[xrd]

I've got a friend who recently was hospitalized for fentanyl addiction.

Twenty years ago he was my first investor in my first startup. He was the guy that taught me about mediation. He was the first vegetarian I knew.

He owned four cab licenses in Portland. Then Uber came in and shredded his retirement plan. The cab company forced him out so he wouldn't even capitalize on the partial ownership of the land they owned. He lost everything. He has nothing left.

He discovered some awful things about his father. His brother died in a gruesome car crash at 25.

I remember him telling me about oxycotin (edited: I misremembered it as oxycodone), this "miracle drug" without the addiction of morphine. He got on that.

Ten years later he was using heroin. Then fentanyl more recently.

I'm pretty angry at the Sakler family. I'm mad at the drug cartels. I'm not mad at my friend. He's a generous and loving person.

Everyone has a story. I'm sure some are full of awful actions that led them to where they are, but I don't see my friend in that way.

[refurb]

Oxycodone was always known to be addictive. It’s right on the label from day one.

“Also at the time of OxyContin’s approval, FDA product labeling warned of the danger of abuse of the drug and that crushing a controlled-release tablet followed by intravenous injection could result in a lethal overdose. There was no evidence to suggest at the time that crushing the controlled-release capsule followed by oral ingestion or snorting would become widespread and lead to a high level of abuse.”

https://www.fda.gov/drugs/information-drug-class/timeline-se...

[xrd]

I remember with distinct anger that my friend told me information to the contrary. He probably got that phrasing from that doctor who got a free trip to Barbados to push it. I wasn't there but i remember him telling me that and it makes my blood boil.

I do share other people's skepticism of the medical industry as you might be able to tell. He should have done more research, agreed.

[fires10]

We license doctors to do the research for us. We can not be expected to experts in all fields. It's why we license professionals.

[zdragnar]

We license doctors you visit to practice medicine, not to do research. Unless they're working at a dedicated research hospital like the Mayo clinic, doctors don't do research on their own.

They'll stay up to date with what is standards of care, but even that is dictated to them by their EHR software or what they expect your insurance will cover.

When I've gotten prescribed a new medicine, I don't really recall a doctor ever even telling me what side effects to watch out for. At most, they've told me not to drink alcohol while on someone.

[arcanemachiner]

People are often taken in by the Big New Thing. That's why I have a default policy of skepticism towards pretty much everything.

[bufio]

The Big New Thing at the moment seems to be a moral panic about oxycodone.

[salad-tycoon]

“Covid” or the constant breathless reporting about every possible little thing over 3 years did this to me. Not rehash any of it but now 3 years later people like Zuck coming out and saying things like “Woops maybe we censored the wrong things and promoted also the wrong things. Woopsies.”

I thought I was world worn and tough.

Then came AI and I was again on the doom and gloom train. Then I had a moment, realized this just the new thing and dropped it down a few degrees.

What’s next?

[SV_BubbleTime]

> That's why I have a default policy of skepticism towards pretty much everything.

I’m convinced anyone who doesn’t do this is either too young to know better or too dumb to have been paying attention.

[daniel-cussen]

Yeah that was saying if you crushed n injected it would be addictive. No. It was addictive in literally any form. They knew that too, n it wasn't on the packaging.

You kind of have to be a monster to say something that callous.

[fweimer]

As far as I understand it, crushing/injecting it makes it more likely to induce pronounced euphoria and other side effects that encourage abuse. But it was known from the start that it was addictive (causing a physical dependency) even if used as intended, simply because it is an opioid. Here's an older package insert:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/02...

Among other things, it says “Physical dependence and tolerance are not unusual during chronic opioid therapy.” I'm no expert, but I think that explains why warnings about dependence weren't more pronounced. The drug was supposed to be distributed in a tightly controlled fashion due to these risks, after all.

In retrospect, the warnings at the start, and the information for patients read like recipes for abuse, though.

[KnobbleMcKnees]

Both sides benefit from the average Joe not knowing the facts. This is, in a nutshell, why so much FUD exists about drug addiction.

For dealers, it gets people through the gateway. For the anti drugs crowd, it's the equivalent of preventing teenage sex by not telling them how it's done

[_8j50]

So, here is my problem: if the sakler family or drug cartels deceived regarding the harmful and addictive nature of drugs, sure thing, hang them for murder! But if an adult human makes a conscious decision, being fully aware of the consequences then it that person's responsibility.

I think you should instead be angry at the government. Your friend should have been able to go to a facility that administers fentanyl or heroin safely while making available counseling and any other help that could be provided to him.

If there is a dosage for any substance where it can be administered without causing near-term death or irreparable physical damage, the government should either ignore it or intervene by implementing safe ways people can can consume these substances. You shouldn't need to go to a street dealer, even if you don't have a medical perscription they should let you get addicted and consume it if you choose to do so against all advice.

Millions die in the US every year because... I don't even know why? It sounds not right to treat people?

[xrd]

Fifteen years ago there was a guy outside my apartment selling the homeless newspaper. He admitted he was addicted to heroin. So I paid for him to go to a halfway house. That was because my friend told me that even though it was unlikely to work, every chance is an extra chance.

That's what I'm hoping for here. I want a story that addiction from these horrible drugs isn't always the end. It would be amazing if he can recover from this. I'm scared but it's all I have for him right now.

[xrd]

Also, my friend is in the hospital and apparently will be there for a week or two. So he will leave with several hundred thousand dollars of debt, which will probably be shackled around his mom's neck.

This is a medical crisis that will never get solved because our medical system doesn't want to handle people with these addictions. No one does of course. But that's the only way to solve it in my opinion.

[ThePhantom]

Sorry to hear about your friend. What was he hospitalized for? Several hundred thousand dollars is an exorbitant amount of money even with how high the cost of healthcare is in the US.

[xrd]

From a mutual friend, apparently the withdrawals were severe. He was actually admitted to a recovery place with his mom's help (that was $45k for a month!). Fentanyl is stored in fat cells apparently. It takes a long time to leave the system. So he was hospitalized because his potassium levels dropped to a dangerous place.

I'm not sure of the price tag. But i had another friend who was told to go to another hospital when his wife's pregnancy took a bad turn. They spent two weeks and it was several hundred thousand. The insurance said, just beg the hospital to reduce it? It was ridiculous. I'm just sure my friend won't leave with that covered. Not the hospitals responsibility for sure but it's outrageous the cost and prevents people from seeking help.

[zoklet-enjoyer]

That sucks about your friend. But how did anyone think there was no abuse potential? I was in highschool in the early to mid 2000s and even I knew there was massive abuse potential. There's a reason it was called hillbilly heroin

[antonvs]

Yeah. Oxycodone was always known to be addictive, like any other opiate.

The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release.

That turned out to be largely BS, but it wasn’t helped by the fact that addicts would crush the tablets, eliminating the slow release aspect.

[retrac]

> The claim from the company was that Oxycontin, which was a slow release form of oxycodone, was less addictive because of the slow release.

A similar claim is now made about Vyvanse, a pro-drug for amphetamine. Like a slow release formulation, but needs to be metabolized first. The slower onset, less sharp peak, makes it less euphoric for a similar effective dose, which is supposedly one of the mechanisms involved with the reward-feedback addiction cycle. Less likely to experience (intentionally or accidentally) the intense euphoria of a bit too much instant-release amphetamine on an empty stomach, and so less likely to seek out the experience again. It also frustrates injection, since it needs to be metabolized first so injecting it doesn't make it work any faster. I'm not sure the premise is wrong, and it is probably fairly similar with opioids. But slightly less abuse risk is certainly not the same as non-addictive.

[pault]

That’s interesting, I’ve been on vyvanse for five years now and never felt any of the telltale signs of dependency (which I am familiar with). I had to stop taking it for a month once and it just made me very drowsy for a week.

[xrd]

Ah, I corrected my original post. That's what he was on. It's confusing even now to me. Anyone in this thread suggesting that anyone with half a brain should be intimate with the difference can tell me I've only got half a brain.

[fires10]

I had this told to me and had family members told this by doctors. A large number of addicts started from medical prescriptions for legitimate pain. I have been scolded for not taking pain meds.

[SV_BubbleTime]

I was at a party in 2001 and they were getting Oxy delivered and figuring out how much and who wanted it. I knew then it wasn’t harmless recreational.

Two party from that party are now dead of overdoses.

[mobilefriendly]

My family member died from his addiction and I'm still angry at him. He made several decades of selfish, disastrous choices. He had every advantage in the world and squandered it all. I'm angry we don't do more to fight these drugs. Drug dealing is very much a violent crime, it killed my cousin. The popular culture that celebrates drugs and dealers.

Plenty of blame all around but central is the person who decides to use.

[pcthrowaway]

> He had every advantage in the world and squandered it all.

I don't believe people get on addictive drugs and squander their lives when they truly have "every advantage in the world". I've been to rehab and recovery programs and I haven't a single person for whom this was the case.

Usually when people say this, they're talking about privileged people who outwardly seem like they have everything they need to succeed. But they have demons: depression, bipolar disorder, mental health, trauma, chronic pain. What's worse, other people are often unwilling acknowledge those demons, and say things like "you have every advantage in the world" which can just make them feel more isolated.

This can lead people to seek relief however they can get it.

I'm sorry for your family member and for you and your family; but for anyone reading this with a loved one struggling with similar issues, know that helping them can sometimes require willingness to understand them first.

[civilitty]

> The popular culture that celebrates drugs and dealers.

You mean modern medicine? That's what makes this problem so pernicious - so much of it was created by the people fictionalized in shows like House MD and Grey's Anatomy not The Wire and Breaking Bad.

[fuzzfactor]

For thousands of years the natural opioids morphine & codeine have been almost universally recognized as harmful dependency-inducing substances in their own category, that build a tolerance which can almost never be limited beyond a certain number of years, before the toxicity overcomes any therapeutic benefit there might have been upon initial administration.

After all this time a religious person of many different faiths over the recent centuries might have often said that for long-term use they were put on earth by god for people who can not be expected to recover.

Synthetic opioids are just the modern version which were developed because the natural product itself can not be patented.

Hence "patent medicine".

The habit-forming effect is what made the Sacklers the richest pharmaceutical barons so far.

[quacked]

Obviously he doesn't mean that, there's an enormous body of media and art that glamorizes drug dealing and using. It stretches across ethnicity and class. It begins with alcohol and weed, stretches into cocaine and hallucinogens, and from there gets into the heavy drugs.

If the only input into drug addiction was the modern medical industry over-prescribing opioids, the landscape of modern drug use would look very different.

[civilitty]

Does any recent media actually glorify the drugs that are causing the worst problems right now? I watch a lot of TV but have less exposure to popular music so I'm genuinely unsure.

There's plenty of alcohol, weed, cocaine, and hallucinogens, I'll give you that, but they're not gateways to opioid addiction. Breaking Bad glorifying the manufacture and sale of meth is the only except I can think of - Oxy, fentanyl, and p2p meth aren't exactly the drugs musicians and Hollywood turn to as a lyrical/plot device.

There's also a fine line between glorifying and entertaining. I struggle to find any such glorification in shows like Snowfall, for example, which mostly shows the very negative impacts of crack cocaine in cities. There's only a single character in the entire run that manages to overcome the drug and the main character is a tragic anti-hero at best.

Any time heroin or another opioid comes up in pop culture it's almost always in the context of horrifying drug dens.

[norir]

I would argue that if one watches Breaking Bad to its conclusion that it's hard to say that it glorified the manufacture and sale of meth. Everyone involved has huge negative consequences in their lives as a result. The collateral damage is staggering. By the end, Walt seems as addicted to the sense of power that making meth gives him as the user of meth desperately seeking their next hit. He sabotages himself and ultimately gets himself shot (probably killed -- though I think this is open to interpretation) chasing his last hit.

[civilitty]

I think "high school chem teacher builds a drug empire that rivals Mexican cartels" is definitely a glorified macho-suburban fantasy elevated to an art form. In reality season 1 would have ended with Bryan Cranston's character dissolving in a vat of drain cleaner or buried out in the New Mexican desert missing his head and fingers. I mean, look at the drug addict that gets the most screen time in the show: he's the cofounder of the drug empire guiding the main character through the drug game like a methed out Master Miyagi.

Compare it with Snowfall: the main character's family has at least some history of drug dealing and he only succeeds because he discovers a cheap and ultra-addictive recipe for crack cocaine and because the CI-freaking-A is using him to fund the global war on communism. Recurring characters get killed off in dumb gang skirmishes all the time and the drug addict with the most screen time is literally a shell of her former self that can barely get through the day up until the latest season.

Or compare it with The Wire: all the people involved in the drug game are only in it because they have literally nothing else to live for except the glory of the game. Basically no one survives except the cops and Bubbles never really gets fully clean.

[benatkin]

It does the antihero bit pretty well. It shows life going on after Walt's brother in-law is killed. In real life people would be a lot more torn apart by it, and not just sad.

The main thing it glorifies I think is that boys will be boys, not drugs per se.

[quacked]

> There's plenty of alcohol, weed, cocaine, and hallucinogens, I'll give you that, but they're not gateways to opioid addiction.

This is only partially accurate. There are two primary "pipelines" to opioid addiction; one of them is overreliance on painkillers, but the other one is fairly standard risk-seeking escalation through a socially deleterious lifestyle, often culminating in an OD or a prison sentence after a predictable years-long risk escalation path through social drug use.

I will agree that I don't think there's a lot of media showing meth or fentanyl use as cool and attractive, but my overall point is less that a specific drug needs to be shown to be cool, and more that the artistic construction of the drug lifestyle as alternative, exciting, rebellious etc. wears down the emotional barriers of a lot of people when they're young and malleable. I've done a good number of drugs in my day and I can assure you that in the case of most of the people I did drugs with, early exposure to "drugs are cool" art and music played a part in their ready acceptance of the lifestyle.

As one example, if you go to a high school party, often the riskiest, coolest kids will go off in private and do drugs. There's no feedback loop in the media to make this look pathetic or sketchy--on the contrary, most drug use is played for laughs, or it's added as another dimension to a lifestyle that's supposed to be tragic but instead looks awesome. "Oh my god, look at this guy's life, he's a mess, his apartment is so dirty, he's doing lines off the mirror... with a smoking hot supermodel-actress while we do a B-plot story about how his small-town parents are boring and stodgy... and he's a rock star..."

I don't really know whether or not you could seriously reduce drug use by not showing it in the media, but I do believe that showing it as positively as it is now increases drug use. And I haven't even mentioned the music surrounding drugs.

[reducesuffering]

> Oxy, fentanyl, and p2p meth aren't exactly the drugs musicians and Hollywood turn to as a lyrical/plot device.

Oxy is hugely glamorized in rap music. Drinking "lean" / cough syrup and doing Percocet pills. Future song "Molly Percocet". The Weeknd's record label is called XO for Ecstasy / Oxy.

[benatkin]

If you want to see a sincere take on it, read the writings of Thich Nhat Hanh.

https://www.lionsroar.com/food-for-thought/#:~:text=I%20hear...

I still tend to disagree because I have a hard time finding balance and not going too far in restricting the media I consume, but it's a nice vision.

A lot of the religious right in the US, especially the part that is led by televangelists like the late Pat Robertson, just wants to suppress it out of ignorance and they have no plan except to throw more and more people in jail, creating more X to prison pipelines.

[quacked]

After reading this article, I agree with the words of Thich Nhat Hanh, thank you for the recommendation.

> The religious right in the US just wants to suppress it out of ignorance

I tend to agree that the religious right in the US is a legislative force that does more harm than good, and that many people who campaign against drugs don't have a solid understanding of drugs or drug culture. However, I don't think that it's ignorant to want to suppress drug culture (either in the media or in real life), and I think more religious conservatives have experience with addict family members than you think.

[benatkin]

Good point, I ninja edited just before you posted to say that a chunk of them have been mislead by televangelists and such.

I can tell Thich Nhat Hanh appreciated the people you're talking about, having read about him traveling all around the world and meeting people from the US (where he lived for quite some time) and countless other countries.

[tudorw]

nice reccomendation.

[benatkin]

There's a longer piece that I found as a PDF by searching for words of an excerpt I happened upon. I can't find a page linking to it, but it seems legit. https://static1.squarespace.com/static/5c03ced75ffd204418037...

Edit: I searched a phrase in the PDF and found this: https://thubtenchodron.org/2017/11/non-harmful-consumption-n...

[mordae]

> Plenty of blame all around but central is the person who decides to use.

Oh get off your high horse.

I've had two uncles die from alcoholism. In reality, it was the divorces and way more complex circumstances that really did them in. It really is the cage.

[lo_zamoyski]

Wow, that's rude. He said something wrong.

It's important that we avoid the twin extremes of, on the one hand, categorically blaming circumstance for everything, and on the other hand, categorically assuming 100% culpability. The proper view is that human beings operate at a nexus between circumstance and decision. Circumstances can create good or bad incentives, and statistically, people will follow incentives (hence the need to legislate properly, for example). These incentives can be strong or weak. They can create more or less pressure to follow through with the incentive. But we must ultimately make a choice and that rests with us (in the extreme case, something like extreme pain can blind a person and effectively rob him of the freedom to choose intentionally which is to say with the capacity to use reason). So how culpable we are for a decision varies on a variety of factors, but there is almost always some culpability.

In the case of your parent comment, it sounds like the person in question is very culpable, that he had the capacity to reason, to know he should have chosen otherwise, but did not. There's nothing wrong with the content of that claim as such.

[mikub]

I mostly agree with you. But when your doctor is telling you to take some 'medicine', and that is what makes you addicted it's not completly in your hands anymore.

[brightball]

After I had surgery on my ankle in college, my dad took away the pain medicine the moment it was no longer necessary (1 day later) and just gave me Advil after that.

I didn’t fully appreciate why until I saw somebody go through it.

But then I got the entire picture. This man struggled. Hid it from his family. Finally confessed it to his wife who stuck by him and sent him to a rehab program to get clean. He was gone for about 4 months and got clean. Got his life back. Got his family back and got back to work.

And then his old dealer came back around. It took another family member telling the dealer he’d shoot him on sight if he ever came around again to get that predator to leave.

[c22]

Of course it is. Doctors work for you and offer advice. They can't force you to take medicine unless you're involuntarily commited.

Do your own research. Get a second opinion. Etc. I rarely end up taking medication that's prescribed to me and overall I think I'm the better for it.

[brightball]

There are a growing number of people who think that drug dealers should be charged with murder in these circumstances.

It’s difficult to argue with the logic. The worse the problem gets, the more it seems like correct path.

[civilitty]

Dealers who sell drugs laced with Fentanyl are increasingly facing manslaughter charges (homicide has a higher premeditation bar to clear)

[2-718-281-828]

of course you shouldn't be mad at your friend. he is suffering and seeking relief. the sacklers and the cartels for sure are despicable. but they aren't responsible for your friend either. they didn't force him to take drugs. it sounds petty but i firmly believe for a number of reasons that it is very important to keep this in mind.

[throw-4e451c8]

> He owned four cab licenses in Portland. Then Uber came in and shredded his retirement plan.

I am sorry for your friend, but not for him losing out on his rent seeker plans.

[nick_]

The folks flagging your post would hunt the poor for sport if it was legally and socially acceptable.

[jojobas]

There's nothing wrong with (and, in fact, it's virtuous) not spending money to consume today in order to have a better life tomorrow.

[euiq]

this exchange is so hacker news

[lo_zamoyski]

Indeed, the idea that we shouldn't criminalize drugs because of some ludicrous personal autonomy argument is silly. It rests on a kind of extreme, libertarian view of human beings and human society in which human beings are construed as atomic, self-sufficient beings shouldering the entire burden of responsibility for their actions (we ARE responsible, but those who encourage or enable bad behavior share responsibility) and society is construed as some kind of purely voluntary association of atomic beings for transactional exchanges. Classical liberal view, extremely anti-social and anti-human. Human beings are social animals. Harming oneself harms society, and harming society harms its members. Society exists for the sake of the common good, and it isn't good to enable or allow drug use.

[Nursie]

Yes, and we need to ban equasy as well, it harms people, predominantly the young, and provides no tangible benefits. Children are being harmed by this scourge!

Society will be much better off without it!

https://journals.sagepub.com/doi/abs/10.1177/026988110809967...