out of the Labor Market Because of Drugs".


Wow. I thought you were kidding. That's disgusting. I don't dare link it here for fear of encouraging such behavior.


Buzzfeed: 1 out of 5 men fired for smoking a joint!


Has anyone seen one to the tune of "4/5 men not fired for doing drugs"?


Is that really what the headline said? Because now it is: "Opioid Use May Explain 20% of Drop in American Men’s Labor-Force Participation"


What is still hyperbolic, since that link is still too tenuous to even call attention to it. The study does not really deserve a mainstream paper headline, but if it must have one, it should be about researchers looking for a link, not a link (maybe) existing.


yes it originally said "Opioid Explains 20% of Drop in American Men’s Labor-Force Participation". It was stealth updated.


Also the fact that it "perhaps" covers 0.6% of the total which is 20% of people dropping out, so the headline should be " 1 in 5 of people leaving work might be doing it because of opioids".


That's jabber to evade political nuance. Opoid and drug abuse is obviously heavily prevalent in American society, and is part of their mainstream culture and media. The Americans spent hundreds billions of dollars just in their media push to make drug abuse a part of everyday American life.

Opoid abuse has been _observed_ in other civilizations as leading to a collapse in labor throughput. The Middle Eastern empires, the Chinese Empires, etc... have all recorded _correlated_ evidence of opoid abuse to a collapse in economic throughput, but never "_proven_" it under the "rigor of Western Science".

The real question isn't so much as to _what_ caused the drop in labor force. It is obviously not only drug abuse, where drug abuse is understood to be a symptom of the problem(s). The question that the scientist cannot or will not answer is why the Americans did this to themselves.




"Opioid Use May Explain 20% of Drop in American Men’s Labor-Force Participation"


Could. Opioid use Could explain. How would you re-phrase it?


As I understand it from the other comments, the title of the article has changed since originally submitted. It looks like it's changed a couple of times. The original slug:

> opioid-use-explains-20-of-drop-in-american-men-from-labor-force

The current title on the article:

> Opioid Use May Explain 20% of Drop in American Men’s Labor-Force Participation


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.


So since there are lots of non druggies out there virtually the entire population in fact I'm guessing employment at said factory is so crappy that the only people willing to hire on are junkies.

This says more about the factory than the junkies. Figure out why nobody decent will work there.


I feel like the vast majority of supposed "labor shortages" have a lot to do with only wanting to pay bottom-of-the-barrel wages.


Do you know how much he is offering to pay entry-level employees?


I do not unfortunately. I do think based on what he was describing he would have enough incentive to pay more if that were feasible and resulted in talent that prevented these issues.


Has he considered offering relocation?


Maybe by the time an employer offered enough compensation to create an incentive to move to northeast Ohio, the cost of the good might be so high that it would just be worth it to manufacture in China.


Then perhaps we should do something about that economic loophole. If our country's employers can't provide a good, rising quality of life to its workers, then something needs to change.


Aren't there a lot of ex-prisoners that can't find jobs because employers are stubborn?


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.


What are you talking about? He's been going after over-proscribing doctors. http://www.rollingstone.com/culture/news/jeff-sessions-targe...


You can certainly do two things at the same time but his policy talk and actions are very much focused primarily on recreational pot usage and state's right to medicinal pot.

Sessions:

"Good people don't smoke marijuana."

"We need grown-ups in charge in Washington to say marijuana is not the kind of thing that ought to be legalized, it ought not to be minimized, that it's in fact a very real danger."

“I thought those guys [the Ku Klux Klan] were OK until I learned they smoked pot.”

“Colorado was one of the leading states that started the movement to suggest that marijuana is not dangerous. And we’re going to find it, in my opinion, ripple throughout the entire American citizenry; and we’re going to see more marijuana use, and it’s not going to be good. We’re going to see more other drug use, illegal drug use, also, which is damaging.”


A comment from earlier this summer that I think explains a lot: https://news.ycombinator.com/item?id=14879335


> 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.

Are you saying what we need is a draconian crackdown on more drug users? I understand the impulse, but I don't agree that that is the solution, personally.


If you think opioid addiction only affects white people outside urban areas I invite you to visit any large city in North America.


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.


Criminalization is not what I'm advocating. If Sessions and Trump are fighting the legalization of medicinal cannibis what exactly do you think are the chances of decrim or state funded medical treatment for opioid and meth addicts?

>rural and suburban Americans haven't been murdering anyone

Those drugs are brought into the US by very violent gangs and I certainly can grow pot peacefully in my home. Ignoring the trafficking of these drugs is morally inexcusable. How many of these addicts make their own opioids or meth? Meth linked crimes are a huge number and almost always violent. Opioid withdrawal brings in a great deal of crime too. Those rural towns that have fallen into opioid addiction are crime hellholes for this very reason.

Heavy opioid use is linked to crime, unlike some drugs:

>(2) heavy opioid users committed crimes significantly more frequently than did moderate opioid users, non-opioid polydrug users, cannabis users or alcohol users

https://www.ncbi.nlm.nih.gov/pubmed/2790266

Also:

>Methamphetamine was the only drug use variable that was strongly correlated with homicide.

https://www.ncbi.nlm.nih.gov/pubmed/18936516

I'd much rather work with "urban pot" users than rural meth and opioid addicts, and so would you. Why the former is more under attack than the latter shows our systemic problems with race in this country. Remember sentiment like this is why pot is illegal, from Harry J. Anslinger, the founder of the war on drugs:

    “There are 100,000 total marijuana smokers in the U.S., and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.”

    “Reefer makes darkies think they’re as good as white men.”


Criminalization only increases the attractiveness of the drug trade. The government's stance doesn't merely ignore the trafficking, it makes it ridiculously lucrative.


Which, of course, ends up hurting people more.


> 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.


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.


That's a real stretch


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.


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.


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.


"The United States spent $15,171 on each young person in the system — more than any other nation covered in the report."

https://www.cbsnews.com/news/us-education-spending-tops-glob...


That doesn't mean that that money is managed well, though.


I totally agree, but any discussion of approaches that might improve the efficacy of the spend, e.g. more competition via charters/vouchers, or creating a merit pay system for teachers, is not permitted in polite society.

The only solution in elite policy circles is to spend more. The reality is we spend plenty, but we have a structure that makes it difficult to experiment. The problem is exacerbated because the most influential members of the upper classes can bypass the problem by either paying for private schools or by taking advantage of our neo-feudal school districting system and buy into exclusive neighborhoods with "public schools" — which are open to anyone who can swing a $1M mortgage!


Nor does it specifically help men. Currently the education system is geared to helping women and some of the policies actually punish men.

https://www.cbsnews.com/news/the-gender-gap-boys-lagging/

Add in the fact that blue collar jobs are declining, most men are going to ask what is the point of trying. The answer they get back from society is one that they are unneeded.


The US also spends more per person on healthcare, yet has worse outcomes[1]. Cost is not always a good indicator of quality.

[1] http://www.latimes.com/nation/la-na-healthcare-comparison-20...


Are you arguing the US Educational System is rigged to maximize corporate profits? Don't we largely have "single-payer" education? Is the issue local control? Do we need to federalize it? Nationalize Addison-Wellesley so they no longer profit from producing text books and curriculum packs?


I don't know. I suppose my comments on a rigged system were premature since I don't know the US educational system enough to know if it is rigged. The main point I was trying to convey is that often times, spending is not a good indicator of quality. I've edited my old post, thanks for the comment.


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...


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 unemployable 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.


But they do need their skills, they've just found a way to get it a lot cheaper by manufacturing in countries that don't have much in terms of environmental or worker protections. One is our neighbor. All they had to do is give a little cash to some campaigns. The ROI on that must have been incredible.


Yes. Complete non-sense. I, too, can't wait until society's only working class citizens unburdened by debt and above the poverty line are software engineers, lawyers, and doctors. Everyone else should have, upon becoming unemployed, mastered more economical skills. We are fortunate that labor force participation is actually just that simple.


It's a fault of business for seeking to reduce the tax load that would provide society with the resources to retrain/etc.


When you offshore clothing production to a country where you can pay your employees $1/day, are you doing it because Americans are dumb and can't provide you with the skills you need? Which skills? The skill to survive in a homeless shelter?

Never mind that if every other business followed suit, they would destroy their customer base...


I'm not sure I would call that an externality. The newly-unemployed worker whose job was just outsourced is part of the transaction. I understand "externality" to refer to economic consequences to uninvolved parties, like when a company sells gas to an automobile owner which causes pollution which affects everyone else.


They can. It's called the UBI TAX :)


UBI isn't a tax, it's a payout. It's typically linked with a land value tax.


Why link it to land value, which could hurt retired people who own their homes but have fixed incomes? Wouldn't a better alternative be to tax corporate income and close loopholes that allow them to pretend they're Irish (or wherever) companies? Google and Apple could certainly afford to pay much more than homeowners.


This. Corporations are where the money saved from automating jobs winds up. They are sitting on larger and larger cash stores. Facebook and others have one engineer per million people. Only corporate shareholders win, and only indirectly.

Bernie would have been a great UBI candidate.


>Google and Apple could certainly afford to pay much more than homeowners.

Total private land value in the US is in the trillions.

Google and Apple could hardly make a dent in paying for a UBI.


That's not the point. Landowners don't make profits from automation as much as corporations do. As automation grows, we capture that savings and redistribute it to the working class and unemployed class equally.

Social Democracy!


>Total private land value in the US is in the trillions.

>Landowners don't make profits from automation as much as corporations do.

Much of that land value is due to demand for space rather than productivity. Corporations generate wealth by adding value (at least theoretically) and benefit greatly from automation, so there is cash flow to tax.

Google and Apple are hardly the only corporations. They were just convenient examples of those who are successful at large-scale tax evasion and yet enjoy a generally good public image, along with Amazon, Facebook, et al.


Yes very good point. When I think about how ridiculously hard I've had to work just to maintain the lifestyle that my parents had and I compare that to how little my parents had to work (and how little ambition they had), it's very clear to me that the baseline amount of work and ambition required to get a decent modest lifestyle has become insanely high.

Giving up actually makes sense. Drugs give back that feeling of satisfaction that has gone missing from people's lives.


I think that is dangerous mindset. It is unnecessarily idealizing the past while glossing over any potential flaws. It insinuates that people were happier in the past and it ignores that the standard of living for most Americans has gone up over the decades (due mostly to technology and globalization even with little to no increased income). There is still a lot of work that needs to be done to improve things, but lamenting about the good old days is further delaying that progress.

EDIT: I changed up the first sentence to be less political as the downvotes reminded me HN is probably not the place for that sentiment.


But it is true that in the past a lower-middle-class family could live on one salary, and office workers would often work less than 36 hours per week. Nowadays two salaries per family are required to stay just above the poverty line, and jobs require a minimum of 40 hours everywhere. This not just in America btw, the same happened all over Western Europe too.

It's ridiculous, because clearly automation and IT have increased output by huge factors; but clearly a number of forces (increased competition due to female candidates entering the workforce and lower-class candidates getting good education; adjustment of consumer prices over two salaries per family; etc etc) made it so that, on average, we "work" more for less pay. The work might be lighter on our bodies, and we all have running water in our homes, but apart from that we are not actually improving that much.


If you dig through the data here [1] you will see that the annual average hours worked by Americans has decreased over the years. The same is true for the French, British, and Germans. Some of that more recent decline might be due to underemployment, but I think it stands in contrast to your accusation that longer hours are some type of new norm.

"We all have running water" is also a huge understatement on the improvements that have been made to American living conditions over the last several decades. As a nation we have bigger and better homes, safer and more reliable cars, cleaner air and water, unlimited access to knowledge, and the list goes on and on.

[1] - https://data.oecd.org/emp/hours-worked.htm


I think healthcare causes a big split. Lower income would-be full time jobs get split into multiple part-time slots when employers don't want to pay healthcare. That drives even lower compensation on already low paying positions. It would be interesting to see a graph over time of hours worked by income deciles for example...


Like I said in my first post, there is still lots of room for improvement, but there is no question that these things are trending in the right direction when measured over generations. Medicaid and Medicare were both huge steps and the ACA built on them for states that were willing to participate.


What is your take on what you've said above when you factor in unpaid labour?

I was struck by my grandmother's stories about the sheer amount of totally manual labour she had to do in the early years of her marriage. Now I have automatic washer/dryers and don't have to make all my food from total scratch.


Where is the lower quality-of-life locale in which less ambitious people can live in peace? I suppose there are some places (cue the Amish Paradise), but it might require relocation. That has to remain an option until people voluntarily decide to "progress up."


That place used to be America.


Its most likely though that the causality flows in all directions at once. Structural unemployment causes drug use, drug use causes unemployment. Unemployment causes more unemployment (if your friends are unemployed, it doesn't seem quite so bad, maybe you don't try as hard to get a job). Drug use causes more drug use (if your friend loves Oxycontin, maybe you'd like it too).


Not to mention that drug use tends to push you into con college (prison) and you can't find a good job after that.


The fact that a felony conviction makes such a strong impact on your ability to find a job, and even to vote, is unfortunate.


And by "unfortunate" you mean "a deliberate strategy among people in power to continue to disenfranchise and control marginalized people".


That's a pretty bold claim. Why do you believe it's deliberate?


Well in certain parts of the nation you used to be able to own black people and derive income from the fruits of their labor along with the proceeds of legal corruption sometimes called campaign contributions.

Inconveniently they get freed and you now have to pay them, worse they vote against you and without sufficient votes you are no longer viable and liable to lose the corruption money.

If only you could shake down the annoying population regularly and you know put them in their place wherein their place is a prison cell wherein you can work them for free again and take away their inconvenient vote.

Disenfranchisement has always been a tool as long as voting has been a thing in America. Its only a bold claim if you missed the last few hundred years.


That has nothing to do with the fact that a felony conviction makes it difficult to get a job, though.


It kinda does, because if your unemployable, your more likely to commit crime and go to jail again


Of course. What I meant is that his post does not make the case that, with respect to employment difficulty, there is any deliberate conspiracy.


I think the powder vs crack disparity speaks volumes. Guess which type of cocaine resulted in felonies at 1/100th the mass of the other?

http://www.huffingtonpost.com/2010/07/28/crack-powder-senten...

So, the law may not make much difference in whether employers take felons, but it makes a huge difference in who is a felon.


It's a well-known effect that policy-makers don't deny knowledge of, and no substantial action has been taken to attempt to correct it.

It is, therefore, clearly intended that it continue, whether or not it was originally intentional.


The fact that it's deliberate is a common viewpoint among people who have studied it. The New Jim Crow is a good book along these lines targeted at a popular audience.

It's definitely an uncomfortable and politically-incorrect claim, but I don't think it's a very bold one (in the sense of being a tenuously-supported leap of logic).


In the US, felony disenfranchisement affects 5.85 million, around 2.5% of the potential voting population [1].

As I'm sure you know, the US has a very long history of racial bias in incarceration, going all the way back to the Civil War and before. Once black people were given the vote by the Fourteenth Amendment, Southern states took to underhanded means to re-disenfranchise them. Literacy tests, poll taxes, grandfather clauses, etc. Any arbitrary voting requirement they could manufacture that "just happened" to exclude more blacks than whites was fair game.

It was (and still is) bad enough to force a federal law to try to clamp it down, the Voting Rights Act of 1965[2], considered one of the most important pieces of civil rights legislation.

After that, Nixon declared the War on Drugs ostensibly to reduce drug use, which it has been famously ineffective at. John Erlichman, his domestic policy advisor at the time later claimed:

    > The Nixon campaign in 1968, and the Nixon White House after that, had two
    > enemies: the antiwar left and black people. You understand what I’m
    > saying? We knew we couldn’t make it illegal to be either against the war
    > or black, but by getting the public to associate the hippies with
    > marijuana and blacks with heroin, and then criminalizing both heavily, we
    > could disrupt those communities. We could arrest their leaders, raid their
    > homes, break up their meetings, and vilify them night after night on the
    > evening news. Did we know we were lying about the drugs? Of course we did.
Whether or not that's true, the War on Drugs has been an excellent vehicle to incarcerate more people. Those incarerations have history of racial bias. In 1998, African-Americans, who only comprised 13% of regular drug users, made up for 35% of drug arrests, 55% of convictions, and 74% of people sent to prison for drug possession crimes. Nationwide African-Americans were sent to state prisons for drug offenses 13 times more often than white men.[3]

In 2010, black people made up 13% of the US population, but 40% of the incarcerated. Black people are imprisoned at something like 5 times the rate of white people.[4]

See also:

https://www.nytimes.com/2014/11/19/opinion/the-racist-origin...

https://www.theatlantic.com/politics/archive/2016/04/virgini...

[1]: https://www.theguardian.com/world/2012/jul/13/felon-voting-l...

[2]: https://en.wikipedia.org/wiki/Voting_Rights_Act_of_1965

[3]: https://en.wikipedia.org/wiki/Race_and_the_War_on_Drugs#cite...

[4]: https://en.wikipedia.org/wiki/Race_in_the_United_States_crim...


(if your friends are unemployed, it doesn't seem quite so bad, maybe you don't try as hard to get a job).

WTF. I wouldn't spend too much time defending this if I were you.


Maybe I'm misunderstanding, but he's talking about peer pressure right? AFAIK we haven't evolved past keeping up with the Joneses. And if the Joneses aren't up to much well then that's one less thing motivating us.

I'm sure it's not the whole story but I think it's reasonable enough to assume it will be a contributing factor for many.


"Evolved?" WTF 2x. "Keeping up with the Joneses" is not a natural law. This entire thread is a shitshow of preconceived notions and willful ignorance, and your last sentence has five layers of weasel words.

I have never heard of peer pressure being a contributing factor in unemployment, does it work for employment, too? Cuz maybe that would make it a confounding variable.


There are innumerable studies indicating people's social group has significant emotional and normative influence. I'm not aware of any study looking at employment specifically, but it's not an unreasonable leap, IMO. Here are some examples:

https://www.ncbi.nlm.nih.gov/pubmed/23773049 http://web.media.mit.edu/~tod/media/pdfs/EmotionalContagion....

I think the idea that unemployment may be socially transmissible to a degree is pretty reasonable. Part of the fear of unemployment is fear of social rejection, due to negative views about unemployment. If others in your peer group are unemployed, that component of the motivation is ameliorated. There are other, stronger, motivations to be employed of course. But it's an effect I would expect to see at the margin.

And yes, I would absolutely expect it to work for employment. I see nothing confounding about that.


Rising poverty, loss of manual labor jobs, and permanent injury from manual labor jobs.

The men aren't working because they're either injured or unemployed. Then, because their life sucks, the are more likely to turn to drugs.

Saying "opioids explain unemployment" has it exactly 100% backwards.

The average guy with a job, a house, wife, and 2.2 kids isn't going to get hooked on opioids. His life is already full.


They want there customers to feel good. Shirking responsibilities for ones fellow human and redistributing blame feels good. Its a similar service as prostitution but for the consciousness.

Im interested on what there stance towards the DAO is going to be. A Contract-golem replacing CEOs - that's there audience being replaced. Wonder if they are going to stay Neo-Liberal while the Revolution they spawned eats them.


i wouldnt put that much meaning into reasons for the misleading headline choice. simplest explanation is "Opioid Use Explains..." is better clickbait than "Not Sure if Opioid Use is Causal or Symptom"


"Opioid use associated with.." would be better journalism. "Explains" is clickbait indeed.


That's better journalism but to the average reader "associated with" means "causes".


> 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.

Why? There's plenty of money to spread around in the drug wars too.


Would it be possible to setup 'no minimum wage' economic zones in the country. I know many ppl got their start in tech from doing tech support, perhaps that would help ppl build their skills ( and confidence) from the jobs that get in-sourced from India. Govt can prbly foot the bill to makeup for the wage loss. Just a thought.

Empty mind is devils workshop.


Given that corporate profits are higher than ever yet only very few are benefiting from that gain, it should be fairly obvious that trickle-down economics isn't working. Why not increase taxes while limiting imports from countries with minimum wages much lower than ours? That way the lower and middle classes would actually see an increase in quality of life, not a decrease that they would see if we removed the minimum wage.


I would definitely not vote for someone in favor of that idea. I see no reason to believe that lower and middle classes here would see an increase in QOL if we started enacting trade restrictions on countries with lower standards of livings than ourselves. What you're talking about is essentially mercantilism, and it's long been discredited in economics.


That would be an interesting way to experiment with UBI, in a economic zone with sufficient UBI, you allow no min wage, no unemployment, etc...


bloomberg has some of the best reporting out there. I would not discount it just because it's business driven.


I didn't discount its general reporting. I suggested its inherent bias on the subject might make it a poor source in this one case.


for some reason you left out the quote just previous to that, “I do think it is related to declining labor-force participation among prime-age workers,” which indicates she thinks there is a relationship?


Yes on the relationship, no on the direction of causality


Misread/paste - added the full quote. I don't think it really changes Yellen's position FWIW which is basically correlation != causation.


Which is good journalism - mentioning alternate explanations to the research paper that is the main subject.


Keyword in title: could

"Opioid use COULD explain 20%..."

Seems backed up by this part of your quote:

"I don’t know if it’s causal or if it’s a symptom of long-running economic maladies..."

The title implies exactly what was quoted.


We updated the headline to include "Could", but the original title does not.


It's possible that one trend feeds the other in a vicious cycle, to be sure.


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Yellen is reflecting the content of the Kreuger paper linked in the article which also states that it has not established causality...


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.


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...


This sums up my thoughts very well. I highly recommend reading Bernard Stiegler on this topic (e.g http://www.samkinsley.com/2016/06/28/how-to-survive-disrupti...)

Unfortunately, little of his work is been translated into English yet, but Wikipedia has compiled a good list of articles: https://en.wikipedia.org/wiki/Bernard_Stiegler#Online_texts. This might help too: http://www.samkinsley.com/2011/11/01/reading-bernard-stiegle...

It's certainly anecdotal, but he started doing philosophy while serving a prison sentence (for armed robbery)


Causality is a difficult debugging tool for control loops (and even worse in economic feedback networks). Even in a simple control loop, you can know every causal link among individual elements in the system, but it can still be difficult to establish the system cause of why it's going off kilter. In controls, there are at least known mathematical tools for well defined cases - but now expand that to a big worldwide, messy, interlocked feedback networks.. you can again correctly identify many individual causal links.. but be entirely wrong about what is actually driving parts of the system to breakdown.

It makes addressing problems at that scale difficult because people tend to argue about individual causal links which are indeed related, but may not be the actual drivers.


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/

2 - http://www.narconon.org/blog/heroin-addiction/5-reasons-pres...


Just a warning, that second link goes to Narconon's site. Narconon is the Church of Scientology's organization for drug treatment. While this particular article seems reasonably factual, do not trust any advice given on that site, or use any phone number found there.


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.


> 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.


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.


>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).

It rarely gets mentioned because it's false.

First off, opiates are usually inefficient for long term pain management. We, at least, have no evidence they are effective for long term (>2 months) pain management and if you actually talk to pain patients the problems with long term opiate use are very obvious. I'm not talking about junkies on the street either, I'm talking about normal people who are obtaining their medication legally through a licensed physician, not the black market.

Patients often rapidly develop tolerance and then dependence. The can also induce hyperalgesia - a paradoxical increase in pain caused by long term opiate use, this is why patients on high doses of opiates usually feel less pain when weened off the drug. Additional side effects are disruption of hormone production, lethargy, listlessness, and sleep apnea.

There's just SO MUCH we don't know about long term use bit it's very clear there is significant harm with questionable benefit in a subset of the population.

>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

Total nonsense.


I was looking through the literature to see if there was good evidence for this, but didn't find much. This paper seems to address the issue most directly, but fails to find much of a causal relationship; indeed, the increase in heroin use predates the reversal in opioid prescription trends.

http://www.nejm.org/doi/full/10.1056/NEJMra1508490#t=article

I don't doubt that prescription opioid abuse is itself a problem, nor that it may exacerbate the heroin epidemic, but the evidence suggests that it does not play a large casual role.


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.


If you (perceive to) lose control over one aspect of your life, it's normal to try to regain control over another aspect of your life. What he might call an automatic depression would just as well be explained as the person struggling to overcome their internal guilt of not being able to clearly locate their life's contributions in an endeavor. Then it becomes difficult to know if you're just floating, or swimming against a current.


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


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


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


https://www.youtube.com/watch?v=R6afA_pypxM He breaks down intelligence, talks about a bunch of interesting topics, then near the end talks about what IQ level can do what kind of job, and at the very end, he touches on what happens to people who are unemployed, but in fairness, he doesn't go in depth on that subject in this video. If I come across a video where he goes into it more, I'll post it here.


I really wish that he would post his arguments in the form of text instead of video - it's easy for someone with good charisma to just speak in a convincing way and not give his listeners time to go back and think deeply about his claims, look up citations, etc.


it's no secret why this is the case.

when society rejects you, it hurts at a tribal and physical level..


Take everything Jordan Peterson says with a massive mound of salt. He has a long history of spouting off controversial opinions on topics without much (if any) evidence backing those opinions.


Which part of people becoming depressed and/or turning to opioid addiction (or both) after becoming unemployed is controversial?


Jordan Peterson has become a very politicized figure in a very homogenous political environment (academia) which seems to be the primary source of controversy. So I wouldn't expect to find many clear answers down this path.


I'm on the fence about him myself but do you not see the irony in your comment?


No, because the idea that JP is a hack is not a controversial opinion among academics.


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.


Fentanyl has been a major accelerant in the opioid crisis. It's extremely potent and extremely cheap to manufacture. This has driven prices down, brought drug strength up, and shot overdoses through the roof.

> Why wouldn't they rather spend the money on things that mattered?

Opioids are incredibly addictive. Once you're hooked, you don't think rationally about how you spend your money.


At Uni, I smoked and I would select smokes over food or rent any day. I guess not having a job wouldn't make me feel any different.

What good is a tin of beans compared to killing the craving for a smoke for an hour? No contest.


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Contributive


Non smoker or ex smoker?


Probably non smoker, most ex-smokers would understand


Has that guy never been addicted to anything?

I could stop doing my shameful and deplorable thing any time I want to, but I will probably never want to stop as long as I keep doing it.

There is a button inside your brain labelled "do that again!", and it is an integral part of animal behavior control, to reinforce things that tend to increase survival potential. If you do something that pushes the button, you're probably going to do it again. And if you do multiple things that push it, you're going to do most often the thing that pushed it the hardest.

Eating food gives it a light tap, but nicotine mashes it really hard. That's why I decided a long, long time ago to never even touch a tobacco cigarette with my fingers, much less put one in my mouth. I'm afraid that not only would I not be able to stop, but that it would displace my lesser addictions, like overeating, video gaming, binge reading, and my other non-salubrious habits, so that I die from lung cancer instead of heart failure, which is the barrel I'm staring down now.

Why couldn't I have been addicted to exercise and fresh vegetables, right?


Ex Smoker of Cigarettes. and Abuser of prescription drugs.


I'm finishing the book Dreamland, by Sam Quinones, which directly addresses your questions (with a particular focus on addiction in middle america/appalachia)

Q1: Medicaid co-pay for $1000 worth of OxyContin was (as of ~2014, might still be) on the order of $3-5. Those unable to get prescriptions fence stolen goods, primarily from rural WalMarts

Q2: Opiods are chemically similar to heroin. Addiction is severe and enslaving. Someone who wouldn't get off the couch to throw out the trash will walk miles in a snowstorm to get their fix.


    > 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.


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.


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.


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.


^This! I used to think "who in their right mind would decide to inject heroin to get high" then I realized most people who transition from oral prescription drug--->all the way to--->IV heroin/fentanyl/opiate use are not in their right mind, and usually are resorting to IV use as a cost effective solution to bring them out of terrible, debilitating withdrawal symptoms, often one step past them switching to nasal inhalation of the same prescription-->then-->street drugs.


shelter is way more expensive than opioids.

> Why wouldn't they rather spend the money on things that mattered?

addicts aren't addicted to things that matter. they can want to spend their money on things to better their situation and be completely unable to do so. addiction is really hard to beat and is best treated with compassion, not judgement about irrational financial decisions.


I have a friend that has chosen the pursuit of crack cocaine all the way down. The job went a few months ago and yet the dedication to crack cocaine continues.

Note how the crack cocaine is the drug here, after an unknown time on normal cocaine the nose got so bad that crack was the only way. Next there will be the mix with heroin, if this has not started yet. Then payment - said friend is blessed with a vagina so along with everything else this will be rented out for crack cocaine.

Coupled with this costs go up. As the addiction continues more crack cocaine is needed to get to baseline normal.

Along the way all friends and family get reamed out. Borrowed money is not returned. Then every line of credit is used, e.g. payday loans.

Moving in to a lover's pad means no rent and food doesn't matter by then.

There are jobs in the black economy for instance babysitting, for your dealer, for crack cocaine as payment, what could go wrong?

I have desperately tried to change the outcome for my friend but know I have as much luck with that as praying for my mum's arthritis to get better. I enabled too, I did lend her money to move flat share before I knew of the problem.

My friend does come from a background of poor single parenting and that gives rise to the so called addictive personality. All it took was to meet the allegedly cool crowd and get partying. It was great at the start but the price was addiction.

This is how a typical drug junkie should be - childhood narcissistic harm due to a lack of love. But we have not got that in America with the pill epidemic, that was a culture of greedy over prescribing by doctors. It has been a stupid epidemic, creating drug addicts. These people just get caught up in it like my friend and end up doing things they would never do just to pay for this descent into hell. It is just a matter of time.

My friend had a good job with great prospects, a lovely flat, a car, many things. Everything is gone. Paving the streets with gold would not have changed things. Making the drugs free would speed up the decline but I think this stuff is a lot cheaper than beer in a restaurant for your minimum next hit requirements. Begging can cover that, eventually.

It is easy to blame social economic matters but that is to miss the mark. The opioid crisis is a really bad deal and I believe that the numbers in the article are acceptable guesses as to the harm done.


I am sorry for your friend and I hope this doesn't come off the wrong way because I really don't know - what stops you from holding down your friend and getting her help?

I'm lucky to never had to deal with this, but if someone I'm close to is addicted I would get them checked into rehab even if I had to physically detain them.


> Why wouldn't they rather spend the money on things that mattered?

This is the difference between an addiction and a hobby.


Drug-dependent people can very, very efficiently wield time and capital to serve that need.


One hypothesis is that there was a movement out of restricted unemployment programs into disability support programs and that would potentially provide funding for opioids ..

http://apps.npr.org/unfit-for-work/


You won't believe the things people will do just to get enough of their drug of choice to stay well for a few hours.

To answer your first question: Burglary, assault and theft, fraud, prostitution and drug dealing.


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

Get hooked on opioids and they ARE the only thing that matters.


> Most people with jobs can barely afford to make ends meat

Source?


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?


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.


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.


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.


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


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.


Got a source for that?


https://www.vice.com/en_us/article/exqm9j/reasons-why-you-ca...

https://www.therecoveryvillage.com/heroin-addiction/faq/addi...

that introductory experience can be the start of a compulsive cycle that quickly leads to addiction.

Probably better sources, but the boogeyman scare tactics taught to children to keep them from experimenting with drugs is too simplistic and flawed - but hey no one is going to explain to kids how brain chemistry works because abstinence is ... easier.


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...


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.


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...


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.


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.


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.


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


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


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 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.


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.


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.


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


Dealing drugs is high risk with relative low work, labor working is most of the times low risk and really high work. It's difficult to educate the population, specially those in the lower tier of society, about the dangers on drug dealing, America et al should legalize and regulate "hard" drugs like we do we with tobacco, alcohol and weed; it won't tackle drug use but will definitively lower the profit.


I heard that drug dealing comes out to about minimum wage. They talked about in the Freakonomics book. http://articles.latimes.com/2005/apr/24/opinion/oe-dubner24


Depending on how reliable the hours are at one job than the other he might still be right. But yeah, most drug dealers aren't striking it rich and I doubt factory managers are particularly knowledgeable about the topic.


How would you do that if price of stuff the factory makes is determined by the market? For me, obvious solution is to legalize drugs so that dealing them doesn't make so much money anymore.


If there is some sort of condition they have no control over where they can't possibly raise prices or cut costs anywhere else and their margins are too thin to eat the difference (which frankly sounds like a just-so explanation) then I guess they're just going to have to deal with the small and drug-addled applicant pool.


Yes they are doing it, essentially that's why so many manufacturers are going out of business. There is no way to reverse it. America is a rich country, it is not supposed to have much manufacturing workplaces.


It's not some ironclad law of the universe that we have to make so that Vietnamese factories and American ones compete on equal footing. That's a choice our leaders have made.


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.


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.


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.


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


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?


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.


Where does the other 80% come from?


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


Yes economists have estimated that video games cause a 1.5 – 3.0% decline in labor hours by young men.

https://scholar.princeton.edu/sites/default/files/maguiar/fi...


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


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.


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.


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...

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-...

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.


Aging population and younger people chosing longer school/education over work. It is in the article.


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


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_...


The white male privilege.


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


correlation != causation


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


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


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.


We've already asked you to please not post generic political boilerplate. Could you stop?

https://news.ycombinator.com/newsguidelines.html


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?


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.


I downvoted you because your comment is offensive and demeaning.

The OP said men are attacked as rapists. There is just no way to interpret that as "decline of the acceptance of rape".

As background, see:

https://www.theatlantic.com/amp/article/538974/

http://www.foxnews.com/politics/2017/09/06/devos-plans-title...

http://www.spiked-online.com/newsite/article/hey-lawyers-lea...

https://www.washingtonpost.com/news/grade-point/wp/2017/07/1...

https://www.washingtonpost.com/news/grade-point/wp/2017/07/2...

http://helpsaveoursons.com/category/court-wins/

The typical University holds kangaroo trials for students accused of rape. Normal behavior includes:

* denial of due process

* refusing to see exculpatory evidence

* "independent investigators" who assist the plaintiff

* allowing the plaintiff to have representation, while denying it to the accused

* refusing to let the accused question the plaintiff

The accusation of rape is so evil that the universities fall all over themselves to violate their own investigative processes in order to convict the accused.

These students (overwhelmingly male) lose everything. They lose not only time at university, they lose grants, membership in university organizations, jobs, etc. Their entire life is destroyed.

So it's offensive for you to read that "men get attacked as rapists", and somehow turn that into a man-hating comment of a "decline in the acceptance of rape".

Do you really hate men that much, that you think they're upset that rape is no longer "accepted"?


> Are you seriously suggesting that the decline of the acceptance of rape

Where did I say that? You are just resorting to outright straw man arguments now?

I'm just pointing out that the lies the media tells about "campus rape culture" as if every college woman is being raped and every college male is a rapist doe a disservice to both men and women.

> or the increasing awareness of discrimination against women in America is causing men to use opioids?

Discrimination of women? What about the discrimination against men?

There are more women at colleges than men. Corporations are favoring hiring women over men.

I guess we can blame the opioid crisis for that.

When more men attended college than women, then it was sexist patriarchy.

Now that more women are attending college than men, the media says it's the "natural" order.

"“At the same time, the slower social development and more serious behavioral problems of boys remained and allowed girls to leapfrog over boys in the race to college.”

In other words: As things got more equal for boys and girls, a natural advantage began to reveal itself."

https://www.washingtonpost.com/news/storyline/wp/2014/12/11/...

Can you imagine if a man said it is the "natural order" for more men to attend colleges than women?

But yes, lets pretend that women are being discriminated against.

Millions more women attend college than men, but it's the women being discriminated against.

https://www.bostonglobe.com/metro/2016/03/28/look-how-women-...


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


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.


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.


I don't buy this. Why are most of these people men then?


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


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

> "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.


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

"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


> 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


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

And yet, oddly, you frittered away the opportunity to identify even one piece of “incorrect crap” to instead go off on a rant about the DEA. At least I think that’s what you’re on about.


I address many points.

1. I addressed how the OP blamed the doctors as the source of people becoming addicted to herion, I believe that to be false

2. I address why in a few limited cases where person starts out on prescriptions and ends up on heroin they are likely there due to aggressive and unethical Drug Control Policy enforced by the DEA

3. The OP implied that Opaties are Over proscribed, i disagree. Further would like to know if the OP has ever suffered or know anyone to suffer from Chronic Plain, and if they would enjoy seeing their loved on suffer daily because of the Actions of the DEA.

You are correct it is a Rant ont eh DEA however, I am 1000000000% opposed to the war on drugs, I feel it is single largest source of freedom in the nation. it is directly lead to the erosion on almost all constitutional rights, has put doctors having to choose between what is best for themselves (i.e staying out of jail) and what is best for the patient (i.e proper pain medication) and has been an abject failure in reducing drug us.


> "1. I addressed how the OP blamed the doctors as the source of people becoming addicted to herion, I believe that to be false"

You believe based on what evidence? Have you done any research into this or is it just a 'gut feeling'? To put it another way, what do you find misleading about the following video?

https://www.youtube.com/watch?v=3sf46cwK9oc


You can't tell someone they are not in pain. If they stub a toe and say their pain is a 10-out-of-10, then you take their word for it.


> What I've never understood is why anyone does drugs to begin with, under any circumstances.

Poverty and the lack of opportunities to participate constructively in society do really fucked up things to human psychology. The current wave of opiate addiction frequently occurs as the result of prescribed pain medication.

>Why even try it? I feel in the media everywhere it is said how terrible it is.

The signals people pick up from their peer groups have a much larger impact on their behavior than media ever could.


> The signals people pick up from their peer groups have a much larger impact on their behavior than media ever could.

This just begs the question. Why did the peers do it? Surely you see someone clearly messed up after doing drugs. Why go in follow them? There are other mindless things you could do like play video games to achieve a similar effect.


There's all sorts of (arguably destructive/harmful) cultural behaviors that you could ask the same question about. Apparently the answer is that they are human.

I also wonder why you are so certain that video games are a substitute for drug use. Do you also not play video games?


I'd love to play, but no time to spare. I mentioned video games because the OP mentioned how peer group effects are strong. If that's the case and is a proposed explanation for opiate use, why aren't these people playing video games instead. Of course they could just be doing them both.


>Surely you see someone clearly messed up after doing drugs.

You may not start to see the negative impact of drug use until years later. By then it's too late.


People often self medicate as well in the absence of proper mental healthcare, or healthcare in general.


A lot of people, when they realize how badly they've been lied to about the dangers of marijuana, assume they've been lied to about the dangers of other drugs too.


All too often with opioids, the answer is: because you are in pain, and your doctor prescribes you these drugs as the recommended treatment for your pain, and you followed the doctor's instructions and got hooked.


How often is that though? Is there research on this? What % of new opioid addicts come from doctor prescribed pain medication? I'm genuinely curious.


>Of those who began their opioid abuse in the 1960s, more than 80% indicated that they initiated their abuse with heroin. In a near complete reversal, 75% of those who began their opioid abuse in the 2000s reported that their first regular opioid was a prescription drug.

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1...


The US prescribes far more opioids than any other country.

http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta...

In 2009 0.57% of the population between 15 and 64 took opiates (products of the poppy such as opium or heroin) and 5.9% of the same population took opioids, of which 5.6% were prescribed opioids.

It's got much worse since then.

Roughly 10% of people taking opioid medication will become addicted to them. (Mostly people taking it long term).

https://www.dea.gov/divisions/hq/2015/hq110415.shtml

> Since 2002, prescription drug deaths have outpaced those of cocaine and heroin combined. Abuse of controlled prescription drugs is higher than that of cocaine, methamphetamine, heroin, MDMA, and PCP combined.


Thanks, this is not the information I was asking for though. I was asking for the % of new opioid addicts began their addiction from medication prescribed to them.


Because it's fun. Does there need to be a more deep reason than that?


When you have no hope, you look for ways to forget. Stuff like drugs and compulsive gambling follow a different kind of logic than people with something to lose apply to decisions. It's about dulling the pain of and distracting from abject poverty.


For me that's what video games are for. Also video games are there for the good times too. Pretty much all video games, all the time, is what I'm saying.

*Not quite true, I have several hobbies, including designing games


My father was given a prescription to an opioid for a scratch on his eye that didn't hurt at all. That was maybe a year ago while the problem with opioids had been obvious for years at that point. If it had been a little painful and he hadn't known better, he might have taken them just because the doctor prescribed them!


I am always amazed how quickly they give you hardcore painkillers. I have taken Vicodin once when I had my orbital bone smashed but otherwise I never fill the prescription. I don't know how prevalent this but I have seen stories in TV where people had kidney stones, got super strong painkillers and got addicted. The doctors notice this and cut their supply off cold turkey so the only way out for those people is heroin.


I've gotten them even when I've claimed not to feel any pain. When I fell off my bicycle I was given a prescription for Vicodin which I proceeded to fill and then never use.


Because being sober feels more terrible in your situation?

As for how they get started, I've been prescribed a large bottle of powerful painkillers for having my wisdom teeth removed. It's not hard to get exposure under doctor's orders in the US.


1. Someone is injured, they are prescribed a painkiller, the prescription runs out before the pain does, and they turn to cheaper street drugs.

2. Desperation and a sense of inescapable hopelessness can make a whole lot of people do things they never thought they'd consider doing.


The article is saying that those unemployed have a higher rate of prescription though, not just illicit use

>Krueger’s study linked county prescription rates to labor force data from the past 15 years


Rather than commenting on the article, my goal is to help the grandparent empathize with how people keep falling into such a seemingly obvious trap. If we can't understand why people keep resorting to these behaviors--if we find their motivations entirely alien--then that precludes the ability to take the steps necessary to help these people, or prevent the same from befalling others (and possibly ourselves).


That kind of makes sense, though. You probably can't keep up with healthy people if you're in pain bad enough to require opioids.


Some people are also more prone to addiction. I have no interest in drugs but I have unsuccessfully tried to stop eating chocolate. Couldn't do it. So if you are prone to addiction it's just really hard to stay away.


Probably because the people who got hooked, got hooked before the media storm. You know, back when Pharma said they weren't addictive because the slow release nature of the pills?

Also, probably boredom.

You have to understand what middle America looks like today. It used to be vibrant, now it's nothing but shells of ghost towns. This happened for a few reasons:

1. Walmartization killed all the independent shops. 2. Agribusiness made family farming untenable. 3. Out of country manufacturing.


I'd say all three are part of a feedback loop death spiral.

1. Walmart - always lower prices (people want cheap crap)

2. So...cheap food means scale it up really big (agrabusiness)

3. And cheap non-food mean outsourced manufacturing (because people want big salaries to buy lots of cheap crap)

...and perhaps that's where it started, that last bit:

People want big salaries (or paychecks, or pay - whatever), so they can buy more stuff (there's also the whole "easy credit" thing - but that's another discussion). They want that stuff cheaper. So businesses searched for ways to make it cheaper: Scale stuff up, have fewer employees (or pay them less), and outsource manufacturing.

Classic death spiral.

/I know I am over-simplifying things here...


Drugs are a tool like any other. Or rather, each drug can be a tool in its own right. There are drugs for sleeping, drugs for focus, drugs for creativity, drugs for fun... You've literally been conditioned by the media (and probably the drug war) to be drug averse. "Drugs" should not be a dirty word.

What the media shows you is the consequences irresponsible use. You dont need to go shoot up laced heroin in a back alley to understand. I am always amused when people correlate drug use with poverty or some other nonsense, implying that white collar professionals dont do drugs. Successful people are just less likely to be caught and/or open about use, I think.

Oh, by the way, alcohol is a drug. Caffeine is a drug. The distinction between legal and illegal drugs is entirely arbitrary and in many cases unconstitutional.


For the same reason that torture doesn't work. People will do anything, and say anything, to escape pain when the pain is bad enough.




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