[diamondap]

A few years ago, I talked to three retired federal law enforcement agents who had each spent 20+ years fighting the cartels that were bringing drugs into the US from Mexico and South America. All three felt betrayed by the US government. They said, essentially, "We put our lives on the line many times to try to stop the flow of drugs. Then the government turned around and basically gave the pharmaceuticals license to sell this stuff professionally, through people's personal physicians."

These retired agents didn't see the drug war as a war on "bad guys," but as an effort to stop the destruction drugs wrought in people's lives. After all their work, their own government undermined their efforts.

My own doctor was taken in by Big Pharma's sales pitch and wound up going to prison for over-prescribing their pills. https://en.wikipedia.org/wiki/William_Hurwitz. Though to hear Big Pharma tell it, there was no such thing as over-prescribing.

If you want to get an idea of how out-of-hand the prescription frenzy got, take a look at John Temple's book American Pain, which describes the pill mills in South Florida. Towns in Appalachia used to send charter buses to these pharmacies. After a 12-20 hour bus ride, each passenger would pick up hundreds or thousands of pills, then ride home to sell them in their small country towns.

Some of the pill mills, which were fully licensed by the state of Florida, were cash-only and would haul garbage bags full of money to the bank each day at closing. For a summary of Temple's book, see https://adiamond.me/2020/01/american-pain-by-john-temple/

[nsagent]

My mom worked as an ER physician in Pennington Gap, VA during the early years of opioid abuse there (late nineties through through the early oughts) [1]. She would constantly complain about drug seekers there and refused to give out pain meds. According to her, she was the only doctor who would refuse to give out pain meds.

Fast forward to 2022, she needed heart surgery and was in the ICU for three weeks afterward. She never asked for pain meds and regularly refused them when asked. I think she had became so accustomed to denying people pain meds, that she even denied herself, though it was clear she was in pain.

[1]: https://www.nytimes.com/2019/08/18/health/opioids-purdue-pen...

[lukan]

"though it was clear she was in pain"

One can learn how to handle pain yourself. Some people went very far with this.

While younger, I was a bit advanced in those technics - basically it is about accepting the pain and working with it.

In my theory, pain was like a alarm sound - and a painkiller just deactivating the alarm, but therefore maybe stopping a adequate body response.

Nowdays I got a bit softer as currently I am on weak painkillers, but a very low dose compared to the recommendations. And for my (disease related) empty stomach, this is probably way better. Also less extra stress on the liver and kidneys.

But even so, I experienced the feeling, that can put people into the path of addiction. Just one more pill and everything feels fine again. No more struggle, being calm again. But this is dangerous.

[_heimdall]

I'm not sure where I would have learned it in my life, but this is very similar to my experience with pain so far. I'll definitely feel it but I do experience it more like an alarm, and once I recognize what happened the pain signal seems to go away after about 30 seconds.

To this day I'm still surprised by it, and appreciative for whatever it is that allows my body to apparently recognize and then silence the pain signals.

[somenameforme]

If she never explained what was happening there, public ERs cannot refuse service to anybody for any reason. So drug addicts will use ERs as an attempt to score drugs by pretending to have some illness or another. If they fail, they'll just go to another one. And then repeat the circle. Even when the people at the ER know they're faking and they're there solely to try to get drugs, they have to continue trying to treat them in good faith. It's a major source of burn-out for ER workers, because it's just never-ending and a complete waste of resources.

[nradov]

That's not quite accurate. Under EMTALA, ERs are only required to stabilize patients. Once an indigent patient is stabilized and no longer at immediate risk, the hospital is free to discharge them even if they have serious medical conditions.

https://www.acep.org/life-as-a-physician/ethics--legal/emtal...

Some hospitals voluntarily do more than the law requires to treat such patients.

[somenameforme]

There's a much more informative article available here. [1] Stabilization does not have the colloquial meaning. It's defined as, "To provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition..."

So somebody with a serious medial condition could be discharged, but only once that condition was treated and unlikely to further deteriorate. And then there's also a bunch of other rules hospitals that accept medicare have to follow for all patients, which are similar in spirit to EMTALA. And then there are going to state rules on top of all of this. Violations are severe with penalties able to be imposed on both the hospital and the doctors/staff involved - up to and including loss of license, and they are not covered by malpractice insurance. And the courts have invariably ruled on the side of patients, so I don't think there's any doctor that's going to be looking to try to short-serve the requirements of the law. Part of the reason you can find a million negative articles about it!

[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/

[n8henrie]

I'd say it's fairly accurate. It's difficult to confidently establish "stable" in a patient with possibly feigned or exaggerated symptoms based on history and exam alone. It is generally agreed that pain management is part of managing an emergency, and so if an emergency has not been confidently excluded, it is usually part of care until a workup is concluded. If one could know from the initial evaluation that an emergency could not possibly be present, one could certainly discharge without additional care, but that can be impossible to know immediately (even with highly trained and calibrated eyeballs).

[_fat_santa]

I remember going to the dentist a number of times a few years back and they always prescribed me something crazy like percs, vicodin, oxy, etc. I never actually got any of the scripts filled because by then I had read too may stories about the opioid crisis and was determined to never venture down that road. I did notice once the opioid crisis really hit the mainstream press, my dentist stopped prescribing those strong painkillers and prescribed prescription grade tylenol or ibuprofen instead. Never filled those prescriptions either because the prescription grade stuff was the same as taking more of the regular OTC medicine.

[nradov]

Back in 2007 an oral surgeon gave me an opioid painkiller prescription after a routine tooth extraction. I never filled it but in retrospect it seems crazy how they were handing out those scripts like nothing.

[cprayingmantis]

It hit this area hard. I’m from neighboring Scott County and I left in 2015 to pursue a job in a larger market. When I brought my family back in 2021 we shocked to see just how much the opioid crisis had hollowed out the community. Whatever big pharma has paid it’s not enough to repair the generations of damage it’s done to the area. I am on the local Board of Supervisors and I’m trying my best (along with the rest of the board) to get everything running back in the right direction.

[hypothesis]

Last I heard, culprits are arguing at SCOTUS that they should get immunity for a fraction of their gains. Also, some payouts will come from selling more of the same, which is nuts. It’s pretty hopeless…

[op00to]

Just a point - the same people who thought they were “saving” people with a drug war were destroying lives themselves over drugs that not so many years later are legal and accepted to possess. Somehow they’re not harmful anymore. It’s all BS.

[dns_snek]

Excellent point, and it's not just a thing of the past, it's still happening right now. Cannabis might be at various stages of legalization throughout the US, but there are countless other substances that are criminalized without any justification, like psychedelics.

The damage that the US-led war on drugs has done throughout the world is staggering. It's probably going to take decades until all the brainwashing and propaganda washes away and we get some form of legalization in Europe, not to mention other parts of the world that take it even more seriously.

[aaomidi]

The war on drugs is also just a much more active participant in harming people vs the drugs themselves.

The drugs aren’t making a conscious choice of destroying someone’s life. Those agents are. They’re by definition worse than the drugs (premeditated vs not).

[fbdab103]

That definitely stands out to me as well. How many lives were destroyed by consuming cannabis vs government retribution for attempting to get high?

[coffeebeqn]

Drug policy is complicated. Amphetamines and opioids certainly have very valid medical uses - but also giving the public unrestricted access to them is a complete disaster.

Psychedelics likely have various mental health treatment uses but they are for some bizarre historical reasons considered dangerous.

Mental health medication like benzos are also tricky. They are amazingly affective but also amazingly addictive and withdrawals can be fatal

[upleft]

Having been a cannabis smoker myself for years, I can understand the danger of self-medicating with psychedelics. They aren’t entirely harmless.

Any drug with a high is a dopamine button. It’s easy to hit that button instead of doing something else to feel good. It’s easy to stop doing other things in favor of just hitting that button all day. But the effects of that button diminish over time, so you hit it more often, and the more you hit it the less other things you want to do.

Psychedelics powerfully activate and deactivate different parts of the brain, changing the way you think and process information. Controlled and intentional, this has huge potential for positive mental health outcomes. With chronic recreational use, cannabis leads toward negative mental health outcomes like depression, disordered thinking, anxiety, and low agency.

[adwi]

Do you still smoke? If not, how did you quit?

Quitting is an interesting grey area for cannabis; culturally and functionally people misusing the drug are able to do so indefinitely, usually not reaching the “rock bottom” emergency state that other drugs (hopefully) convince the user to seek treatment. So it feels like “just weed” isn’t serious enough to warrant a 30 day treatment center, but the behavior patterns can be so ingrained it can be hard to see breaking them without.

[upleft]

I haven’t quit but have pulled back and am using it far more occasionally rather than most of the time.

The sense of increased focus after smoking is a big plus for me, but the decrease in focus after that coupled with the overall disorganized thinking is a big minus. Disorganized thinking can be great if you are trying to generate a variety of ideas, but bad if you are trying to communicate them. Learning more about what is actually happening in my brain with focus, memory, agency, etc has been one of the biggest motivators in pulling back from chronic use. I don’t enjoy it much knowing that I’m avoiding other things or going to be grumpy and depressed later because of it.

Agree about the grey area for quitting. There isn’t a rock bottom, but with chronic use there is a kind of dull limbo where everything feels harder to do, but you’re demotivated to make a change. It is literally a drag - it slows and lessens you overall.

[coffeebeqn]

For me after daily use for 6 months or so I just had a realization that it’s a net negative. I was always tired, cranky, forgetful, and the highs weren’t that high - more like maintaining some rather low level of life satisfaction. If you use it a lot there is probably some root cause why you think you need to get fucked up all the time.

What helped me quit was really seeing it for what it is - it was making a few hedonistic experiences “richer” but kind of draining the color out of all the experiences outside of that. I never had any negative effects while high - like anxiety so it seemed harmless. For practical tips think of something to do for the first few days at least when you’d normally toke up if youre just bored at home. Out with friends, walking, playing a new game, hobbies, etc

[303uru]

In the early 2000s I was a pharmacist intern and then early in my career working retail pharmacy as a PharmD. I knew the pill mills around me, I would provide DEA agents with clear examples and little to nothing was done about it. What I did get were credible legal threats from patients and physicians for not carte blanche filling what was written by their doc and then I started getting pressure from my district manager (after all I was denying big fat cash payers!). At the same time I saw pharmacist going to jail for "inappropriate dispensing" while the doctors who were running the pill mills were getting in no trouble at all. I left outpatient pharmacy as fast as I could. It was clear no on wanted to do anything to actually solve the issues at hand.

I also get so frustrated with all the border bullshit. Doing anything at the border is trying to solve the problem two thousand miles from the root cause. And pretending that migrants (people trying to come to the US permanently) have anything to do with drug runners is about as stupid as it gets.

[_heimdall]

The idea of someone going to a bank with a garbage bag full of cash and depositing it into a pharmacy's business account is insane. That's the kind of thing that can only happen when the system is fundamentally corrupt.

[zdragnar]

A friend of mine was a mechanic in the air Force and took a wrench to the knee. The VA basically prescribed him a giant bottle of benzos and told him to take them as needed.

Young man laid up at home with nothing to do but sit on the couch playing video games and drink beer. Add in a big bottle of pain pills to take "as needed" and you've got an addict.

[nonameiguess]

Because people form their impressions of what the world is like by continually reading anecdotes like this, I'd like to at least throw my own experience out there. I (not my friend) got out of the Army needing three spine surgeries in the span of 16 months, after years of increasingly worthless non-invasive treatments. This involved daily percocet for a very long time along with periods of time in which I couldn't do much beyond mindlessly watch television while falling in and out of sleep.

I did recover, though. Today, I run 40-50 miles a week, lift 6 days a week, work in software making five times what the Army ever paid me, haven't touched a painkiller in 7 years, and don't even drink.

Make of it what you will, but people are individuals and medical policy should reflect this. Pill mills are a problem but physicians deserve the judgment and discretion you should expect of someone we spend up to a decade training and licensing.

[elzbardico]

Yes, a lot of the problems with drugs is probably cultural. We decided to convince people that they are absolutely powerless against addiction, that this is a disease they were born with it and there's no much they can do themselves, that they can't have absolutely no agency.

[devilbunny]

Benzos are not pain meds. Might make you an addict, but if that’s what was prescribed, it wasn’t for pain. Dunk on the VA all you like, but they’re not that bad.

[zdragnar]

You're right, I got my wires crossed for some reason. Pretty sure it was either for Percocet or the generic equivalent.

When he recounted this to be, he was frustrated that they didn't give him a small prescription to start with, but more or less gave him a large quantity up front and let him dose himself.

He managed to beat the addiction, and when I'd met him it was in a software development gig so it's not like it ruined his life or anything. He certainly wasn't happy with how casually he'd been treated was the jist of the story.

Edit: just realized I had a different friend at the same company who had been on benzos and dealt with the withdrawal... The three of us chatted quite a bit and I imagine that was the context for the conversation but it's been a decade or so.

[devilbunny]

That makes more sense. As for why, just look at the responses to my other comment saying that opioids aren’t generally warranted for weeks after a dental extraction.

[insane_dreamer]

sounds like the only difference between the Columbian Drug Cartels (cocaine producers and street pushers distribution network) and the American Drug Cartels (Big Pharma and pill mill distribution network) is the latter paid taxes

[rsynnott]

Funny you should say that… https://www.washingtonpost.com/business/2021/02/12/opioid-se...

[knightofmars]

Florida has a history of being supported by and enabling drug money.

https://www.theguardian.com/tv-and-radio/2021/aug/03/cocaine...

[ofslidingfeet]

And funny enough, here I was just thinking about how these jerks are making it so that, after the midwit backlash against all the criminal behavior encouraged by the Biden admin, I'll get to just live in pain the next time I have an injury!

[rsynnott]

… Eh? Purdue Pharma’s downfall was long and protracted, but it started in 2007 and ended in 2019; presumably Biden was encouraging it using his time machine? Like, the US opioid crisis isn’t exactly _new_.