Children of the Opioid Epidemic Are Flooding Foster Homes

http://www.motherjones.com/politics/2017/07/children-ohio-opioid-epidemic/

85 91 9 years ago

dreamdu5t2• 9 years ago

According to Pew Research: "National data doesn’t identify how many children are removed from their homes because of a parent’s substance abuse. And there’s no one standard for how states report substance abuse and child neglect."

http://www.pewtrusts.org/en/research-and-analysis/blogs/stat...

shams93• 9 years ago

It's interesting we could be developing whole new non addictive classes of pain killer from cannabis extracts but instead we standardize on oxyconton and opiates. With a beat up, aging population of working people with chronic pain of course it's a perfect storm. But in states that have embraced cannabis we don't see this level of crisis .

StevePerkins2• 9 years ago

I think you're seriously downplaying a few variables, to reach a desired conclusion. How many coal mines and textile mills are there in Portland or San Francisco?

hirsin• 9 years ago

And there's definitely no aging physical labor population in Washington, home of Boeing plants and a massive agricultural industry.

dreamdu5t2• 9 years ago

It's a myth that heroin and opiate addiction are the result of pain killer prescriptions: "According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. "

throwanem3• 9 years ago

That certainly is the result of painkiller prescriptions - just not ones written for the person who starts using.

myleshenderson• 9 years ago

The initial availability of the drugs was from a prescription. If it weren't for the ready availability of the drugs, far fewer people would be addicted.

DanBC9• 9 years ago

that's from https://blogs.scientificamerican.com/mind-guest-blog/opioid-...

Which says eg

A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.

Let's have a look at what that Cochrane review says:

http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-tre...

The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment.

This tells us that the carefully selected patients were not getting pain relief or had too many side effects; (a third dropped out because of these) and we can't say too much about addiction because not all the studies reported it: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome"

It's hard to see that 0.27% (with who knows how many unreported cases of addiction) and that later 8-12% in the same paragraph.

Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.

I mean, doesn't that tell you there's a massive problem with prescribing?

recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors.

THat para links to a document called "THE OPIOID CRISIS IN AMERICA'S WORKFORCE" http://www.castlighthealth.com/typ/the-opioid-crisis/

The first para of that report says:

The use and abuse of prescription opioids continues to be a challenging and costly crisis for the U.S. The facts underscore the severity of this crisis:
• Nearly 2 million Americans are abusing prescription opioids1
• 16,000 people die every year from prescription opioid overdoses2
• Sales of opioid prescriptions in the U.S. nearly quadrupled from 1999 to 20103
• 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills4

That Scientific American writer has misrepresented every source so far.

For fuck's sake, that last link specifically says:

One out of every three (32%) opioid prescriptions is being abused.

throwanem3• 9 years ago

Transparently tendentious reasoning of this sort fails to serve your turn, and that's especially regrettable in this case because I agree with you that we would be very well served to look for means of addressing severe and chronic pain that don't involve the most addictive class of drugs known to man.

I would esteem it a kindness of you to find a way of advancing your thesis that does more to support it than, by retreat into intellectually dishonest tactics, to make it look indefensible.

notadoc11• 9 years ago

but instead we standardize on oxyconton and opiates

That's because oxycontin and opiates work for relieving pain.

But in states that have embraced cannabis we don't see this level of crisis .

That's a baseless claim that couldn't be further from the truth. Take a walk around SF, LA, Seattle, Portland, etc, there are tons of strung out junkies laying around on the streets surrounded by needles.

The existence of painkillers are not the reason we have drug addicts.

DanBC9• 9 years ago

That's because oxycontin and opiates work for relieving pain.

They do not work for relieving long term pain.

https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

> 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain
> 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).
The existence of painkillers are not the reason we have drug addicts.

This is just untrue. Please provide a valid source.

DanBC9• 9 years ago

Given the scale of the crisis, it’s not hard to understand why, when Donald Trump promised Ohioans on the campaign trail to “spend the money” to confront the opioid crisis and build a wall so drugs would stop flowing in,

Have a look at this document with data from 2009. Compare usage rates in Americans for opiates with opioids with prescription opioids:

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

Annual Prevalence of use as a percentage of the population aged 15-64 for the year 2009

  Opioids 5.90%
  Opiates 0.57%
  Prescription Opioids 5.60%

Those drugs are being prescribed by doctors. The cause is not illicit drugs from outside the US. The cause is the terrible healthcare for pain. Illicit fentanyl coming in from outside the US now is just a symptom - stopping that fentanyl will prevent death (because it's a very dangerous opioid) but it won't do anything about the real problem: people in pain with inadequate treatment for that pain.

notadoc11• 9 years ago

it won't do anything about the real problem: people in pain with inadequate treatment for that pain.

Careful, you're sounding awfully reasonable!

Harassing doctors and patients is beyond stupid, I suspect it will result in even more people turning to illegal drugs to self-medicate once their personal doctor gets some external political/media pressure to stop prescribing anything effective.

throwaway91111• 9 years ago

Also, fentanyl, which is a major illicit opiate source, mainly comes from china. A wall could have no effect at all; and in fact could spur more deaths if people turn to fentanyl.

rhspeer2• 9 years ago

Contimplating fostering a computer nerd to do QA. I believe that is how the old apprenticeships worked.

Would also move out with a savings, a marketable skill, and references at 18.

Not a bad start for a Dev.

rhspeer2• 9 years ago

Huh, down votes signal it is reasonable to want a pet human, but not an apprentice?

notadoc11• 9 years ago

The "opioid epidemic" is manufactured political and media hysteria. There have always been drug addicts.

The end result to all of this hysteria will be nothing but more political interference in doctor-patient relationships, more annoying obstacles and hoops for patients to jump through, and more suffering for patients.

veeberz• 9 years ago

If you'd cared to talk to people outside your bubble, then you might've had a different opinion. And besides, the fact that there are people exploiting a crisis doesn't mean that the crisis was manufactured.

notadoc11• 9 years ago

Don't assume because you are in a bubble that others are too.

DanBC9• 9 years ago

It really, honestly, is not manufactured outrage.

https://www.vox.com/policy-and-politics/2017/6/28/15881246/d...

America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths

The US uses far more opioids than any other country. Does the US have far more pain than any other country?

and more suffering for patients.

No.

You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain.

People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.

notadoc11• 9 years ago

You seem to think that opioids are an effective treatment for long term pain

Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions.

and is now addicted to opioids

Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant.

People with long term pain need rapid access to a specialist pain management clinic.

Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.

kakarot• 9 years ago

Bro my old city's opiate overdose death rates have doubled annually for several years now. I have several friends whose lives have been claimed by opiates in that span of time. It's most certainly a thing. No offense but you shouldn't talk completely out of your ass.

paulddraper3• 9 years ago

I'm a foster parent, and this is definitely a real thing.

My state recently went into crisis mode for foster care, where they struggled placing kids and filled up the group facility they normal use for short term overflow. They're starting a program specializing in short-term placements.

Opioids have been blamed for the recent increases.

http://fox13now.com/2017/05/12/resources-stretched-thin-as-m...

And this is in a state (Utah) with an already relatively low rate of children in state custody. Surely if we are struggling, other states must be as well.

I don't know what politics to sorry or what macro policy changes will "fix" this, but I know how I can help. Circumstances vary, but if yours permit you to do foster care, I recommend looking seriously at it.

ericabiz• 9 years ago

Can you say more here or offer some links on what it's like to be a foster parent? I'm adopted and had to deal with some ACEs, and being a foster parent really does call to me. My dad was an attorney and also volunteered to help with foster kids, so I had exposure to them as a child. I want to look more into it.

Also, if you have biological kids of your own, how did they deal with foster kids? I have a daughter and would like to have another bio child as well.

esthercrawford• 9 years ago

I fostered for nearly 2 years, and ended up adopting my foster daughter who was just a few weeks shy of her 7th birthday. I had a 1 yr old bio son when she joined the family.

I’d say what worked best for me was doing the very hard and frustrating process of building trust between me and her birth mom & family. It was at times maddening but so worth it for her. Especially since the system itself is broken.

My son was actually a plus - she was able to bond with him first and I believe that enabled her to then trust and bond with us.

Now she’s 12 and is amazing. I feel like the luckiest mom in the world to be able to spend my life with her.

paulddraper3• 9 years ago

My mother was in foster care, some good, some bad, and that was a motivator for me to do it.

We don't do foster-to-adopt. We do the other kinds: for situations where the goal is still reunification, or adoption by a family member.

Biologically, we have a two-year-old daughter , three-year-old son, and a son on the way. We have the right to know the history of placements and say yes/no to each one. Our foster care rep knows that we can't (won't) take aggressive children or children over 12, because we gave young kids. We also only do Level 1 care. (There are three levels in our state for rating behavioral and handicapped difficulty. Levels 2 and 3 require extra training.) We do, however, take sibling groups.

Our bio kids LOVE having foster kids. They now think that any friends they make should live at our house, because their other ones do.

I don't have any foster horror stories though I've heard plenty of course. We've been lucky enough to have remarkably well-adjusted kids. I think poor circumstances often demands increased maturity. IMO, the hardest people to deal with are the parents, not the kids.

Getting licensed involved 30 hours of in person training over a few months, a few hours online training, a house inspection (fire extinguisher, escape latter, handrails on stairs), and an interview with very personal questions (e.g. if you're married, "Have you ever considered divorce?").

The hardest parts of parenting are also the hardest parts of foster parenting. So I would expect a biological parent to have a pretty solid idea of what foster parenting would be like.

Animats• 9 years ago

A lesbian couple in Oakland I know have two foster girls from a Nepal refugee camp. It's been all uphill with them. They've had them since age 14, and now they're 18. English was a problem, but they're mostly past that. Their schooling is poor; despite Kumon, tutoring, and the Berkeley International School, one of them can't pass the DMV written driving test.

Attitude is an issue. The girls grew up in a refugee camp where they didn't have much, but nobody had to do anything. Now they've been dumped into an complex alien society where they have to become self-supporting. It doesn't help that the girls think their role is to find a man and be supported by him. The girls have strong ideas about the role of women, and despite being fostered by lesbians who do home remodeling and industrial design, they have zero interest in learning those skills.

The people who supervise the foster child program think they're doing a great job. The kids have sort of learned to read, and one of them got a job at an ice cream store. They got high school diplomas, only because California stopped requiring the high school exit exam at the beginning of 2016. This is better than average for the program.

Both girls can use a smartphone for entertainment purposes.

ransom1538• 9 years ago

What bothers me about this epidemic is how easy it could be for authorities to stop. Fentanyl isn't created in the back of a motor home. It is a manufactured and controlled narcotic. How controlled - just see the link below. All that needs to happen is for the DEA (et al) to stop raiding homes and torturing people and to pay a visit to these out of control doctors. Why a "Nurse Practitioner" is allowed to prescribe opioids 21937 times - wtf? Opioid prescribing is totally open and public - they aren't hiding it.

Here I have a list of the highest prescribing opioid doctors (sunday with beer project): https://www.opendoctor.io/opioid/highest

(let me know if you want the sql or whatever).

wildmusings• 9 years ago

I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They were complaining that doctors often felt that they couldn't prescribe even when there was legitimate need.

I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now.

As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.

DanBC9• 9 years ago

I don't know what happened in the interim

The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated.

They also said that opioids are not addictive if prescribed for pain.

It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids.

The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mc...

We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

mgkimsal2• 9 years ago

but if only we had draconian DEA policies aggressively stopping overprescription now.

Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc"

Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him).

What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").

WalterBright2• 9 years ago

why that's a horrible idea

Making drugs that people want illegal has never worked. Why should it work now?

Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.

notadoc11• 9 years ago

As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.

You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that?

Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive.

Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.

sndean• 9 years ago

Fentanyl isn't created in the back of a motor home.

But it probably could be, if there's a market for it. There are trained chemists making meth [0]. The sale of the precursors of fentanyl is controlled, but so are the precursors to meth. If fentanyl (or an analog) stays popular we'll have people making their own.

Edit: I'm not saying it would be as obtaining PSE, but if you're a member of a chem lab, the only thing between you and an order to Sigma is ~two signatures? There's too much money involved for it to not happen.

[0] http://news.sky.com/story/inside-the-cartels-cooking-crack-i... (I know, Sky News..)

tomjen3• 9 years ago

My brother studies Chemistry. One of the first things they told them was that they could make Meth (I think) with a street value of about 1000 times the cost of the materials, but the police would know where to start looking as soon as they got their hands on some, because it would be too pure, too well made.

Mind you, this was told to incoming (freshmen) students, presumably the professors would be able to make the precursors in such a way that the authorities wouldn't know.

vzcx4• 9 years ago

Setting up a lab capable of producing fentanyl has significant up-front costs associated with it. Running the lab and keeping it stocked with precursors is an ongoing risk. For better or worse, the golden age of american clandestine laboratories is probably past: it is far easier to import an uncontrolled, custom-synthesized fentanyl analog, although I would not recommend getting into this business.

Fentanyl isn't popular _at all_ among opioid addicts. The duration of effect is short relative to morphine-like molecules and it absolutely wrecks one's opioid tolerance. Fentanyl is popular among unscrupulous heroin dealers that try to pass off a cheap synthetic opioid as $200/gram diacetylmorphine.

dpc59• 9 years ago

A lot of the fentanyl in Canada comes from china and was ordered over the dark web.

hackermailman• 9 years ago

Fentanyl and other opioid synthetics were legal to export in China until very recently, so ordering it was as simple as going on Alibaba or other wholesaler chemical sites and just bringing in enough of it that customs would miss a few shipments. Now that there are regulations involved on the Chinese side the price of Fentanyl smuggling has risen and it's no longer an attractive synthetic to maximize profits for dealers so they are importing other synthetics or Fentanyl from countries who still don't have export laws.

Realistically the only way to stop this problem besides legalization is labs for testing pills and powders like they have in Spain and Netherlands, and mobile Suboxone clinics[1] which were proven here (Vancouver, Canada) to be the best solution for addict recovery as they can pick up the phone and have somebody quietly prescribe them Suboxone treatment without having to queue up at the methodone clinics everyday. Suboxone was described to me as satisfying the 'fiend' cravings while not making you high, so you can function sober and no longer need to chase daily money to satisfy a drug addiction and can actually plan things. It also ensures you won't use again since the antagonist ingredients makes it more difficult or impossible to use other opioids at the same time, making relapse less likely.

The safe injection sites here are a double edged sword. On one hand they are helpful for street addicts but on the other hand they are more likely to take risks, knowing there's a nurse there so aren't afraid of mystery powders like they used to be, according to anecdotes of people I've talked to who frequent them. The city handed out overdose kits to street users who demanded a peer to peer type safe injection network but the junkies stole the needles out of the kits to shoot up with basically rendering them useless and wasting the hundreds of thousands it cost to distribute them.

There's some data here about the Netherlands success in drug use reduction, they put a lot of funds into prevention instead of just treatment. http://www.emcdda.europa.eu/publications/country-drug-report...

[1] https://www.theglobeandmail.com/news/british-columbia/a-bc-c...

opportune2• 9 years ago

You're right that doctors can prescribe fentanyl, but I'm not so sure about your (implied) claim that prescribed fentanyl is contributing to the opioid epidemic. To my knowledge, fentanyl is safe to take when done in proper doses (as are most painkillers). The problem with fentanyl is that since it is so much more potent than drugs like heroin, when the two are mixed people can overdose much more easily since they won't know that the fentanyl. And the fentanyl being mixed in with heroin isn't coming from Dilaudid prescriptions, it's coming from China: http://securepackages.org/wp-content/uploads/2017/02/USCC-St...

So unless you can figure out a way to stop the drug trafficking industry, fentanyl+heroin aren't going away. Perhaps we will see fentanyl produced less if China cracks down / increases regulations on their pharmaceutical industry.

Unfortunately the opioid epidemic is going to have to be stopped by moving away from the casual prescription of opioids, which is what creates opioid addiction in the first place. I think your open doctor project is really cool and is a good way to start: shame doctors who are essentially operating as pill mills for their "patients." My hope is that people so obviously abusing the system like the doctors at the top of your list end up losing their license to practice medicine, or behind bars.

hammock• 9 years ago

A lot of fentanyl is coming from Mexico, where they easily synthesize it, and it's introduced into the heroin supply as a cutting agent. Whether or not it's "contributing to the opioid epidemic" depends on how you interpret that phrase. In other words, people are getting HOOKED on opioids because of the 12hr dosing of oxy etc that has been discussed on HN in the past. But people are DYING OF OVERDOSES because they cannot afford/lose access to pills and switch to heroin from the street (adulterated with fentanyl).

actsasbuffoon• 9 years ago

According to most of what I’ve read and seen, opioid prescriptions are contributing to the problem. It’s true that people aren’t overdosing when following their prescribed dosages, but some people are getting addicted.

A common story for opioid addicts starts with, “I was in a car accident, and they prescribed opioids to deal with the pain. Once the prescription ran out, I was in incredible pain, maybe even worse than before I started taking the pills. I started buying pills illegally. Once the pills got too expensive, I switched to heroin.”

I’ve seen far too many stories that follow that basic path. It’s definitely not the only way people get addicted, but it’s too common.

chrshawkes• 9 years ago

Fentanyl even killed Prince

notadoc11• 9 years ago

Have you ever considered that perhaps there are just a lot of people with various levels of chronic pain, and, shockingly, some of them may want to manage their pain and see a doctor and end up with medication?

"an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain."

https://nccih.nih.gov/news/press/08112015

ekianjo3• 9 years ago

Yes but opoids has many risks and should only be prescribed to a minority. This is not what is happening.

pasbesoin• 9 years ago

I spent the first half of 2016 helping a drug and alcohol addict kick her habit of 20+ years. 6 days inpatient detox. Would have had 30 days rehab if she'd stuck with it.

Had lost her driver's license years ago. So after she checked herself out (admittedly, upon my investigating, for some legitimate reasons vis a vis that program), I spent the next couple of months driving her to meetings, providing childcare to make that possible, helping her get to the job her sister found her, then the second job. Making sure she wasn't alone in the evenings, when she would drink...

My major point. 6 days at one of the area's premier hospitals. Thanks to the ACA expansion of Medicaid. The rehab program would have gone under that, as well. Foodstamps for her and her kids. A social worker and case management for her daughter (living with grandma). Etc. Etc.

I had some warning signs, early on, but I hung in there -- advice from experienced friends and experts advising patience. And thinking not just of her, but of the kids; things seemed to gradually get better with them once I got involved.

Anyway... Not just my support. All this public support. That I don't begrudge: Treat the problem. Take care of the kids.

Come fall, she's back together with her ex-boyfriend, who was a big Cruz supporter. ("The Constitution! La la la, blah blah blah...")

And she -- previously having stated her indifference to politics, except for hating Hillary for whatever gut felt reason -- starts expressing herself as a big Trump supporter.

I'd explained to her, early on, that the ACA is what enabled me to keep insurance. I don't get a tax break. It just gives me the opportunity to participate, whereas before insurance companies would look for any pimple as the basis to exclude me.

She gained sobriety through the support of the State, and someone who depends on the ACA for his own well-being.

None of that seems to matter to her.

This experience has caused me to fundamentally rethink my ideas about how the world works and how we can (or can't) tackle these problems.

Writing about all this makes me feel kind of small. Laying the situation out there and sounding aggrieved.

But I do it, all the same, for the point it impressed upon me: I'm no longer sure some people can be reached, through any level of action and good will.

It's a pretty sobering -- and saddening -- perspective.

P.S. We've been out of touch for months -- her choice. As far as I know, she's still sober. Making plans a year out.

She's doing ok. But there seems to be no connection in her mind with providing that opportunity to others.

I've been forced to realize and acknowledge that some people appear to be in it purely for themselves. They can exhibit charm and engagement in furtherance of this purpose. But real empathy and cooperation?

And, looking around, it's not just the addicts and "miscreants". There's a significant portion of the population who really does believe and follow "I got mine". And that is all they really respect in others.

It is, it turns out, a dog eat dog world. At least when it comes to dealing with these people. Who, en masse, present a formidable problem to a functioning society.

krastanov• 9 years ago

Thank you for helping other people! You are making the world a better place, and when you average it out it is working - humanity is more "humane" this century than it was over the last couple of millennia.

Sure, there are those really disappointing frustrations, but I try to just chalk them up to cost of doing business. That way you can focus on the fact that the average is getting better and your efforts are making a difference, even if slowly.

Children of the Opioid Epidemic Are Flooding Foster Homes

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