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60 journalists all spend one week covering Cincinnati's battle with heroin (cincinnati.com)
211 points by carlmungz 8 months ago | hide | past | web | favorite | 134 comments

Let's not forget who to blame for this. Pharmaceutical companies and Doctors.

West Virgina is the most effected - http://www.pulitzer.org/winners/eric-eyre

These articles shouldn't make you sad but MAD.

"In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers" That's 433 pills for every man, woman and child in the state.

Perhaps you could include poverty and despair (and trace back from there to a collapsing education system, ideological pathology...).

It's hard not to see the opioid crisis as anything but an "ensemble effort" of everything that's falling apart in America - punctuated by the refusal of pundits and politicians to acknowledge these problems or move towards solving them.

Edit: you could even say the willingness of drug companies to effectively transform themselves to dope dealers comes as a combination of for-profit medicine and regulatory capture, problems that have been festering for a while.

> Perhaps you could include poverty and despair (and trace back from there to a collapsing education system, ideological pathology...).

It's really not about that -- although that certainly contributes to some drug use.

"The opioid epidemic began in the 1990s, when doctors became increasingly aware of the burdens of chronic pain. Pharmaceutical companies saw an opportunity, and pushed doctors — with misleading marketing about the safety and efficacy of the drugs — to prescribe opioids to treat all sorts of pain. Doctors, many exhausted by dealing with difficult-to-treat pain patients, complied — in some states, writing enough prescriptions to fill a bottle of pills for each resident."

This is not about people in poverty turning to drugs -- this is about people in pain going to the doctor, and being prescribed an addictive, dangerous substance as treatment.

"Over the past couple of decades, the health care system, bolstered by pharmaceutical companies, flooded the US with painkillers. Then illicit drug traffickers followed suit, inundating the country with heroin and other illegally produced opioids that people could use once they ran out of painkillers or wanted something stronger.

"The other opioids arguably pose even bigger risks than painkillers. Heroin is generally more potent, so it’s more addictive and more likely to cause overdose. And fentanyl is even more potent than heroin, and it’s also often laced into illicitly sold heroin without a user’s knowledge — increasing the odds he’ll take a much bigger dose than he can handle.

"The result is that as opioid painkiller deaths leveled off over the past few years, heroin and fentanyl deaths have rapidly increased."


Chronic pain is strongly correlated with poverty and low educational attainment. You can't separate medical, social and economic factors - they're far too deeply intertwined.


You can because some poorer countries don't have an opiod epedimic. For example, opiod use is higher in West Virginia than Mexico.

Certainly true that comparative poverty plays a role but we need to first hold accountable those directly responsible.


Overprescribing is undoubtedly a key part of the problem, but so is poverty. The opioid epidemic is having a vastly disproportionate effect on poor communities, in large part because poor people are vastly disproportionately likely to suffer from chronic pain.

Doctors didn't cause the crack epidemic in the 80s. We can't isolate any single factor, but must consider the problem in a holistic manner. Fixing the problem of overprescribing is a really important step, but the problems of poverty and addiction won't just disappear if we stop dishing out vicodin and oxcycontin.

There are several issues around that association that have little direct connections to poverty rather than more US specific issues. First lack of medical care to fix or prevent the underlying causes of much chronic pain.

The second is a tendency to prescribe opiods to poor populations rather than focusing on less addictive medications. Further, non chronic pain can transform into chronic pain as Opiod uses/addiction increases pain sensitivity.

Combine the above and poor healthcare more directly links to Opiod addiction than you're suggesting.

EX: Mildly Injured > no medical care > working while Injured due to lack of sick leave > more significant problem > prescribed Opiod's vs surgery > addiction.

I should probably use a throwaway, but I won't.

I'm an addict. I was a functional addict, for many years. When I retired, I no longer needed to be functional. Things went downhill quickly. Today, I am on Suboxone. It reduces the harmful behavior.

I tell you that as a way to share that I have some experience.

Anyhow, it was in the early-to-mid 70s when I first started. My first exposure was to codeine and morphine. Those were relatively easy to get. There just weren't a lot of people trying to get them.

Later, I'd relocate and heroin became easier to get. I'd sobered up in the Marines, mostly. But I'd still 'chip' and sometimes get morphine from legitimate sources. Off-base, heroin was pretty easy to get. It was, at that point, largely a drug used in the black communities.

To pay to survive through grad school, I'd return to the military. Again, I'd sober up a bit and sometimes chip, but drug testing was becoming more popular.

I'd get out, finish grad school, and continually using. I was the very definition of functional addict and did quite well for myself. I was always able to provide for my family and never had to beg, borrow, or steal my fix.

Then, the 90s came. Oh, we addicts were in heaven. They were throwing oxy out like candy, to anyone who asked. The prices were so cheap. The street price for an oxy 80 was $5. It was less if you bought in bulk.

It stayed like this for a while. It was like manna from heaven. Nobody used that wasn't already using, and the patients too which they were prescribed. It was not all that bad.

Sometime in the mid-2000s is when it all changed. You could tell that it changed, because the prices for that oxy 80 went from $5 to $80. You can expect to pay $120 for it, today.

I'm not going to speculate about what prompted the change. I'm simply giving a timeline of events.

Now, these prices coincided with the start of them really cracking down on prescriptions being diverted. It is also when I noticed the color of the heroin users skin changing. It was being consumed in the white communities, more and more.

The prescription drugs were, if nothing else, usually not counterfeit and consistent dosages. But, heroin was cheaper and, compared to some opiates, stronger. So, people did the natural thing and switched to heroin.

I'd also notice a lot more folks buying insulin needles. People were junking out all over the place. These people were probably popping pills or snorting pills, just a few years before.

Me? I'd move to fentanyl. I found a reliable source, learned to extract the drug, and would IV it. I can't complain, I had a good time.

Anyhow, part of the trouble comes from the crackdown on consistent quality and dosaged drugs. It's comfortable to place the blame on the pharmaceutical companies, but I think a larger discussion should be had about the right to ingest drugs of your choosing. People are going to do drugs. It seems better to minimize the harm than it does to push the uses into engaging in riskier activities.

Prohibition is woefully ineffective. We have a drug problem because it's not difficult to get drugs. It never will be difficult to get drugs.

Anyhow, there's some timeline and info. If you want to understand addiction, try this: I switched to fentanyl, straight, because I learned that was what was in the dope and was killing people. My thought was that I had to get some of that. And, to be honest, it's pretty damned powerful stuff. It will knock your dick in the dirt and make you feel like you're being embraced in a loving hug.

I'm not really sure what my point is. I mostly wanted to share a bit of the timeline, as I experienced it. I don't mind posting this attached to my username.


Confession time...

At the height of my drug addictions I was injecting methamphetamine three to five days a week, taking benzos to sleep, and Heroin or Suboxone two to three days a week to come down from the meth.

Wanna know what caused me the most suffering: a close brush with the law, narrowly avoiding a drug trafficking trial.

I'm clean ~4 years now. I go to work every day, pay the bills, I bought a house. Fairly normal.

In my opinion one of the major problems with illicit substances is the lack of healthy social norms around any kind of recreational use, having to hide that you're a drug user.

We junkies have a worse PR department than nuclear energy. We're addicts, we're supposed to be degenerate perverts that live under bridges, beat our spouses, and leave our children.

It couldn't be further from the truth, in many instances. Having to hide it, or hang out with those who are more criminally minded as being your junkie peers, probably stems from the illegal nature of the beast.

I'm pretty sure legalization is a good idea. Let's face it, if you want to try drugs then you can get drugs. Drugs are plentiful, that's why we have drug users. Making them legal seems unlikely to create more users. "Hey, heroin is legal! I'm going to try it!" Said nobody, ever.

Actually, now that weed is legal, it's not nearly as much fun growing it.

So, yeah, there could be healthy societal norms, but not while it's illegal.

Related: I'm still not sure why coke users always seem to end up in the bathroom. It can be in a house in the middle of nowhere, but they'll still congregate in the bathroom. I don't mind coke, but crowding into a bathroom always seemed strange.

Thank you for posting this.

You're most welcome. I am not 'clean' in that I maintain with Suboxone. For me, it is about harm reduction.

I'm in a position where I was fortunate. I can say these things with my moniker and not have to worry about my reputation or future employment opportunities.

Most of the addicts that I know wear suits to work. They don't have the luxury to admit these sorts of things.

Hey man. I've got 5 years on Suboxone after 6 years of addiction. Frankly I consider myself clean (and I'm down to 1.6mg this week from 32mg at the start) -- my DOC was always heroin and I've not touched it since beginning treatment.

Anyway thanks for your post. There's quite a few of us in the tech community who battle the same demons, a lot have reached out to me to talk about it when I comment on my experience.

Well, find a way to make it on-topic and post it. ;-)

I expect to be on the Subs for the rest of my life. I'm okay with that.

Tangentially related: It is damned difficult to find a provider who will treat your addiction as well as my doctor. They are just fine with me staying on the Subs and are very much happy with the idea of harm reduction.

It's absurdly expensive, but worth it. They usually do my appointments right in my house. He ensures I can have a ready supply for when I travel. He lets me change my dosage, if I want. Well, within reason. I am under no pressure to taper.

Curiously, I've never had them take even a second look when I roll through customs with a stack of Suboxone. I've never even been asked about it. I leave the country, probably an average of two times per month. I used to just bring fentanyl patches with me. Imagine trying that with a finger of H?

> It's absurdly expensive

How much do you pay?

Mine is $4.50 AUD per day, regardless of dose.

RE. Customs: it depends on where I'm travelling. I get a letter from the Queensland government (signed by the Attorney-General, interestingly) and have zero issues with even months worth of take-home doses.

Downside is, some countries (like Dubai, which I wanted to go over to for a conference) won't let me in at all with it. Oh well, only another 24 weeks and I'm off it entirely -- though I'm not looking forward to my depression returning, its an amazingly effective anti-depressant for myself.

~$300 US/week. $400 for my doctor, but my doctor comes to my house. That also enables me to attend a couple of group sessions that I never go to.

I literally stomped around the planet with forged prescription stickers (they go on the box) on a couple dozen boxes of fentanyl patches, long-since expired insulin (I'm not diabetic), and insulin needles.

The closest inspection that I got, customs noticed that I had no test strips and told me where to get them. I got away with this for years.

That really speaks to the difference between having money and not having money. Nice suit, flew in on first class, costly luggage, paperwork in order, frequent traveler with appropriate length stays, and just about half the legal limit in cash. Imagine the stereotypical junkie trying to do that.

Good luck when you get off. I know this is moving into off topic, but, seriously watch out for the depression. Have someone else note any behavioral differences, maybe? Be mindful of your own physiological cues, perhaps? I don't actually have depression issues, or any diagnosable mental health problems besides addiction, I just like being high. I wasn't treating anything but boredom.

I seriously wish you the best of luck. Email is uninvolved@outlook.com if you need to yell at the wind.

Fascinating and brutally honest comment. Very interesting to see the economic realities and how that moved you to more illicit drugs over time. Do you think the solution is legalization then? If the drugs you needed were cheaper and safer, would that change things? Would the Mexican drug cartels ever permit that?

I am pro legalization. I say we don't give the cartels a choice in the matter. Much of the harm from drug use comes from the illegality of them. Consistent quality supplies would go a long ways.

Tax, educate, and treat.

I use 'safe' drugs, namely Suboxone. I doubt I'd change back to other opiates because I like the protection Suboxone offers me. Namely, I can pretty much only do it. It then blocks the receptors and doing additional opiates is mostly futile. I like that control.

I've heard suboxone doctors are difficult to find, because of artificial restrictions... How did you find your suboxone doctor? (Are you in the US?)

My friend was on Methadone when I met her. After six months she realized she "hated everything about Methadone", which I understand has all of the addiction of heroin but none of the thrill. This is my most recent comment about her: https://news.ycombinator.com/item?id=15024780

I was able to find them by casting a wider net. I live in a very, very remote area. He has a practice that he visits that's not too far away. When he is up, he makes the drive to my house and we chat for an hour, usually over a small meal. Sometimes, I go down to see him but he enjoys the drive and coming to visit me.

I am in the US. I am retired in Maine. I am fortunate in that I sold my business and am financially secure. So, I can afford some of the best medical care.

I've since helped to seed another program, at a not terribly distant medical facility, that helps treat others with addiction problems. It's a bit of a money sink, but it makes me feel good. The provider is a different person, however.

I never liked methadone. Of course, when I tried it last, I was using fentanyl and methadone couldn't come close to helping because my tolerance was so high. Suboxone doesn't really get me high, it just keeps me from getting sick. I am allowed to take enough to get high, but I seldom do. My doctor is pretty cool about stuff like that.

Again, the goal is harm reduction and not strict sobriety. Finding a doctor interested in that was key for me. It took some phone calls, some false starts, and some time. I can't stress this enough - it helps to have money. Insurance would not cover much of this. I pay my doctor in cash. I'm pretty sure I spend more now than I usually did when using illegally.


Would you expect something else? I'm not seeing anything funny about it. The vast majority of harm comes from the illegality, not from the drugs themselves. Do you want to reduce harm, or do you want to impose your morality on other people?

Well since you asked, no, I would not expect something else. Their (your) addiction has affected the organ that they use for making decisions. I would expect an addict to find any way he or she can to find access to more of the addictive substance their now compromised brain demands. Being smart or high functioning only means they can find even more clever and inventive ways of achieving their desires.

You say that the vast majority of harm comes from the illegality of drug use. I don't see any reason to believe that is true. You haven't presented an argument or evidence to persuade me one way or the other. On the contrary, I think addiction is itself harm. It removes the ability to choose.

It attacks the very organ that makes your choices.

You have access to resource, so you can mitigate the consequences of your actions more than others. Remove your resource, or replace it with a $40,000/year salary and a tough service industry job, and the consequences will find you. I think eventually the consequences will find even you, however much resource you have amassed. You should make a pact with yourself to see if in 20 years (assuming you make it that long) you still think your life is as good as it could have been without your addiction.

Do I want to reduce harm or impose my morality on other people?

My answer is YES.

I want to reduce harm by imposing my morality on other people. Any time you vote you are imposing your views on ethical issues onto society. Let's all agree that everyone imposes their own views on morality onto others. You are doing it to me right now, and for that I thank you. Let's duke it out in the public square. If you convince more people with your arguments, your views will be codified into law. If I convince more people with my arguments, then my views will be codified into law. This form of reasonable discourse is how we avoid solving our issues with violence.

Look up the studies for areas where it is decriminalized and areas where certain drugs are legal. Portugal would be a good place to start. Let Google be your guide.


No, I expect you to do the work on your own. I gave you some keywords. Good luck.

Sorry you're being downvoted. It's not me that is doing it. HN doesn't allow it, but I'd not do it anyhow.

I understand what you're doing, shifting the work to me, but it is generally courteous in a discussion to provide an argument to support your points. Why should I do the work for you and then let you sit back and pick at my arguments? I am not making a positive statement either way on the issue. You are the one that has made the assertion that illegality of heroin is the primary causal factor in it's being harmful, so you are the one that has the onus to provide supporting evidence for your claims.

I'm being downvoted because I started this off being snarky and, frankly, an ass to you. I think my points are still valid but it's not a kind way of communicating them, and for that I apologize.

If I was given an infinite supply of free heroin and all the time in the world to sell it to my neighbours, friends, family, workmates and anyone else in the locality then I would struggle to make a sale. My client base would be zero and I would have to go back to the day job.

If you rewind America to before the opioid epidemic then that would be the situation for anyone aspiring to sell heroin in normal America. The demand would not have been there, you would need to get a sizeable community onto crack cocaine before they need heroin too.

The prescription drugs and how that worked out has changed the demand side of the situation. So it is not a matter of some external evil drug kingpins dumping vast quantities of cheap heroin onto the innocent U.S. market, it is more the vast quantities of Americans doing whatever they can to get their fix.

Err... Heroin was available before the current epidemic. It was easy to find. There were plenty of sellers and users.

It may be that you are not a user? However, it was there and easy to find. A user can spot another user, though I'm not sure why. They look just like normal people, to you. Most users aren't homeless and dirty. They have jobs and houses. They have cars and families.

Heroin has been here for a long, long time. The dealers were making money for as long as I've been alive.

Source: Me. I started using in the 70s.

You may find it hard to believe but I've been around heroin all my adult life as well (though not using). I've seen a lot of people die, whole groups of friends and so-forth.

Certainly you have the fully functioning addicts. But you also have a lot of people driven by despair.

Plus - the fully functioning addicts functioned a lot more when the economy functioned. Heroin, at the minimum, is one more heavy ball to keep in the air for a person juggling a lot in their lives. The state of the economy today guarantees people are going to be dropping those balls on the ground.

So is it the economy make the addiction problem worse or is it that the economy makes addicts die and we see the problem more? Hey, I bet neither you nor I nor the social scientists can figure out for sure - what with the replication crisis and all.

I am not sure what causes what. I also have a bit of a different view than some others. I've never had a habit larger than I could afford.

I can't speak to the experiences of others. The point was, mostly, that heroin has been readily available for a long time, well before the current epidemic. I can be dropped into most any city and score within a few hours. I don't even have to speak the language.

I am not sure what causes what.

Well, if you mean whether misery 'cause addiction or addiction causes misery; given that people actually vary a lot in how they react to things, I'm pretty sure that each causes the other some significant part of the time. And maybe life out-of-control just cause habit out of control. But if so, "same difference" as they said in the eighties.

Add peer pressure causing a lot of this too.

> If I was given an infinite supply of free heroin and all the time in the world to sell it to my neighbours, friends, family, workmates and anyone else in the locality then I would struggle to make a sale.

I suspect you are being naive.

While heroin isn't a popular drug, it's not exactly rare either. Especially among the "artist" community, it has always seemed to be fairly common. Guitar players seem to particularly gravitate to it--and not just the "hard core" ones. (See: Emily Remler http://www.allmusic.com/artist/emily-remler-mn0000800814/bio...)

The war on drugs did NOT help. I remember one musician saying (paraphrased) "They lied to us about pot and it was fine. So we assumed they were lying about heroin--WRONG! Heroin is every bit as addictive and dangerous as they claim."

Politicians and pundits mostly live in coastal megacities. Everything is fine there. Why do they not eat cake?

it goes further, though. I think folks in the states wind up working and doing other things well before they are healed enough to do so because of lack of job security and lack of paid sick leave. This puts folks in more pain, furthering the cycle.

Yeah, my point isn't that I have calculated the X factors leading to the opium explosion but that the causes are multidimensional and economic insecurity combined with rapacious companies magnify all the other factors.

"a study shows that drug manufacturers paid more than $46 million to more than 68,000 doctors over a 29-month period." https://news.brown.edu/articles/2017/08/opioids-influence

"Most recently, the FDA announced that it will begin reviewing prescription opioid products that contain hydrocodone or codeine to treat children's coughs."


When they are writing pop songs about it, it's probably time to do something...


GlaxoSmithKline to pay $20 million to settle U.S. foreign bribery case. http://www.reuters.com/article/us-sec-glaxosmithkline-corrup...

McKesson paying $150 million in prescription drug probe, halting sales from Colorado center. https://www.bizjournals.com/denver/news/2017/01/17/mckesson-...

Several pharmaceutical executives and managers, formerly employed by Insys Therapeutics, Inc., were arrested today on charges that they led a nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud healthcare insurers. https://www.justice.gov/usao-ma/pr/pharmaceutical-executives...

Galena Biopharma Inc. to Pay More Than $7.55 Million to Resolve Alleged False Claims Related to Opioid Drug https://www.justice.gov/usao-nj/pr/galena-biopharma-inc-pay-...

National Health Care Fraud Takedown Results in Charges Against Over 412 Individuals Responsible for $1.3 Billion in Fraud Losses. "Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics."


That's crazy, if this is because of doctors, that shows $280 a year is enough to substantially influence a doctor making 500-2000x that.

I suspect most receive less than 20 dollars worth of free pills. Vacations and cash payouts to the doctors who prescribed the most is usually the game.

I know everyone pictures the kid with a broken arm getting it set when they hear about socializing medicine, but all I picture is the US paying large corporations to make more people OD on opioids.

One factor is that if you're on disability/Medicaid, you can get $1000 worth of Oxycontin for a $3 copay.

Those pills in turns have a street value of $10,000.

This stream of federal drug money is¹ one big driver of the opioid epidemic. In some parts of the country, a huge part of the population is on disability, and it's hard to say no this kind of money.

¹ Or at least was. The system has probably tightened a bit the last 5-10 years.

We don't have socialized (single-payer) medicine but we are still over-prescribing painkillers. Why do you think socializing medicine would change this? Do countries that have single-payer healthcare have more or less problems with heroin and prescription drug abuse?

less, for several reasons

- in the US system, treating symptoms instead of the underlying cause is easier for the doctor and more profitable in the long run.

- "an ounce of prevention is worth a pound of cure"; less patients that wait until pain is unbearable (due to its cost) which then need different treatment.

- less conflict of interest that affect what doctors prescribe

- there is only one buyer, with a strong negotiation position, potential profits are capped

Many of these points apply to socialized medicine as well. Take Germany for example:

- "an ounce of prevention is worth a pound of cure"; less patients wait until pain is unbearable and as a result doctors are inundated a lot of mildly sick people (who probably didn't need a doctor).

- Treating symptoms instead of the underlying cause is easier for the doctor who is inundated with people that have mild sniffles and aches.

Hence, a lot of my German friends were prescribed "spa time" in the hopes that it would clear itself up before getting a "real" prescription if spa time didn't work.

Also with one buyer they are more keenly aware of when one particular drug or class of drugs spikes in usage.

1 in 3 Americans are prescribed opioids in any given year. 80% of the world opioid supply is consumed by the USA.

I can't say whether opioid prescription rates have an inverse relationship with single-payer healthcare, but the USA has astonishing rates of opioid prescription compared to the rest of the world.

I believe countries with single-payer healthcare have less problems with this, but they also have very different cultures around the amount of healthcare and drugs they provide. I can't see it being politically viable to impose single-payer-style restrictions on access to healthcare in the US any time soon.

Also, the US does more drugs, per capita, than the rest of the planet - unless those numbers have changed recently. It's probably a cultural thing, in some regards. We love our drugs.

Because there would be an endless supply of government money for rehab centers. Already the ACA has spawned an entire addiction market in Florida.


I'm sure the US could mess it up that badly, but it doesn't have to be that way.

Really? Take a look at everything else the federal government does and tell me it could possibly end up being anything better.

Sure, but that's the choice of people electing anti-government wreckers and crass opportunists, like that guy charging his security detail to stay in his own hotels. It's also the country that went to the moon. Your choice.

The US is not the country that went to the moon. That was their grandparents. The US is their poor, obese, undereducated, and overconfident offspring.

Two doses of Narcan in the USA is $75.

Three doses of it here in Brisbane are $5. You're right to blame the pharmaceutical industry.

People abuse that stuff when life sucks.

So widespread opiate abuse is a symptom of a "sick society", right?

> People took such awful chances with chemicals and their bodies because they wanted the quality of their lives to improve. They lived in ugly places where there were only ugly things to do. They didn't own doodley-squat, so they couldn't improve their surroundings, so they did their best to make their insides beautiful instead — Breakfast of Champions

Holy crap that's insane. That's 72 pills per year for each man woman and child.

The US uses more than 99% of the world supply of hydrocodone.


Having recovered from surgery both with- and without-hydrocodone, it's not hard to understand why. It works really really well as a painkiller.

I hope there is a solution that can address addiction and abuse without eliminating the drug itself. A less judgmental approach than spiking it with acetaminophen which just makes abuse do even more damage.

I have similar mixed feelings about prescription stimulants. They work, but a lot of people end up abusing them.

I've seen this stat repeated quite a bit, but a person with chronic pain might take 2-4 pills a day right? Assuming 28 pills a week, that figure doesn't seem as crazy. Perhaps this is an insane quantity, but it feels like a stat that could be made to sound scarier than it is by using proper vocal intonation.

I see the point you're trying to make - but have you ever taken 2-4 opiate pills per day for over a couple weeks at a time? This has a terrible ravaging effect on your body. It's not good for anybody, regardless of how much pain they are in. Furthermore, opiate tolerance goes up very quickly and that 2-4 pills can turn into 4-8 very quickly.

If that were really true, the drug distributors would not be settling with the state.

Payback from the Afghanistan War ?

Let's not forget who to blame for this. Pharmaceutical companies and Doctors.

It's almost certainly not true. This massive susceptibility to addiction is a larger social problem of alienation, lack of community and purpose, not getting a couple of pills from your doctor.

Prohibition worked to some extent and would work tried again but it does not address the root problem.

It almost certainly is true. Doctors in the US overprescribe opioids like you wouldn't believe. They do this as a result of Purdue Pharma's super expensive marketing campaign designed to stamp out "opiphobia" -- a term they used for doctors unwilling to write out opiate scripts.

As a side benefit, they re-engineered the "slow release" version of the tablet. Except it didn't release evenly over 12 hours, like it said. Instead, it led to withdrawals towards the end of the period, which taught a user's brain the ups and downs of withdrawal -> high -> withdrawal. IE, it conditioned them to become addicted.

When you instruct people to wait 12 hours between taking painkillers that last 8, you will reliably get them addicted to painkillers. The on/off whipsaw of the medication will do that.

Sure, the social ills exacerbate the problem. But a lot of it is pure physiology.

>>not getting a couple of pills from your doctor.

You're gonna have to back that claim up. All the evidence points to the claim that over-prescribing is a real epidemic.

You're not wrong that there are larger social problems, but your argument essential boils down to "drugs addicts are drug addicts". The root problem is not being born a heroin addict, or not having a purpose in life, or not having a strong community. It's over prescribed pain medication pushed onto people for profits sake.

"Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014,1 but there has not been an overall change in the amount of pain Americans report.2,3 During this time period, prescription opioid overdose deaths increased similarly." https://www.cdc.gov/drugoverdose/data/prescribing.html

It's a famous story/finding. Vietnam soldiers who were actively addicted to heroin and came back to the States simply stopped.


Obviously you can only become addicted to what is available and opiates are being made available through prescription. But the fact that so many people are susceptible to addiction is a completely different problem.

The huge social changes of 19th century led to the same problem with alcohol. And well meaning activists did try to solve it by banning alcohol. Prohibition did work to some extent. But what really made a difference was an improvement in people's lives, a change in the environment for the better: more rooted, connected communities, less financial stress, migrant work, etc.

Drug addicts are addicts because of their environment first and drugs second. (Some genetic disposition exists as well, of course.)

Not attacking you but do you think cigarette companies are liable for smoking addiction?

My biggest problem with Pharma on this is that Oxy is 100x (?) more likely to get someone addicted than Tylenol 3 with Codeine or maybe even Morphine. I think part of selling Oxy should be a mandatory tax that goes to pay for opioid addiction.

A tax on who? The taxpayers that are paying for Medicaid to pay the drug companies?

Healthcare in America is disgustingly perverse.

No, I meant treat it like casinos are. A tax on revenue that specifically goes to pay for addiction.

I was born in Cincinnati, and lived there for 18 years until going to Ohio State. Today I live on the peninsula.

I'm here in Cincinnati now, for family stuff. And I'm concerned. Cincinnati still has a large industrial component (P&G has their HQ here), but many factories are gone. A lot of the east side of the city has been converted into microbreweries, homes, and shopping. My Mom works at a biomedical company that's growing. Gigabit FTTH for residences is available.

I'm still concerned. Property taxes have grown beyond reasonable limits. There are so many areas that are not benefiting from the improvements being made. There is culture being destroyed by rising rents and gentrification. And the pain killer/opioid epidemic gives a perfect path to "release".

Case in point: Today I met some relatives at a brewery for lunch. But my Aunt had a problem ordering: They send a text message when your order is ready to pick up, and she doesn't have a mobile phone. The place was all stools and tables; if we had invited my grandfather, he wouldn't have had a place to sit.

There are good places and people though. I'm here to attend my grandmothers funeral. In addition to my boss, two of my relatives also had flowers sent by their place of work. On the day we were doing planning, my uncle suddenly shows up: My uncle builds furniture; he was sent by his place of work to pick up some big sandwich & pasta platters, and drop it off to my grandfather. All paid for.

I'm rambling. The point is: There is so much good here, and it is so at risk. And sometimes I think that if I moved back here (either working remotely, or finding a similar job locally), that I would just exacerbate the problem.

I Also grew up in cincinnati. You've probably seen signs with my last name (Neyer) on them, as my family has been there a while. Also live in the bay area now. Cincinnati really was like a small town; people did seem to look after each other.

I think if people like us moved back there to work for other tech companies, we'd exacerbate the problem.

If we moved back and started companies that employed low skilled labor, we'd make things better. If we could end the pointless war on drugs, and spend that same money repairing infrastructure, we'd be way better off.

Our old system is breaking down. Unfortunately i think it'll have to get worse before it gets better.

I live in Cincinnati. I don't think gentrification is responsible for the opioid epidemic. I would blame the increase in the supply of opioids and structural changes to the economy. Plenty of places without gentrification (rural Indiana) are being hit even harder.

I'd also disagree that moving back would exacerbate the problem. A higher tax base would help the city to better combat the problem. You could also donate to non-profits or volunteer.

Another Cincinnatian, now living in the Peninsula.

Just to nit-pick one part:

> I'm still concerned. Property taxes have grown beyond reasonable limits.

There is some truth in this, but only because property taxes are a weird beast; a combination of one of the worst taxes (a tax on one's home) and one of the best taxes (the tax on the unimproved value of land).

In a land-poor place (bad neighborhoods in the rust belt, say), the property tax lies mostly on improvements, and tends to hurt the most vulnerable.

However, we see how in a land-rich place (the Bay Area), a crippled property tax, in the form of Prop 13, has devastated the land market.

Well, that's all I have to say about that. Love Cincinnati. Hate the peninsula.

> They’ve tried spraying naloxone into his nostrils, but it’s had no effect. He’s not breathing. They’re running out of time.

> One of the medics takes a drill out of his bag and turns it on. It whirs like a dental drill as he pushes it into the man’s shin bone, trying to create a more direct path for the naloxone to enter the bloodstream.

Wow. Just wow.

edit: more info, I'd never heard of it: https://en.wikipedia.org/wiki/Intraosseous_infusion

Pretty cool huh?! They used to have to auger the bit right into the bone by hand. As you can imagine, trying to twist them into the bone while the patient is alive is not easy. Also, once you punched through, there was usually enough momentum and force by the MD's hand, that they would then punch on through the other side of the bone and then right into their other hand that was stabilizing the procedure. Now you had two patients instead of one. Many MDs would really hesitate in doing it, as expected. These little sterile and disposable drill have saved a lot of lives. These are a 'poster boy' of modern bioengineering in general.

We place intraosseous (IO) lines as a crash line during cardiac arrests when we don't already have adequate access. Done right, they permit resuscitation without as much delay as gaining central venous access would require.

>Heroin is big business, but not for the Mexican immigrant Reagan is tailing today. He’s just a suspected courier who might make $500 or so. The real money flows to the gangs that control distribution, and to the drug cartels back in Mexico.

>When they finally pull him over, police rip up the floor boards and dig through the driver’s back pack. They check the bumpers and the trunk and look for secret compartments in the doors.


>Reagan is frustrated. There have to be drugs in that car, he thinks.

Wait, they pulled someone over and destroyed their car over nothing? I hope they had some really solid evidence, but the article didn't say.

>The agents don’t have time to dwell on what went wrong. About 7,000 kilograms of heroin are seized in the United States every year, three times as much as a decade ago. They will be hunting someone new tomorrow.

Oh, okay then. They don't have time to dwell on what went wrong.

> They don't have time to dwell on what went wrong.

But damnmit the bigger issue and what I'm really mad at is people protesting Police abuse! /s

It's absurd how skewed this country has become in the "Police can do no wrong" mentality.

When spoken in the abstract people are quick to say of course there is corruption and things can be improved in policing. But when it comes to specifics or even specific instances popular opinion and the justice system never fails to side with the police.

And no, it's not just the conflict of interest for prosecutors that's at issue. We have a serious issue with the role of Police as public servants in this country.

The (deliberate) pendulum swing to overly idolizing soldiers post-Vietnam, the declaration that police were now in a war against an inanimate object (drugs) including equipment and tactics, and the "otherization" / racial aspect have really made a perfect storm that is has now begun to spread out to society at large.

Hmm, I do agree with you but when I read that I read that as literally meaning "these police officers have no time to dwell on whats wrong".

With that many deaths and overdoses in just one week a lot of these departments are pretty taxed. A lot of these guys are doing the best they can with what little time they have and showing compassion where they can.

Fortunately for those battling these addictions I suspect, this epidemic is touching people the police know and care about. When it's not quite literally a black and white issue (or latino and white), and when the victims look like the officers or their friends or family, I think you see a bit more compassion.

But boy are a lot of these places just plain overrun with calls these days.

Hopefully one day we'll see more compassion for every citizen and I'm hopeful we're slowly but surely moving in that direction. I dunno what it is I just have a decent amount of faith in America's ability to generally move forward over time.

Man, some of those stories were really heartwrenching.

> I dunno what it is I just have a decent amount of faith in America's ability to generally move forward over time.

So with this, you just happened to touch upon an only tangentially related strongly held opinion of mine. So I'll rant for a sec: It is my strongly held belief that society and life does not just get better over time. All of the improvements we've seen in society have been from people fighting incredibly hard against entrenched systems in order to improve live for future people. Rights to vote for women and minorities, child labor laws, ending slavery, workplace improvements, anit-discrimination laws. Absolutely none of those improved "with time". All of them involved difficult, confrontational and frankly uncomfortable fights to improve society for everyone.

I think your view (and i'm not selecting you) is endemic in a lot of people in this country (particularly younger generations) that think life will improve if we just sit back and do nothing and give it time. This has never been the case in American society. People have been pushing hard to improve society and I really feel like a lot of people now have a view of "just wait and it will just happen". I personally believe this is an extremely misguided and hazardous view.

I'm definitely not looking to start an argument about it, but I do ask people to think of any major social improvements of the last century+ that didn't involve a large associated active social fight for it. Without people pushing us forward systems and societies calcify and then begin to rot.


On the topic at hand I absolutely think the majority of police mean well and are trying to help. However I do think as an broad generalization - as an organization police departments (and their unions) don't take feedback well, often work to defend/justify their actions rather than find ways to improve, and have a view of being above the law or that they should be granted exceptions because of their circumstances. This makes it difficult to root out those offices who condone and commit bad behaviors.

There is a reason why teachers choose goodie-two-shoes types to be hall-monitors. When given power over others, people need to be held to an even higher standard of behavior, vs be granted exemptions from rules/laws/accountability because of their job. Everyone should feel 100% at ease and trusting of their encounters with police. For whatever reason in today's society a lot of people justifiably don't feel that way. And we as Americans should make it a priority to fix that. Police and society should be on the same side - both against criminals.

Oh yea. I absolutely agree with you. My faith is in the American people to continue fighting.

Also, in a lot of places officers are carrying narcan and saving lots of lives. Maybe that's the best thing these guys have done in a long time.

Yeah, it's just a terrible situation all around. I'm sure the cops don't go after innocent people just to spite us, but they are clearly overworked and lacking acvountability. And it shouldn't be their job to deal with all of this, anyways. It's a public health issue.

It IS absurd and I'm with you in thinking it is a perfect storm. Possibly even a fundamental crisis of freedom. My latest tactic is to label these people "copsuckers". It makes me feel good anyway.

Labeling people does nothing to help change the situation other than alienate people from agreeing with you and understanding that things need to improve.

That's often very wise, but sometimes a well-placed label or even insult gets a person thinking. In this case, it's a thought like, "Why do I have this cop in my mouth?"

Shocking to read. But what really shocks me is the amount of arrests mentioned for possession of heroin or syringes.

When will the US (and the rest of the world) finally learn that locking users up just perpetuates the problem - you won't get a job with a criminal record, same for housing. All this arresting does is fill the coffers of (private) jails and creates needless suffering.

Also, why do people keep calling the cops on relatives and friends who OD? That just makes the problem worse. In fact, it should be made illegal to arrest anyone when emergency services are called to an OD, and this must be publically announced. People rather let other people die than save their lives because they're afraid of jail.

> She’s part of a protest against Butler County Sheriff Rick Jones, who won’t let his deputies carry Narcan. He's the only sheriff in southwest Ohio whose department doesn't use it. Two doses of Narcan cost about $75.

And, what kind of person is this moron? He should be in jail for willfully preventing deaths!

> “Either she got a new dealer, or her dealer hosed her,” a paramedic says.

Yet another case for why it 'd be really necessary that the state provides drugs like heroin, with proper quality control. So many deaths and near-deaths that could be avoided.

>Also, why do people keep calling the cops on relatives and friends who OD?

They probably call 911 in the US, and the dispatcher is deciding who to send. Is there something that suggests otherwise?

Separate from OD cases, though, friends and family DO often try to turn in loved ones. Addiction often turns your loved ones into genuine risks for other family members. And, sadly, jail is often the only existing place to send them if you can't have them in your house.

> They probably call 911 in the US, and the dispatcher is deciding who to send. Is there something that suggests otherwise?

Ah, that explains it. In Germany, it's split - 110 calls the cops, and 112 medical/fire services.

> And, sadly, jail is often the only existing place to send them if you can't have them in your house.

It's a short-term fix, unfortunately. People suffering from addiction issues should not be in jail, they should be in a medical facility or whatever, as long as it does not appear on background checks.

>It's a short-term fix, unfortunately.

Agreed. If there were a reasonable alternative, people would use it. There's not really anything like that in the US. The private institutions for addiction are shams. They exist to drain your insurance for 1 to 2 weeks, then boot the patient out until the insurance renews again a year later. They do nothing to fix addiction...just milk it for money.

Families calling the cops is absolutely essential when the addicted person is harmful to others and refuses to get help, even if for understandable reasons (like fear of withdrawal). Hopefully the courts would offer a choice to get themselves interned into a rehabilitation house, like they do here, but that's a second step.

It took me eight months before I spoke to the police about a friend's addiction problems, plus a child protection issue (dealer selling crack and living life as a single mum). Looking back on it now with all the excuses I made for them, not talking to the police was enabling the habit. I thought I would never have reason to report a friend to the police, I could not imagine not being in that situation. You have to go a long way before you go to the police and out of love for someone tell them everything you know in the vain hope that the situation can change. Prison is better than hell or death. We tried other 'rock bottoms' but there is an end to the road plus you do have a responsibility to do the right thing, if my friend died and then I thought of the eight months that I sat on the fence, how would I feel then?

Not going to the cops about class A drugs is enabling. As per the law it is that intent to supply that is the detail, people buying these things are on it, they aren't accepting a cup of coffee at a friends, they are buying it.

There is shock and horror seeing someone die of addiction and this also stymies one's efforts to go to the police about the situation.

> When will the US (and the rest of the world) finally learn that locking users up just perpetuates the problem...

I couldn't agree more with you on this point, but the point in this article when a sentenced addict chose jail instead of treatment nearly made my jaw drop. A lot of these people are simply hopeless.

> “You’re not going to change me,” he says.

To your point of state-provided heroin, I hope that more conclusive data comes out about safe injection sites soon. People are antsy about them getting installed in Seattle but I feel like it's simply time to try something.

> A lot of these people are simply hopeless.

I can certainly understand his motives: being in jail for 6 months means you have safe housing for 6 months, don't need to scrape together money for food in that time and if you end up in a jail not run by a disgrace like Arpaio or by a greedy corporation you have the chance to receive some medical care.

The core problem is that the hopelessness that is driving people to drugs in the first place won't be gone. The rust belt jobs won't come back, and either politicians find an alternative or they're going to have a drug pandemic more sooner than later.

> To your point of state-provided heroin, I hope that more conclusive data comes out about safe injection sites soon.

In Germany we call them "Druckräume". Effective at keeping needles off public spaces and getting help for ODed people, but I don't know if there's anything in English about them.

I’m surprised that drug use is normalised to the extent that you can say with a straight face that the state should provide heroin.

I’m not in favour of punitive measures, but the state providing it? Really? I’d also like to see data on providing a milder form of an opiate working better to wean people off a dependency.

So far, all I’ve seen is the dependency switching to the replacement.

> I’m surprised that drug use is normalised to the extent that you can say with a straight face that the state should provide heroin.

People won't stop doing drugs, so it is more than justified to try to reduce the harm done by having people rely on street dealers:

- wildly fluctuating dosages, leading to ODs

- "stretching" agents, from harmless herbs in weed over rat dung to fentanyl in heroin (which doesn't mix evenly so you end up, from the same supply, with one dose having vastly more of the stuff than the other) and their associated side effects

- massive amounts of cash (2010: 109 billion dollars per https://www.bloomberg.com/news/articles/2014-03-10/more-pot-...) funneled to the black market. This "competition for cash" creates violence by itself (e.g. gang turf wars), creates massive incentives for bribery (if I were a customs agent, I don't know if I'd say no to a million dollars for letting the occasional shipment through), directly funds wars and destabilizes countries (e.g. Afghanistan, Mexico) and also increases the amount of crimes the users do in order to afford a dose (e.g. if a user needs, for the same amount of heroin, to rack up 10$ vs 1000$, then the amount of crime he has to do in order to get said money is reduced massively)

> So far, all I’ve seen is the dependency switching to the replacement.

Better have the money flow to the state in form of taxes and (in a fully state-provided drug regime) revenues, than in the coffers of hardcore criminals.

Normally done in the form of methadone. It's not great, but it's better than death or inprisonment.

Suffering is a business. Perpetuating the problem is synonymous with guaranteeing future revenues.

ibogaine. saved my life. it's sad more people don't know about this miracle. even sadder that government has chosen to outlaw the best available treatment for addiction that exists.

please, if you or someone in your family suffers from drug addiction, especially heroin, please investigate ibogaine. seriously, just google it.

The fact that ibogaine, a drug with little if any neurotoxicity, is a Schedule 1 drug in the U.S. while millions of opioid pills get handed out every year to hopelessly addicted poor people makes me very, VERY upset. Does your government care if you live or die?

Only if you are an embryo.

What country are you in? In most Western countries, embryos are pretty much fair game.

I think it's a dig at the US Republican Christian Right, whom are "Pro-life" but anti-"taking care of that, or the mother's, life." Considering Republicans control the majority of all three branches of government, they have an opportunity to ram through their unpopular ideological agenda.

Disclaimer: Neither party is currently relevant to the average US citizen. People ought to seek post-partisanship and post-identity to side-step divide-and-conquer polarization and unify to attack the corruption.

> Disclaimer: Neither party is currently relevant to the average US citizen. People ought to seek post-partisanship and post-identity to side-step divide-and-conquer polarization and unify to attack the corruption.

Horseshit. Both parties are NOT the same and one is quite relevant to the common citizen.

For example: One party has been attempting to fix healthcare; one party is attempting to dismantle it.

That's REALLY FUCKING RELEVANT to the average citizen--especially in red states--especially in states with an opiate epidemic.

One party is attempting to legalize some drugs; the other continues to want to throw everybody in jail. I can go on.

There is no such thing as "post-partisanship" until the Republican party starts operating on truth and fact, again.

Could the Democrats be a lot better? Sure. However, I don't see Democrats assaulting people and still hanging onto their office. Weiner and Spitzer got chucked out of office for far less.

Come talk to me about "post-partisanship" when Gianforte isn't in office anymore. Until then, I am quite free to assume that Republicans actually SUPPORT the current level of corruption.

Another helpful plant that maybe is more easily obtainable is Kratom. I don't personally know about using it for opiate/opioid addiction, but many anecdotal accounts on r/Kratom

Did you get it through an Rx from a doctor?

Wow, just wow. As someone not affected by the heroin epidemic, this was very hard to read. I was almost brought to tears at how many stories involved children of heroin users and how their lives are affected.

The children celebrating a birthday in a time-limited jail room got me. They're a similar age to my own children. It's probably far better than a lifetime of health issues, but it seriously saddened me that those children didn't get to do that at their pace, in their family home, without third-party supervision, with friends, etc. Their "normal" gets entirely defined by mistakes of their parents compounded by their parents' inability to control that mistake.

I thought I was also not affected by the heroin epidemic. Last week my son's best friend's mom died in a heroin related incident. They're in first grade (6 years old). Heartbreaking.

For anyone who may be struggling with chronic pain and/or opioid addiction, I implore you to research kratom. As far as anyone can tell, it is safe, minimally addictive, and in my experience it is good for head pain, stomach pain, anxiety, minor depression, not to mention potentiation of all kinds of other drugs.

Of course, use at your own risk. It may interact dangerously with many compounds, because it inhibits the cytochrome p450 enzyme. That said, after a six month up to three times a day habit, I've quit cold turkey twice without too much trouble.

I recommend I highly if you're out of other options.

One last warning, do not buy in person, you will be ripped off. You can get 250g for less than $30 online, and a dose for pain is 1-2 grams. Higher doses are mildly psychoactive, but OD is anecdotally impossible because you quickly become nauseaus and throw the powder up if you take in excess of 8-10+grams.

I'm seeing lots of addicts wandering about Portland, OR. I read your comment with interest. I wonder if someone distributed this to addicts on the street if it would make a difference. I feel very helpless in reclaiming our city from an addiction crisis.

There are numerous anecdotal reports online of heroin users using kratom to kick the habit. At the very least, one can be functional on kratom, contribute to society, and withdrawal shouldn't be terrible enough to motivate violent crime.

Kratom saved my wife's life. She has suffered chronic pain* for the past few years. Literally near suicide from it, but doctors wouldn't prescribe anything, because they couldn't find anything wrong. We are still looking into the reason she's in such pain, but at least she has something that allows her to live not confined to the bed all day put of agony. She's finally moving around again, doing the dishes, etc.


Read all the timestamps this morning. It's a sobering view on something we are already aware of. Not sure how this issue rids itself. Circling back on my gratitude to be healthy.

Wonder if anyone will see this, but I have a general question I might as well ask here.

What if, you put an addicted person in a padded cell, and supply progressively decreasing doses of the drug(s) the person is addicted to?

The dosage gradient could be mathematically computed to find the lowest possible harmful withdrawal effects.

The person would stay in the cell environment until completely past the hardest phases of withdrawal (however long this takes, whether days, weeks, months(?)), but they would be free to move around (within the secure complex) as they please, and have limited access to technology (anything enabling communication would be heavily vetoed, but eg unlimited access to a video library could work well).

It seems that the current models in use depend entirely on the will of a person who is heavily compromised. I honestly have to say, that seems fundamentally and ridiculously broken, and yeah, even suspiciously so: it's so obvious that this approach is not going to work for most, so why does every "treatment center" continue down this path?

The only caveat I can think of with the suggestion above is about the violent phase of withdrawals, and sedating a person enough when in that phase so they can eat/drink/etc. (I'm not sure how long it is - I vaguely recall it's just a couple of days right?)

Also, about the padded room - I'm not talking "psychotically mad-proof" padding, but just enough for this context. Obviously that's going to change per drug and person, and maybe thick padding is what would be required.

I'm just thinking about cost here (cost of sedation and padding), because I know that a) everything health-related in the US seems to attract the most markup and overhead in any field in the world, and b) because (as per my notation that the current model is _suspiciously_ broken) I wouldn't be surprised if anyone who tried this would find it mysteriously hard to get funding.

On the other hand, I must admit that I've never really tried to find out if this idea has been attempted or not. Would/does it not work?

I am doing a version of this myself (minus the padded room), using buprenorphine under the supervision of an excellent case worker and doctor. It's taken 5 years, but I'm down to 1.6mg from 32mg at the start, and 24 works in the future I'll be off it entirely (and taking a month off to go down to my family's holiday home on the beach here in Australia, for the final withdrawal symptoms).

One weird thing: even with my much lower dose, the acute withdrawals every morning are mostly the same. A little less bad, sure, but still rather terrible. I just put up with it, because it's better to be productive and able to move forward with my life after 6 years of heroin addiction than go back to where I was.

Interestingly, opiate replacement therapy done with heroin itself has had quite good results. The downsides to buprenorphine and methadone is that the withdrawals are rather "drawn out" compared to heroin and morphine. The upside is that the fact they last so long in terms of binding is what makes them excellent at stopping a user from bouncing back and forward between the two (in theory anyway; a given users metabolism means this isn't always true. I could've easily used heroin any time during my treatment as I metabolise bupe and methadone extremely rapidly -- I just chose not to. It wasn't worth it.)

> I am doing a version of this myself (minus the padded room), using buprenorphine under the supervision of an excellent case worker and doctor.

Wow, that's absolutely awesome.

> It's taken 5 years, but I'm down to 1.6mg from 32mg at the start, and 24 works in the future I'll be off it entirely (and taking a month off to go down to my family's holiday home on the beach here in Australia, for the final withdrawal symptoms).

Niiice. (I'm actually in .au too (Sydney area), I agree that some of the beach environments are really nice. Cool.)

> One weird thing: even with my much lower dose, the acute withdrawals every morning are mostly the same.

Hah. I figured it might be like that! (Unfortunately!)

> A little less bad, sure, but still rather terrible.


> I just put up with it, because it's better to be productive and able to move forward with my life after 6 years of heroin addiction than go back to where I was.

Indeed. And kudos for having the strength - as I said in my previous comment, not everyone has the willpower to strong-arm a rewired reward center into doing things completely differently.

Survival of the fittest :D

> Interestingly, opiate replacement therapy done with heroin itself has had quite good results. The downsides to buprenorphine and methadone is that the withdrawals are rather "drawn out" compared to heroin and morphine. The upside is that the fact they last so long in terms of binding is what makes them excellent at stopping a user from bouncing back and forward between the two (in theory anyway; a given users metabolism means this isn't always true. I could've easily used heroin any time during my treatment as I metabolise bupe and methadone extremely rapidly -- I just chose not to. It wasn't worth it.)

I see. Yeah, buprenorphine isn't heroin. It's very good to distance oneself.

So... when you say buprenorphine works great in terms of binding, I get the impression that you mean that the effect lasts longer, and that it is needed less frequently? That would have helpful practical ramifications, yeah.

> So... when you say buprenorphine works great in terms of binding, I get the impression that you mean that the effect lasts longer, and that it is needed less frequently? That would have helpful practical ramifications, yeah.

Exactly, yeah. For most people it will "hold" them for 24-48 hours. Unfortunately for me, it only holds me for about 12, but that should hopefully mean that my final withdrawal symptoms are more acute and less drawn out.

I'd rather a week or two of agony than months of less-intense but still terrible shit!


This is a duplicate of an earlier post:


Which has the exact same URL:


Is there a bug in the submission system?

If a page was recently submitted and didn't get many comments people can repost it.

as a Lyft driver in Cincinnati, this is really making me rethink my main source of income

most of my passengers during the day are lower income, and while I personally haven't had any major issues there are definitely times when I'm glad certain passengers are out of my car. I feel like if the drug problem is really this bad, it's only a matter of time until one of these stories is in the back of my car

Does anyone know of anyone using the drugs listed here (ibogaine was one) to help addicts? Because of the FDA, is this something illegal? It would be fascinating if cryptocurrencies permitted a black market for drug trade that allowed concerned citizens to buy these drugs and distribute them to addicts without fear of interference by the federal government. A silk road that we could all stand behind.

Anecdotally, the three people I know/knew who used ibogaine to get "clean" failed to various degrees. It truly seemed to help each of them to begin with, but after about 6 months each one of them relapsed -- probably due to the lack of counselling and dealing with the original reasons they started using to begin with, I'd wager. Two of them are dead from overdoses, the other I'm unsure, I haven't seen or heard from him in years now.

That would be an interesting YC non profit.

I always wonder what would happen if caffeine/caffeine containing products (coffee, tea etc.) were illegal. Would people go to the same extremes for a caffeine fix?

I'm curious why this would be down voted.

I gave you an upvote, as the question seems fair. But if you're a coffee/caffeine drinker, you can answer this for yourself by going without coffee for a couple of weeks. You'll miss it for a few days, but it's ultimately not something worth going to jail or having a hole drilled into your leg for.

Is this journalism or just a publicity stunt for journalists? And why is everything a "battle", "war", etc. War against drugs. War against terror. Battle against heroin.

And must everything be a "crisis". Maybe just knowing how the news industry works has me a bit cynical.

Anyways there is always a "crisis". A few years ago, there was the meth crisis. A few years before that, the ecstasy crisis. Before that there was the crack crisis. Before that the marijuana crisis. All the way to opium.

I guess as more things change, the more they stay the same.

And not one mention of doctors over-prescribing opioids!

One thing not mentioned in the article is the size of the area and the population. I have no idea how big Cincinatti is or how many people live in those counties. So I don't know if those are big numbers or not.

It's probably an oversight given they're writing first for a local audience?

When I went to school they made sure that Drugs Are Bad, Just Say No was a message that was hammered into every single child. Think about how our culture views drug addicts -- if you hear an acquaintance or a friend of a friend is doing drugs, especially heroin, do you think "Man, that person's got it together! I really want to be like them!" No, you think about how they're a shitty person living a shitty life and you want to stay far, far away from them, because you know they'll lie and steal from you to get their fix.

So I don't really have sympathy for addicts. It's not like drug addiction is a thing that happens to you, unlike losing your home to a hurricane, or getting cancer. If you choose to shove a needle of heroin in your arm of your own free will, that's a choice you've made -- and the consequences of that choice are also things that you've chosen for yourself.

It's not like that people don't know that drugs ruin lives. It's not like it's a secret that drugs are illegal and you'll get sent to jail.

The area I grew up in is a Rust Belt town in similar circumstances -- maybe with even more drugs and less hope than Cincinnati. So I share my understanding and dismay of the economic situation that community's in. But drugs aren't the answer, and anyone who turns to them is clearly lacking in moral character and common sense.

> "It's not like drug addiction is a thing that happens to you"

A common route that leads people to taking heroin is...

1. Go to the doctor, get prescribed pain medication.

2. Become addicted to pain medication during treatment.

3. After supply of pain medication dries up, turn to illegal alternatives (which includes heroin).

So it really could happen to anyone, as it's possible to become an addict without any prior intention to take illegal substances.

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