[plastiquebeech]

We need to be very careful with brain implants designed to relieve pain, lest we repeat the mistakes which brought us the opioid crisis.

I've seen videos at BCI conferences of deep brain stimulation implants which provide the patient with a "happy button" to relieve chronic pain/anxiety/depression/etc. They seem to work very well in a clinical setting, but the patient reactions make it clear that there will be an enormous potential for recreational use (and abuse).

[skissane]

The “opioid crisis” is a crisis because (1) it is easy to accidentally kill yourself with opioids; (2) drug criminalisation makes recreational drug use a lot less safe than it could be were it legal and regulated

I doubt overuse of a “happy button” brain implant is going to kill you; and I doubt it is going to end up in a similar legal situation to recreational drugs. So, whatever the negative impacts of overuse of such a button might be, I expect they’ll be a lot less severe than the opioid crisis

[dgoldstein0]

It's a bit more complicated than that: the pharmaceutical companies underplayed the addictiveness and overplayed the benefits of opioids for years - so even under doctor supervision tons of folks got hooked, and many turned to the black market when they got cut off.

https://www.northpointwashington.com/blog/big-pharma-big-lie... is an interesting article about this in the context of Oxycontin. One detail I find particularly interesting is that Purdue pharma marketed it as a 12 hour pain killer when the data clearly only supported it being good for 8 hours... leading to increasingly stronger doses being prescribed rather that admit the 12hr guideline was wrong.

[mLuby]

> I doubt overuse of a “happy button” brain implant is going to kill you

An addiction needn't kill you to destroy your life.

The better outcome for this technology is a user-settable mood regulator, not a user-pressable happy button.

[greggman3]

> drug criminalisation makes recreational drug use a lot less safe than it could be were it legal and regulated

This is debatable. Here's a legal drug that kills 3 million people a year

https://www.alcoholrehabguide.org/resources/medical-conditio...

Here's another that kills 7 million people per year

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast...

Note that I'm mostly for legalized drugs. I just have heard this data and I don't have an answer to it. My impression is I just take it on faith that less criminalization will be a net positive but I don't know that's for sure.

[fragmede]

Alcohol is a terrible drug and kills you in a known fashion, but you don't buy a can of beer from the store and then die from drinking that can because it was actually bleach, because alcohol is legal and regulated product. Drug addicts hooked on oxy getting their fix off the street are getting killed because street supply is dirty and inconsistent. Having a consistent supply would lead to fewer accidental deaths from unknown supply.

[9wzYQbTYsAIc]

Also, with a brain implant, it would be possible to rate limit the “happy button” similar to time-locked IV buttons or medicine bottles.

[ClumsyPilot]

lets deliver digital rights management inside your body.

Maybe also if you pay a premium subscribtion the happy button can be pressed more often!

[Jensson]

More likely: It releases happy stuff when you see the right politician, and stop when you see the wrong. Imagine that sort of manipulation at scale and you get the future of brain implants.

[concordDance]

As long as patients can decide between the DRM version and the equal cost non-DRM version this may be OK.

[stavros]

Why?

[9wzYQbTYsAIc]

I believe that this document discusses some of the details of patient administered IV opiods in a hospital setting: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certifi...

[stavros]

Right, but why limit a button that removes pain via direct brain stimulation?

[9wzYQbTYsAIc]

To mitigate what was mentioned by the parent commenter: “whatever the negative impacts of overuse of such a button might be”

[heather45879]

Opiate crisis has less to do with people’s deaths and more about their addiction. The lengths they go to score another fix—stabbing people, robbing family members, selling themselves, etc.

It’s one thing to die from doing something stupid—it’s something else entirely to inflict pain and hardship on others.

[skissane]

> The lengths they go to score another fix—stabbing people, robbing family members, selling themselves, etc.

Would they do that if the government just gave them the drug they are addicted to for free? I don’t think so.

Is the real problem then the addiction, or the public policy context in which the addiction exists?

Of course, I wouldn’t want to be addicted to opioids, even if the government gave them to me for free, due to the potential negative long-term health consequences, and also potential negative impacts on cognitive functioning which may in turn limit one’s educational/career/life prospects. But I don’t know if being in such a scenario, even if millions were in such a scenario, would be a “crisis” in the same sense that opioids currently are

[haskellandchill]

Methadone/Suboxone are opioids prescribed for addiction and are often free through low income programs. If they were made more accessible would that solve the crisis? I don’t think so. It’s hard to get to the stage where you accept them as a necessary solution and are still in the dangerous area of trying to taper with unknown quality substances. High quality government heroin/pills and supervised usage would likely work but it’s clear the US would never consider that an option.

[skissane]

> Methadone/Suboxone are opioids prescribed for addiction and are often free through low income programs. If they were made more accessible would that solve the crisis? I don’t think so.

It is unsurprising that if a person is addicted to substance A, trying to substitute it with substance B, which has different properties (even if chemically related to A), doesn't always work. The real solution is to supply them, legally, in pharmaceutical quality, and for consumption under trained supervision (whenever safety demands that), the actual drug they are addicted to, not some substitute.

> High quality government heroin/pills and supervised usage would likely work but it’s clear the US would never consider that an option.

Okay, but if you aren't willing to seriously consider every possible solution to a crisis, that makes your stubbornness a major part of its cause. Government drug policy is a huge contributor to the crisis, and if the government isn't willing to make major changes to its drug policies, the crisis is likely to continue, and the government deserves every blame for that.

[ratboy666]

All I need to do is provide a heroin user fentanyl. We have tried heroin from the government, but the users want fentanyl. And, of course, the "black market" will not limit the amount the user gets.

Now, if you provide a "safe injection/usage site", that attracts the "black market" dealers. Seemingly, that also attracts other "undesired". Take, for example, the problem of homelessness where I live. It is actually difficult to remain unhoused. But, the care demands "no alcohol", "no drugs", "no violence". And a lot of customers do not like those terms and rather live on the street.

Government to blame? Do we not live in a democracy?

[adolph]

Part of the longer term crisis comes from maladaptive coping mechanisms. Time will tell if a “happy button” is adaptive or not. My guess is that those tools which promote use ahead of outcome aren’t really fit for purpose.

That said, I’d gladly stick my head in a microwave if it’s make a bad day more bearable.

[heavyset_go]

There are plenty of people on long-term treatment with opioids, like Suboxone, that almost eliminate the major problems concerning illicit opioid addiction.

Plenty of people live normal lives while on Suboxone, where they might have been living on the streets and doing things no one wants to do in order to obtain illegal opioids. A lot, if not the majority, of those people used illegal drugs as coping mechanisms.

Criminalization, lack of supply, lack of purity of substances and lack of public health treatment are really what makes opioid addiction a life threatening/ruining problem. Things like Suboxone address all of those issues, and the successful lives of Suboxone patients say a lot.

[adolph]

This comment almost reads like an ad, like everyone should take this magical substance that alleviates the problems of the world.

https://www.drugs.com/suboxone.html

[heavyset_go]

> everyone should take this magical substance that alleviates the problems of the world.

That's a weird claim considering no one said that.

There are currently two long-term maintenance opioids on the market: Suboxone and methadone.

Compared to committing crime in order to afford a $200+/day heroin or fentanyl habit, regularly overdosing and/or living on the street, yeah, these drugs can be life saving and let people live normal lives.

They of course have their downsides, they're still opioids and you're still addicted if you take them, but they're legal, pure and given under controlled conditions, which seems to eliminate 99% of the life threatening/ruining effects of illicit opioid addiction. People can live functional lives on them, which given the alternative, is pretty nice. It also shows that drug use, under safe conditions, doesn't necessarily result in a long-term crisis.

That said, the only people who should consider long-term maintenance opioids are people who are going to die or end up in prison if they continue taking heroin/fentanyl/etc. The idea that "everyone should take this magical substance" is a joke that no one has ever claimed.

[nopenopenopeno]

What are you talking about? Opioids are already literally legal and regulated.

[skissane]

They are not "legal and regulated" for recreational use.

Furthermore, some argue that even medical use is over-regulated, to the point that people with genuine needs for them are being denied them by doctors who have become overly hesitant to prescribe them out of fear of the regulators. (Of course, if these claims of excessive prescriber hesitancy are true, that hesitancy itself is not a cause of the "opioid crisis", maybe rather a consequence of it; instead, that hesitancy would be a contributor to the "pain crisis" which has been with us since the dawn of time.)

One thing I personally find shocking - in a number of Australian states (and I believe the same is true in some US states), terminally ill people in severe pain can legally request assisted suicide – and yet, they can't legally have diamorphine (heroin) as a pain treatment, despite evidence that in some cases it is actually a superior pain treatment to any other opioid available.

Claims made by government agencies in some countries (such as the US or Australia) that diamorphine has "no legitimate use in medical treatment" are simply falsehoods. In some cases, it is the best clinical option. Those cases may be relatively rare, but they aren't non-existent, and to continue with an absolute ban on its clinical use (despite the fact that other jurisdictions, such as the UK, use it clinically with no major issues) is totally unjustifiable

[xen2xen1]

The character Garak on DS9 had a brain implant that was designed for resistance to torture. One day he just turned it on, and getting off it was like drug withdrawal. About the same for Louis Wu on Ringworld. "Wireheads" would die of starvation when their implant was turned on. Implants like this have been widely covered in fiction, and among the scariest drugs possible.