The Poison We Pick

https://nymag.com/daily/intelligencer/2018/02/americas-opioid-epidemic.html

by matt4077 • 8 years ago

309 197 8 years ago

gt_7• 8 years ago

At least we are moving past the scape goats and taking a thoughtful, considerate look at what is actually happening.

I regularly have long conversations about this with my mother, a nurse in Louisville, KY and steadfast American patriot. She is at a loss of any explanation these days. I am torn when we talk about it because I know her pride in our country is a big part of her, but it doesn’t rest with what she is seeing. Watching her spirit shift into curiosity then skepticism has been difficult to witness. She wants to blame someone but she no longer believes that someone is out there.

jacobush• 8 years ago

This sounds like a good development?

dmreedy3• 8 years ago

The loss of a source of meaning in life is a dangerous thing, especially if it isn't replaced by something else. That way lies nihilism, and, if the thesis of the article is to be believed, opiod addiction.

gt_7• 8 years ago

Well, it depends on what you believe is the culprit, but the easy scape goats are long debunked at this point.

We will some day realize that the psychological situation of income inequality (or other socioeconomic equivalences) is the root of drug epidemics.

The sooner that happens, the better, because neither incarceration or isolated treatment can address this.

Everyone grows up with different experiences and I think being raised different would have delayed where I’m at with this but I have worried for a long time that particular increases of drug use cannot happen purely due to availability of the substance. It doesn’t make sense in the narratives I’ve witnessed, mainly referring to what motivates mass drug use, accounting for lushes and party behavior as constants.

I have never been a drug user but have observed my friends use and have lost a few of them when I was younger.

It simply doesn’t happen in healthy social environments.

I am a motivated and passionate person. My life always has goals and ideas floating around. When I was younger, sometimes my friends didn’t keep up, or something like that. Every time I have lost a friend to drugs(death or otherwise), it was preceded by me acknowledging they no longer felt the hope and excitement for the future we had once shared. In retrospect, it usually correlated with something in their life they were ashamed of, a harsh reality or realization that they didn’t have certain opportunities. It could be small but still have big repercussions. I have felt shame for thinking I may have overwhelmed them with my dreaming, higher-than-average curiosity or motivation for constructive activities. Although I am that weirdo, it doesn’t usually send people to drug use. What does is usually private and disguised in shame.

The monster here is loss of hope.

I have learned this argument usually comes across as either fleeting or ideological. It’s very hard to put into words to someone with another comprehension of the problem, and witnessing one or two people face substance abuse doesn’t bring it home either. I developed this view from watching how crowds of people use drugs. When you isolate the party people and the lushes, you are left with people who simply feel like they don’t count.

ilackarms• 8 years ago

all this talk about opioids and no mention of ibogaine

kylek• 8 years ago

Wanted to say this too. Unfortunate. It’s awful that it is illegal (and for the most part unknown) in the states.

mmjaa4• 8 years ago

The way to treat the opioid crisis is that it is a battlefield, and America is losing. Drugs have long been seen as a way of usurping the will of ones' enemies; it is no different now. America has been under pharmacological attack for decades; its people are too addicted to see that this is by design.

Drugs have weakened America, and that is by design of its enemies.

the-dude5• 8 years ago

From the article :

"The drug was ubiquitous among both the British and American forces in the War of Independence as an indispensable medicine for the pain of battlefield injuries."

What is your point exactly?

mmjaa4• 8 years ago

The point is that there is a war being fought against American society, and the weapon is: drugs. Its one of those weapons where the willingness of the intended recipient to apply it to themselves is key to its effectiveness.

Its not a 'popular' opinion, but it has to be pointed out that the use of drugs to devolve society is as old as the political hills, yet its not something that is taught in schools, nor do generations grow up with an awareness that widespread drug adoption is a consequence of someone wanting to destroy civil society, by design.

Its as much a battle of identity as it is pharmaceutical in nature. Too many Americans feel their identity is challenged if you question their use of drugs - legal, and illegal. This is why its such an effective weapon in creating devolved society: the targets willingly apply it to themselves. All you have to do is get it to them.

sevensor• 8 years ago

Which enemies are we talking about here? Are they domestic or foreign? What is their goal? I see where you're going with this argument, there are certainly historical precedents, but you haven't said enough to make it plausible.

odMFJFHBvn2zyR2• 8 years ago

From the article, "Fentanyl comes from labs in China".

Also:

The Opium Wars still shape China’s view of the West

https://www.economist.com/news/christmas-specials/21732706-b...

Angostura• 8 years ago

Well written and insightful, thank you. Useful fodder as I answer my kids' questions about drugs.

shaki-dora• 8 years ago

This article, especially the end, is actually more about the fundamental ills of American society, rather than just drugs.

It’s about the breakdown of the social glue in the face of relentless market pressure and individualism, and the diminish end of trust and solidarity, along with institutions like organized religion, unions,families, or even sports clubs.

thecheops• 8 years ago

I was the first to blame the drug companies (they certainly warrant blame) but there are other factors to consider that are addressed in this article that I failed to previous realize. Worth the 15-20 minutes to read.

dmreedy3• 8 years ago

I've been talking with my brother a lot about this recently, especially as a function of the overall decrease of 'meaning' in the world. I think it goes back even further, to the advent of postmodernism in the throes of World War I. They were the first lost generation, but I don't think they were the last. The death of modernism and the accompanying assault on the bastions of objective meaning (as discussed in the article, Religion, Jingoism, and Community by way of Tribalism) is in some sense a healthy thing, as 'objective' meaning is too often used as false justification to do battle with other, contradicting 'objective' meaning. But it hasn't been replaced with anything. And the intervening years have only weakened it further. Maybe we had a brief sputter of national identity again with World War II, but the atomic bomb saw to that, and Vietnam finished the job (in America, at any rate). And now we're drifting in a world without objectivity. And what do you work for when the only objective truth is death, and the end of your accomplishments? Some people seem to be able to answer this question for themselves, some cannot.

We thought as well that this may be why there are so many people engaged rabidly in the consumption of fiction these days; it seems to me just as much a symptom of a broader crisis of meaning as opiods may be. A fictional world is readily graspable; you can wrap your whole head around the whole thing. And meaning is easily found in the simplified moral space that these simulations are often constructed under. It seems to me just as much a salve for the meta-crisis of meaninglessness as a drug, in some sense.

I don't mean to ascribe any moral right or wrong to any of this; in fact, that's the whole thrust of it. It's harder and harder to know what moral right and wrong are.

---

EDIT: it's been pointed out that I should probably be less careless throwing a word like "objective" around: I mean it only in the sense of mass perceived objectivity. If a society agrees on it, it's as close to objectivity as we seem to be able to get. Substitute it for "Societal Consensus", if it pleases you, but I think the brain treats them as one and the same.

thomzi12• 8 years ago

Um, people have been “rabidly” consuming fiction since the Greeks created theater?

cornholio• 8 years ago

They were also busy surviving, most of the time. First world problems.

graphitezepp• 8 years ago

The appeal of fiction has never changed and been around. Availability and the volume people consume has changed drastically.

tclancy3• 8 years ago

A fictional world is readily graspable

I've been reading "Sapiens" and one of the recurring themes is the idea humanity's success is built on the ability to create useful fictions to bind large groups to a goal or cause. I think we are struggling with that in the first world as we give up religion without a clear replacement fiction that reassures people someone will be there if they get sick and when they die. In addition, we are discovering some groups have (for want of a better term) weaponized fiction to achieve their goals.

I liked it all a lot better when that last sentence lived entirely in the fiction of people like Warren Ellis and not in reality.

EDIT: Sapiens, not Simians.

cstavish• 8 years ago

Sapiens?

maxerickson2• 8 years ago

What if it is simpler than a quest for meaning?

What if our pandering to rugged individualism has simply lead us to create a society where institutions, instead of providing a level playing field, reward those that have already won and punish those that have not?

Buy a million dollar house? Write off the cost of financing it. Get injured and not be able to work for a year? Huh, not sure someone with that kind of resume gap is the kind of person that we want to hire.

Then we wring our hands about why a frustrating, alienating society frustrates and alienates people.

dictum2• 8 years ago

Get injured and not be able to work for a year? Huh, not sure someone with that kind of resume gap is the kind of person that we want to hire.

This is often voiced in HN as "a bad hire is a liability", which I mentally translate to "my life has gone so smoothly, I've lost the ability to imagine a life history unlike my own".

kldavis42• 8 years ago

Your comment about the rabid consumption of fiction these days hits home for me personally. In this "golden age" of television, with more high quality entertainment than anyone can possibly consume, I've begun to feel that my media consumption is more compulsive escapism than casual enjoyment.

I find Pitirim Sorokin's classification of societies as either ideational (spiritual) or sensate (materialistic) helpful in understanding where we are. I strongly believe the evidence points to our modern civilization being in the late stages of sensate decline. Science and technology has brought enormous benefits to the world but has utterly devastated the individual dignity of man, leaving only meaningless pleasures to provide any motivation for living. I think we will soon (100 years?) see a cultural shift back towards immaterial values and purposes higher than the satisfaction of our sensory desires. The question in my mind is whether that shift happens before or after our current civilization destroys itself.

api5• 8 years ago

utterly devastated the individual dignity of man

I smell survivorship bias.

Have the masses of humanity ever had dignity?

In the distant past the peasantry were largely illiterate, so nothing of them survives. What we get are a lot of stories written by upper class literate people suggesting that they had dignity and meaning.

In the more recent past they lacked access to broadcast media or television stations, so very little of them survives. What we get is again a lot of survivorship bias.

Now they all have Internet connections and can fill cyberspace with their cries for help, so now we say "hey, why are all these people so unhappy?"

History is one consistent story of wars over nothing, constant crime and drama, and escapism through sex, drugs, entertainment, and religion-used-as-opiate. Those are things that people who lack a sense of dignity or purpose do to pass the time until they die.

cptskippy2• 8 years ago

It's harder and harder to know what moral right and wrong are.

Morality isn't about what is right or wrong. You need to get past that. There are plenty of situations where there is no right answer and an individual is forced to choose between two wrongs.

Morality is what an individual ascribes to be proper or improper and it is very fluid. An individual's morality is influenced by everything from the situation to the people around them. They may inherit their sense of morality of another person or group but morality is still a personal choice.

We tend to think that everyone shares the same morality and so it becomes confusing when we encounter situations where our moral beliefs are at odds with others and we're in the minority. It doesn't help that the moral code ascribed to by a community might be completely different from the one the next town over.

jeffreyrogers• 8 years ago

This viewpoint is part of the problem the person you're replying to was describing. That we are freer than ever to choose our own values, but people are simultaneously finding less meaning in life. That with the erosion of constraints, religion, and social roles people have to create their own substitutes for these things. It's the idea of Nietzsche's Übermensch.

dnomad• 8 years ago

Only a very disingenuous reading of history would lead to the conclusion that our society is less "objective" than the past.

What has been lost is widespread confidence and faith in those institutions that previously served as the pillars of society -- the church, the king and the nobility. Now people are completely on their own for their worldview. What's become abundantly clear is that people are very, very bad at constructing useful or reliable models of the world. Left to their own devices the people will readily embrace all sorts of nonsense, the more extreme the better. Some will turn to drugs and some will turn to ranting about crisis actors and some will turn to video games.

None of this is a cause for concern. These people's lives are still orders of magnitude better than those enjoyed by people just a century ago. A life wasted playing video games for 12 hours a day still beats one wasted slaving away for 12 hours a day on the farm.

What is disconcerting is that the "poison" is seeping into the vital and core institutions and systems that contribute to our extraordinary quality of life. The author is concerned about the suicide rate (which impressively continues to break new records every year) but what should really be frightening is the extraordinary poor governance that Americans have enjoyed for the past 20 years. (Seriously, trillions of dollars flushed down the drain on completely pointless wars.) When the real engine of American prosperity sputters out we will have much more significant and difficult problems than a bunch of dumb, bored kids getting high on dope.

dmreedy3• 8 years ago

In a world without objectivity, perception of objectivity and objectivity are indistinguishable. I was using the word as short hand for those very pillars you're referring to; hence 'religion and jingoism'.

overthemoon• 8 years ago

It could be that mere freedom from discomfort isn't enough to call life good. Anyway, by what measure is a life spent slaving away for twelve hours on a farm worse than 12 hours spent playing video games? Both seem demeaning to human dignity, and the fact that one was "chosen" and one was (maybe) not is missing the point--both states of being are inflicted from without, whether slavery (wage or actual) or alienation. Both are symptoms of systems that dehumanize.

jimbokun• 8 years ago

"A life wasted playing video games for 12 hours a day still beats one wasted slaving away for 12 hours a day on the farm."

This is not at all self evident, can you back up this statement?

"orders of magnitude"

So people living today are literally 100x or 1000x happier than a century ago? Again, do you have any basis for this claim? How do you measure it?

latencyloser• 8 years ago

I remember in college reading "Laborem Exercens", despite it's very religious justifications, had a major point that resonated with me about the "dignity of work". In my interpretation of it (as a 20 year old), it argued that much of man's (and woman's) meaning in life is derived from the work that they do because of the interactions with the earth that work often creates. If you take that away, much of life's meaning tends to fall to the wayside as well.

That being said, if I stop to think really hard about whether I'd enjoy 12 hours of farm work or 12 hours of video games, I can't say I really know which one I'd prefer. A tired, overworked me says the video games. But I know having had several days of uninterrupted laziness before, that I'd quickly feel lost and unhappy with the video games as well because there's no "larger" gratification from them than whatever immediate feedback the game system provides.

clairity2• 8 years ago

i don’t agree with everything you said but you make an important point here:

“what should really be frightening is the extraordinary poor governance that Americans have enjoyed for the past 20 years. (Seriously, trillions of dollars flushed down the drain on completely pointless wars.)”

those wars were a political attempt to focus americans on an externl enemy and thereby create social cohesion via patriotic solidarity, but vietnam (and to a lesser extent the gulf war) soured us on that strategy. we don’t want to fight random, far-away people we don’t know and don’t threaten us in the least (despite the propaganda of trying to equate muslims with terrorists).

it was literally an attempt to fix domestic issues like the opioid crisis (while also catering to the military-industrial complex) through a reflexive desire to return to post-world war II american prosperity. somehow that failure is lost on many americans, but let’s not do that again.

njarboe• 8 years ago

If those 12 hours is working on a farm that you own, I think that produces a very different outcome in the long run. If you can see a buildup of improvements and a reduction of hours over the long haul. Build a shed or a barn, improve the well, build a fence to last, breed the next generation of cattle, plant an orchard, etc. Maybe these operations are hard to fund by themselves, but the popularity of farm-to-table consumption could help bring it back. Being a steward to the land can bring great meaning especially when also getting to raise a family in that situation.

This is sort the situation that a lot of video games simulate, so doing it in real life might just work.

logfromblammo• 8 years ago

It's a false dichotomy. The life spent doing farm work for 12 hours per day, forever, is not to be compared against the life spent in non-productive consumption of entertainment, forever.

The alternative is to spend one's days doing anything at all--whatever a person may find pleasing. That may include playing video games for 12 hours every day. It may also include injecting as much heroin as the person can lay hands on. It might also include writing out a 1000-page mathematical proof. Or breeding rats to have better bladder control and better responsiveness to humans. Or designing a near-space habitat suitable for supporting a population of humans indefinitely. Or deciphering ancient scripts. Or building a roadworthy vehicle from scratch. Or building cosplay outfits. That kind of life completely blows the farm work out of the water.

A lot of jobs only get done because someone has to do them in order for everyone else to live. Those jobs compete with the things that don't need to get done, but people want to do because they think it's challenging, interesting, or fun. Nobody thinks that a job that can be done by a stupid robot is challenging, interesting, or fun. Boring, mind-numbing drudgery does not give anyone purpose.

It's not that people are bad at generating their own world views. They are bad at reconciling the colossal dungheap of comforting lies that have been fed to them for most of their lives with the objective reality that is starting to sneak past it, as lines of communication start to route around the gatekeepers that have traditionally been able to control the spread of information. The confidence and faith were never deserved in the first place. The story that could have previously been quashed by a local news editor, before reaching a national or worldwide audience, can now be spread instantly via social websites, and so too can the unfounded rumors of a malicious gossip. Before, people had to trust their kings, bishops, bosses, and touts. They had no alternatives--believe my bullshit now, or wonder forever what the truth might have been. Now, they are faced with a whole world filled with story-tellers, and are forced to decide whether any given person is trustworthy or not. For obvious reasons, the rulers that were formerly trust-because-you-have-to were lax in teaching those subject to their info-control about how to detect falsehoods or think critically.

The institutions formerly relied on most people believing them when they told plausible lies. They will be forced to educate people in critical thinking, now that everyone can be a believable liar on the Internet, because otherwise people will be more likely to disbelieve when the institutions tell lies, and also disbelieve them when they tell the truth.

fishtank• 8 years ago

You may be interested in reading Man's Search for Meaning by Viktor Frankl, which says (roughly speaking, and after Kierkegaard) that the striving to find a meaning in life is the primary motivating force in the lives of people, and its frustration creates an existential vacuum that leads to boredom, distress, depression, aggression, addiction, and the rest. He would agree that there has been a sort of crisis of meaning since around the middle of the last century, loss of religion and other societal conventions having a lot to do with it.

I think what you regard as "people engaged rabidly in the consumption of fiction" he might interpret as people living passively, bored and confused, abdicating a sense of responsibility for their own lives. I think he is a precursor to the Neil Postman line of cultural criticism, if anyone's looking for more books.

Man's Search for Meaning is a short and compelling book, he describes a way forward that doesn't involve resurgent nationalism or religious fundamentalism, and I've gotten a lot out of it personally.

evunveot2• 8 years ago

I'll be the one to bring up Jordan Peterson, I guess. To attempt to synthesize his views:

1. Even if you start from a position of complete nihilism, you can recognize that pain (both physical and psychological) is real and that you don't like it.

2. You can observe that people who perceive their life as meaningful are more likely to be capable of persevering in the face of extreme pain and suffering. So in a sense meaning is "more real" (stronger) than pain. (I don't get much out of the "more real" aspect, but I think it's part of Peterson's attempt to find harmony between rationality and religion.)

3. Even if/though meaning is completely subjective, you can derive meaning from taking steps toward a goal, specifically a positive vision for your own life that you've imagined in great detail (and ideally written down), including how you want to affect the people around you and the wider community. Having a vision of the life you want to avoid (Hell) is good, too.

4. Your goal (life vision) will change as you move toward it, but that's a good thing because it means you're learning and expanding your horizon.

Peterson and some colleagues created a kind of self-help course based on this sort of thing called Self Authoring and he often cites the positive outcomes it had when they researched it using college students (higher grades and lower dropout rates).

I think he would say that the societal malaise you're talking about is essentially Nietzsche's death of God and that you can draw a line from that loss of a foundation to the horrors of the 20th century (Peterson would probably just say "the gulags"; he sees more of a danger from "radical leftism" in contemporary society than fascism). The above could perhaps be described as his alternative to attempting to address the lack of a social firmament through some totalistic ideology, which has in the past led to pathological totalitarian states like Hitler's Germany and Stalin's USSR.

api5• 8 years ago

It's really too bad the alt-right has adopted him. I'm not sure the affinity is mutual but it's tarred everything he's said with a toxic association with fascism.

Asking why the fascists like Peterson yields a great deal of insight into fascism.

Among other things fascism represents a fanatical reaction to post-modernity's undermining of foundations. The fascist sees the same problems that Peterson is talking about (hence the affinity) but the fascist's reaction is less intellectual and more emotionally driven. Fascism just says "I will myself to have this meaning, and to defend that meaning I will assert that anyone not holding it is wrong." The fascist actually accepts the premise of nihilism but then rebels against it by substituting "violence" (verbal or physical) for objectivity.

In other words instead of "it is true because God said so" or "it is true because facts demonstrate it" you get "it is true because if you disagree I will hit you."

Other types of totalitarianism are similar, though I think fascism may be alone in the degree to which it is conscious of this. Others such as theocracy and totalitarian forms of leftism seem unaware of their nature as violent cults of will against nihilism but they behave similarly.

lighttower• 8 years ago

Are you being downvoted only because you mentioned Peterson? What you are writing here, and attributing to Peterson, was first described in depth by Viktor Frankl in Man's Search for Meaning[0]. In that book he describes how prisoners in Nazi concentration camps who didn't find meaning to their suffering would quickly die by illness or suicide while those that ascribed meaning to their suffering (such as staying alive to take care of someone or to reunite with their wives in another camp) would survive. He synthesized these lessons into Logotherapy. I highly recommend that book.

[0] https://archive.org/details/MansSearchForMeaning-English

api5• 8 years ago

But it hasn't been replaced with anything.

Can it be? Maybe the universe is so information-rich that it yields a vast and ever multiplying array of fundamentally undecidable questions. Everyone knows the big ones: god/gods, life after death, ultimate origin of the universe and consciousness, etc., but there's quite a few more.

If there are lots of undecidable things then how do we ever agree on objective meaning without some totalitarian or tribal pressure just dictating one to us?

It takes me back to one of my favorite quotes ever:

“The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents... some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the light into the peace and safety of a new Dark Age.” ― H.P. Lovecraft

fsloth• 8 years ago

Note: This crisis exists only in america. The philosophical context is more or less the same in other rich countries.

I would look in ways american society puts more pressure on individuals, than, say , scandinavian societies do.

I would look to economic and not existential issues.

I think the article nailed it when it pointed out america has no experience of pre-industrial culture at large.

meri_dian4• 8 years ago

There is sadness in every corner of the world, but that only overlaps with opiate availability in certain places.

In America, like every nation, there is sadness. However in America, unlike many other nations, we have widespread opiate availability.

This combinations leads to opiate deaths on the scale we see. It's not complex.

What is the answer? China knows the evils of opiate addiction, perhaps in the future, after enough of our own society is ravaged by it we will adopt the Chinese attitude towards opiates and look back at the naive past as our future selves tend to do.

gt_7• 8 years ago

I think this conclusion is premature. Obviously it’s a hard question but I will share a few reasons why I hesitate here:

- The last 2 major drug-use epidemics in the US erupted in communities afflicted by major financial hardship and growing socioeconomic disparities. Both were victims of the poppy. I hesitate to discard the correlation.

-I have taken hydrocodone. Personally, I hate it. I can’t think or function, but yeah other than that nothing seems like it matters. For me, it feels deadening, like suicide, the other epidemic that happens to be afflicting the same communities as the opioid epidemic. There is no recorded rise in suicide availability. I hesitate to discard the correlation.

-Although much of the world has been outlawing opioid availability, opioids are available and prescribed throughout. We do not/cannot know how many people would be using opioids if they lacked availability to them but this drug has a nature worth considering, which I think the article gets at very well.

-Let’s say the pharmaceutical cowboys’ are privy to ‘supply and demand’. No we aren’t talking about a fluid market but let’s also say, hypothetically, that not every society in the world is feening to collapse itself for opioid highs. And let’s assume US pharmaceutical suppliers have ways of identifying and responding to demands with supply despite being a regulated industry. I personally find none of these to be even a stretch, and to conclude, I have no problem imagining how it would play out exactly like we have observed.

vzcx• 8 years ago

Um... The Chinese like opiates, too. The majority of heroin produced in the golden triangle region finds its way into China.

Why all of the moralizing about the "evils" of opiate addiction? Addiction is complicated, and while substance abuse can be harmful to the user, widespread social intolerance and the subsequent prohibitions on addictive substances only serve to amplify that harm.

The opioid deaths we see are a direct result of the prohibition of opioids. Shipping into different jurisdictions carries the largest risk in the black economy. Thus, the transition from opium to morphine to heroin to the various fentanyls. There can be no quality control or FDA-enforced purity standards, hence the overdoses.

If you want to reduce deaths, opioids need to become more available, not less.

If you want to talk about morality, my question for you is: why do you want to restrict access to the chemicals that make these poor souls feel normal, pushing them into the black market?

pwaivers• 8 years ago

"And so we wait to see what amount of death will be tolerable in America as the price of retaining prohibition. Is it 100,000 deaths a year? More? At what point does a medical emergency actually provoke a government response that takes mass death seriously? Imagine a terror attack that killed over 40,000 people. Imagine a new virus that threatened to kill 52,000 Americans this year. Wouldn’t any government make it the top priority before any other?"

This is a very good point and really puts it into perspective. Overall this is an excellent essay. I also really like how he addresses the physical affects of opioids, rather than just saying it gets you "high".

meri_dian4• 8 years ago

It's actually a foolish quote. What can the government do in the face of tens of thousands of people essentially choosing to kill themselves? It could jail them, but our culture is moving towards one where doing that to drug users is frowned upon. So what option does it have?

Putting the onus on the government to solve this problem goes against the very essence of this piece. If social fragmentation is truly the cause of the opioid crisis, then government intervention will by like putting a mud wall in front of a raging river.

Arnt3• 8 years ago

Do you intend to say that the Scandinavian countries' deliberate policies against social fragmentation since about 1950 haven't had any effect? Or that they wouldn't have any effect elsewhere? Or that they don't exist?

GuiA• 8 years ago

Except the article mentions successful approaches to reducing the problem other governments have used, so I don’t know, maybe read the article?

One of the few proven ways to reduce overdose deaths is to establish supervised injection sites that eventually wean users off the hard stuff while steering them into counseling, safe housing, and job training. After the first injection site in North America opened in Vancouver, deaths from heroin overdoses plunged by 35 percent. In Switzerland, where such sites operate nationwide, overdose deaths have been cut in half. By treating the addicted as human beings with dignity rather than as losers and criminals who have ostracized themselves, these programs have coaxed many away from the cliff face of extinction toward a more productive life.

seren• 8 years ago

What do you think should be done and by who ? If anyone should do something to resolve the crisis ?

(This is not a trick question I am genuinely interested by your response)

zbentley• 8 years ago

In America, the distribution of deaths has an (at least) equally significant effect as the number of deaths, at least up to a point where the number gets particularly huge.

The distribution effect is often ignored by non-US reporting about various "social maladies" (stupid term, but gets the idea across) in the country: the US is surprisingly internally divided not just in politics, but in empathy. There's often a nation-tribalist effect of "people are dying not in my (city|town|state|area|demographic|politcal party); I consider those deaths sad, but no sadder than someone dying in another country", which I think is important and often overlooked.

curun1r• 8 years ago

In the grand scheme of things, 100,000 deaths is a non-event for a government representing over 300,000,000 constituents. Almost 6 times that many people die from both cancer and heart disease each year. Where it becomes a problem for governments is when there's bad PR. They focus their attention on terrorism because it commands the national attention, not because it's a significant threat. While the abuse of opioids is no doubt a problem, it's getting government attention now because of media scrutiny, not because it absolutely needs to be solved by government.

Humans are terrible at estimating risk. We seem to do it by attributing it to the ease which we can recall an incidence of something similar happening. This may have worked well when we were part of small tribes, but it's terribly adapted to a world where every unusual, capricious event is is broadcast nationally and the mundane, common dangers receive very little media attention.

You can see this with the current debate over guns. Now I favor the liberal position of drastically increasing gun control, but only around 11,000 people are murdered with guns each year and another 22,000 or so kill themselves. That's around a 1/30,000 chance of being the victim of gun violence. Those deaths may be largely unnecessary, but we should still have the perspective to realize that they're not a significant threat to our health.

dkural3• 8 years ago

The article keeps repeating how America is the "most highly evolved liberal democracy", most advanced / modern country etc. This is simply not true. Many European countries have free / low cost education, including higher education, free healthcare where it is rationed by need as opposed to $, maternal and paternal leave, paid vacations, some have free childcare, access to mental healthcare, decriminalization of drug addiction accompanied with treatment, higher gender and social equality, and more importantly, higher social mobility (since access to education and healthcare is more equal); affordable and high quality public transportation, and walkable cities. Property tax %s are lower in most of Europe as well.

Their effective tax rate is lower too, since once you don't need to pay as much for education and healthcare, your take-home pay is higher. You have extra time to sleep, spend with your family and friends, or go out for a walk / read. Your mind doesn't constantly worry about the future of your children or healthcare access due to the social net. This means you're more productive at work and in society.

What's described above is the most evolved liberal democracy. Not the white collar rat race we got here, where we worship billionaires and tax cuts for corporations, where it is still a debate if weapons of mass carnage can be sold to children, where the police force murders its own citizens every day on the streets, where politicians are bought and sold to the highest bidder, in the country with the highest incarceration rate in the world.

tomp2• 8 years ago

on the other hand, US has been a democracy for by far the longest. Other European countries pale in comparision, with the possible exception of the UK.

dkural3• 8 years ago

If black people don't count, sure.

I would argue that the US has not been a full democracy until Civil Rights.

Jim Crow laws were in effect until 1965. Also, black people could not exercise their vote, were not allowed to attend university, eat in the same restaurants, or even sit on the same section of the bus. As far as black people were concerned, the US was not a democracy.

smackay• 8 years ago

I think the good people of Iceland might disagree with that, https://en.wikipedia.org/wiki/Althing

meuk3• 8 years ago

It's mostly a matter of perception, but I agree wholeheartedly. While the US is a beautiful, rich, and diverse country, it is hardly developed in many aspects.

The education and healthcare is problematic and class-based, and many policies are near-sighted. There is an unhealthy obsession with shallow entertainment. Public opinion matters more than truth. There's no justice if you're not a ultra-rich, companies will just go to court until you're broke.

There are only two important political parties - both seem to have some moral issues. In general, Americans don't live very sustainable (gasoline, cars, and tech is really cheap, so why bother?). There is also a weird obsession with race - it's for some reason very common to divide people in races (apparently, you're either black, white, hispanic, or asian and there is nothing in between).

While most of the Americans I met work extremely hard and are a joy to be around, I also found them to be quite nationalistic and oblivious to criticism on the USA. Of course, this whole rant is a huge generalization :)

thisiszilff• 8 years ago

A part of it is definitely perception. If this country is so great, why does it have so many problems?

As to what distinguishes the US from European countries is probably the lack of continuity and history. One doesn't really feel like an "American" as one might feel "Spanish" or "French." An unfortunate consequence of this lack of unity is that democracy becomes very, very messy, and what might have unified the US--a common set of values, hopes, ideals, etc.--is being chipped away at. On the flip side US culture promotes individualism which sometimes leads people away from unity.

With respect to the issue at hand, there's a great quote by David Foster Wallace: “This is so American, man: either make something your god and cosmos and then worship it, or else kill it.” There's a bizarre zeal that's valued in US life and culture (think startup culture) that's great if you find that something to "worship," but if not you're left with this overzealous impulse to do something, something great, something worthy of your time, but you don't have anywhere to direct that energy. It becomes destructive. Europeans have a steadier pace of life that recognizes that 90% of the people aren't going to becomes famous, have amazing carers, be important figures, and that instead of that they can have good, stable, happy lives. In the US, that just doesn't cut it.

kerkeslager• 8 years ago

https://www.youtube.com/watch?v=Rpn0vh2Rj0Y&t=4m39s

refurb4• 8 years ago

Their effective tax rate is lower too, since once you don't need to pay as much for education and healthcare, your take-home pay is higher.

Based on what I've seen this is certainly not true baring a few exceptions.

meuk3• 8 years ago

I think the pay is more equal in Europe. I have finished multiple studies and work as a software developer, but I only make about 15% more than a friend who did not finish an academic study and works in logistics. If you're a bartender, Europe is a better place to be ;)

noahdesu2• 8 years ago

The first thing I did when I opened this article was search for "rat", and was happy to see it there. From the comments I saw I had a hunch it might be: I recently finished a really powerful chapter in the book "Chasing the Scream: The First and Last Days of the War on Drugs" which describes an experiment involving rats that ostensibly shows that addiction isn't about the chemical, but rather it's about the environment and feeling alone.

But that chapter also discussed the broader challenge of escaping the view point entrenched in a generation that has only known addiction as a direct result of chemical action. And a huge part of this article, at least the first half or so I got through, painted this chemical action picture:

"The molecules derived from it have effectively conquered contemporary America." and it kept going on and on, to describe all the effects in wondrous terms, which seems to just reinforce what the book I've been reading claims are already a societal level view points.

I'm by no means qualified to speak about addiction from a public health stand point, nor do I really understand the pharmacological action of any drugs. But this book highlights many experiments or studies that indicate our current thinking is ass backwards, only to have the work squashed and funding ripped away. Now, I cannot stop but seeing these threads in most content produced regarding the drug war or opioid crisis. It'd be nice to know for sure, but it has become very difficult to even entertain the bullshit that politicians are still peddling w.r.t. to the drug war and realistic solutions.

lamename3• 8 years ago

Environment and social setting is known to be important for addiction (along with basically everything else in perception and behavior, e.g. compensatory responses [1]), I think it's just a matter of how long it takes for scientific nuance to go mainstream.

The simplified picture is still often the chemical picture, imo, for 2 reasons: 1) the public forgets that the brain is an organ that obeys physical laws, and that behavior and perception depend entirely on the brain. 2) Ok, yes, environment is important, but how is that represented in the brain? It's still physiological, which inevitably includes chemicals.

[1] http://nobaproject.com/modules/conditioning-and-learning

foxbarrington• 8 years ago

In addition to rat park[0], there's also been an amazing study wrt to Viet Nam vets[1]. Only 5% of soldiers relapsed to heroin use in the first year of returning home. Compared to a traditional 90% relapse rate when addicts treated in the US return to their homes.

[0] https://en.wikipedia.org/wiki/Rat_Park

[1] https://www.npr.org/sections/health-shots/2015/01/05/3718949...

lamename3• 8 years ago

This is one reason why 1) some rehab is more effective than others 2) people aren't always encouraged to go back to their home environment after rehab

noahdesu2• 8 years ago

Ahh yes, this story of Vietnam is also in the book. Thanks for mentioning it. It was also a really powerful anecdote.

andrewjl3• 8 years ago

I find the rat park experiment intriguing, but have there been any further studies or attempts to replicate the results?

Qub3d• 8 years ago

Fair warning, this video is pop science and therefore prone to many of its pitfalls, but when viewed in context I find Kurzgesagt[0] did an nice summary of this addiction theory.

[0] https://www.youtube.com/watch?v=ao8L-0nSYzg

lostlogin• 8 years ago

Would be intersting to see relapse rates for those doing another tour.

jaredhansen• 8 years ago

Regarding the Rat Park experiment, Scott Alexander had a pretty thorough discussion here:

http://slatestarcodex.com/2017/10/25/against-rat-park/

api5• 8 years ago

TL;DR: like almost everything else in human psychology "it's complicated" and there are "many factors" yayaya...

majormajor3• 8 years ago

It definitely seems like a mix. I've been addicted (to the point of losing thousands and thousands) to gambling in the past - looking for a way out, something to change things financially - but alcohol or narcotic drugs did nothing for me. But I knew other people in the same situation whose relief came - more destructively, more difficult to recover from - from the drugs.

newnewpdro• 8 years ago

Did you try psychedelic drugs?

Ibogaine [1] has been found to be particularly effective in helping those suffering from addiction. Psilocybin has also seen research in this area with some positive results. [2]

[1] https://en.wikipedia.org/wiki/Ibogaine#Addiction_treatment

[2] https://en.wikipedia.org/wiki/Psilocybin#Research

danieltillett2• 8 years ago

I have to say I find addiction to gambling quite fascinating as I get absolutely no pleasure from gambling. The thinking a gambler must have is so different to my thinking that it is impossible for me to imagine what they are thinking.

My observations from Mars of people at casinos gambling is nobody seems to be having a good time there.

arprocter2• 8 years ago

The author mentioned by Sullivan (Johann Hari) was recently on Joe Rogan #1077

njwi332• 8 years ago

The article specifically mentions Chasing the Scream in the second half. I do recommend finishing it.

chrisgd2• 8 years ago

I think almost all problems we discuss every day: political divide, millennial job prospects, student loan debt, drug crises can be traced to wealth inequality. At it's core, all these problems evolve from unfettered capitalistic pursuits. The middle man taking their cut of student loans and having no means to resolve that debt through bakruptcy. No growth jobs that offer no safety net. For profit schools, prisons and healthcare allowing those at the top to accumulate wealth by depriving more people of what was once considered a community benefit. We yell that the other side has it wrong while owners of gun manufacturers escape any civil liability and providers of medicare admin routinely overbill, then pay fines less than the wealth accumulated. Opiates provide an opportunity to escape what seems unescapable. I am not sure the answer but the framing is continually wrong.

arca_vorago• 8 years ago

I agree with just about all of what you said. So many bad things are tied to this. Crime rate. Horrible educational results and environments (I worked in Baltimore schools as a contractor and it's one of the saddest experiences I ever had and I'm a combat vet).

One thing to remember though about the war on drugs and especially the opiate crisis is that it was also largely a creation of the CIA who learned it from the Brits who had been doing it as far back as the opium wars. Black markets provide black money budgets not overseen by Congress, and the CIA really hates oversight (they prefer overlook committees). The main opiate crisis in particular stems from Vietnam, where generals would play along for a cut while the CIA had drug operations all over including Laos, etc. They'd then ship it back and sell it specifically in the inner (mostly black and other minority) city.

The same thing is true of this opiate crisis. The war in Afghanistan has massively increased poppy production (which the taliban had outlawed) while US forces would eradicate weed crops they allowed poppy fields, and low and behold, the vast majority of the heroin, etc now in America can be traced (Chem analysis) right back to Afghanistan. I promise you it's Vietnam on repeat, and the CIA has their hands all over it.

Of course south America is the same. Behind every top cartel member is a CIA man pulling their strings, and look at the destruction they are wreaking on the border towns. The death toll of civilians is higher than allied casualties in OIF!

It's just like Iran contra. Since lots of the time they don't want to pay full price, the Intel agencies will ship arms to them as well.

It's high time for a new church committee!

The problem is the surveillance engine is so pervasive, which enables the blackmail and extortion system, just about every senator or congressman who pushed back would be quickly compromised.

This is the real deep state, in the Peter Dale Scott sense of the term, and it must be addressed if we are going to strike at the root of many of our problems, instead of hacking at the branches.

naeemtee• 8 years ago

Singapore has one of the world's highest income inequalities and faces virtually none of those problems. Distilling it down to "income inequality" is reductionist, political scapegoating.

iamcasen2• 8 years ago

Singapore is also an extremely authoritarian state. Possession of drugs can get you the death penalty, or state sanctioned torture and beatings.

Kinda apples to oranges when you compare to the US.

chrisgd2• 8 years ago

It is a bit simplified, as all online treatises need to be, but less reductionist than picking one counter example without any thought.

clarkmoody2• 8 years ago

I disagree with just about everything you said and would argue nearly the opposite: too much state involvement in education, healthcare, and the economy is to blame for the deteriorating society.

Children are forced to conform to the state's schooling program from a very early age, and those who fail to do so are labeled as such with bad grades and trips to the school office. They are humiliated in front of their peers and feel powerless and dehumanized. This record follows them through their entire schooling career. The religious and cultural traditions of their parents are ridiculed by the authority figures at school. School zones keep poor children out of good schools.

Wealth inequality will naturally arise in any system, but when gains go to the politically-connected or well-lobbied, then the state is artificially enriching those at the expense of others. This is not the functioning of capitalism but rather of cronyism and corruption.

Student loans are out of control precisely because the government got in the business. Higher education costs are out of control because of the excess money from the student loans.

The job prospects suck because of excess regulation in the economy. Entrepreneurs are not able to innovate as well due to so much red tape. Occupational licensing sets up barriers at all levels of the workforce, enriching the incumbents and limiting competition. Healthcare is so overrun with regulation it's laughable to mention the word "market" in the same sentence. Those are barriers put in place of market forces by the state.

The drug epidemic is merely the result of all these forces put together.

pdonis4• 8 years ago

I think almost all problems we discuss every day: political divide, millennial job prospects, student loan debt, drug crises can be traced to wealth inequality.

I would put one caveat on this: it's due to wealth inequality that doesn't come from having created more wealth. All of the examples are of people not creating wealth, but accumulating it by transferring it from other people to themselves. That kind of wealth inequality is bad not because wealth inequality is bad in itself, but because our society as a whole needs people to be creating wealth in order to continue to exist; so if all of the smart, talented people find they can get more wealth by transferring it from others instead of creating it, our society will eventually collapse.

I think Pg had an essay about this a while back.

ArcticUnicorn• 8 years ago

"It’s been several decades since Daniel Bell wrote The Cultural Contradictions of Capitalism, but his insights have proven prescient. Ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations, destroying what conservatives value the most. They create a less human world. They make us less happy. They generate pain."

This articulates the feelings/observations I've been mulling over recently. Also the idea of opiate abusers being a self-selecting group of the "failed" areas of society was something I hadn't thoroughly considered. Very interesting. If opiates caused a more distinct rise in violet crime, would public policy be forced to respond similar to the other drug epidemics? (Though I might argue that those epidemics were just replaced with this one, yielding quieter and more easily ignored victims.)

maratd2• 8 years ago

ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations

Is there an actual example of this? I can't think of a single one.

mistermann• 8 years ago

Society splitting into haves and have nots due to technology, globalization, and a myriad of other things most definitely changes social cohesion. That's just one example, when (if?)people finally start paying attention there will be many more obvious effects.

api5• 8 years ago

The escalating offensiveness of media due to the fact that offensive speech gets attention and therefore makes money?

hebbonline• 8 years ago

Not a single one? That is unbelievable.

You could check out the article at top of this page since you’re so close.

Most TV shows or movies have numerous. Have you ever watched TV shows or...

Actually, since these things are so easy to find, I think it’s safe to assume you don’t even know where to start. We could start with your comments for inspiration.

I just copied the very first one in your profile becaue it includes a good start of what an example of this could look like.

“Start your own category, create software for it, then convince everyone that the category is important.”

This sounds like advice on how to navigate a market, which is an effort that will represent our force. There are many economic theories to explain why markets are the best environment to generate useful products. Can you imagine how your advice could lead to a product that is not useful? I can: if the category is not important but you succeed in convincing people that it is, what have we accomplished collectively? Nothing important! That is for sure.

Well, the problem about things like social stability, tradition, religion, and civil associations is they are important.

If your advice is enough to do well in a free-market economy, then that is good for you, and somebody else will do the important things. This is all fine and good assuming somebody else doesn’t fuck up.

But what if somebody else is an HN reader? And what if they come across your revalational advice, and realize they can just convince people things are important instead of doing the important things? They quit the important things.

Now there is nobody tending to important things: social stability, tradition, religion, civil associations which is a sure bet for havoc!

Easy shmeezy. It’s right under your nose if you pay any attention at all. Maybe you are an example yourself. Seems possible.

clairity2• 8 years ago

while that quote is interesting, it also posits progressivism as the culprit, and by allusion, points to conservatism as the solution, but that’s plainly wrong.

it must be taken as a given that change (i.e., progress) will happen. you can thank the 2nd law of thermodynamics for that. so then the perspective must shift from “can we keep the world the same as we imagine it to have been in the past (while ignoring all the bad parts and negative consequences)?” to “how do we deal with a changing world, adapt to it, and focus our efforts toward positive change?” we just don’t get to sit still. life only happens in the gap between order and chaos.

the quote i prefer is

“The oxytocin we experience from love or friendship or orgasm is chemically replicated by the molecules derived from the poppy plant. It’s a shortcut — and an instant intensification — of the happiness we might ordinarily experience in a good and fruitful communal life. It ends not just physical pain but psychological, emotional, even existential pain.”

this articulates a mechanism by which opioid addiction lodges itself in the failed corners of society. so how do we fix that? it’s not by considering addicts criminals. the “war on drugs” experiment has proven that doesn’t work. instead, we need to accept the social responsibility of creating “losers” in the first place. we need to progress to the next level of societal structure that redirects folks back into meaningful and purposeful lives.

i think the stage might be set to move to a kind of globally-aware localism. that is, having people focus on their microcommunities (the 5-10 block radius around where we live in cities, a bit bigger in less dense areas). how do we organize homes, schools, businesses, offices, services, etc. in ways that reinforce our ties to each other rather than two-dimensional celebrities and fantasies of far-off wealth and fame that make you feel like you’re losing? but also use technology to learn from those far-flung places to improve your own lives locally. you only need a few people around you appreciating your efforts to get plenty of oxytocin to forget about the hard opioids.

clarkmoody2• 8 years ago

I would argue that the public school system is the strongest force in weakening "tradition, religion, and robust civil associations." Much of the schooling experience is designed to suppress individuality and encourage conformity to the state's ideals. And of course capitalism (the non-crony type) doesn't really play any role in the public school system.

scottlegrand2• 8 years ago

This is bad, really bad, but just wait til our roads are filled with self-driving trucks and the remaining factories with robots then the fentanyl party will really begin unfortunately.

It is fantastic that OpenAI is attempting to address the more dire threats of a rogue AI, but there's a big near term threat already staring us in the face and seemingly zero leadership here in the United States aware of the crisis that will arrive in the next decade or so. And what passes for leadership has absolutely no concrete plan to get us past it.

tcj_phx• 8 years ago

When I met the friend who taught me about heroin, I figured she was "high as a kite" because she chattered from topic to topic like a butterfly. She called back a few days later, and started to invite me into her world. I didn't know anything about the street pharmacy, except that cannabis had been helpful for another friend to get her alcohol use under control.

She said she'd relapsed on cocaine because of severe depression, then shortly later on heroin -- supposedly to treat her high blood pressure (from smoking cocaine). I think really she was just lonely. A chapter in Gabor Maté's book is titled Through a Needle, a Soft, Warm Hug [0].

She was going to the methadone clinic daily when we met. If she couldn't get to the clinic by the 11am closing, she'd have to order heroin from her street pharmacist. It was almost as if the clinic had contempt for its clients -- their business was to be their clients' legal dealer.

Four months after she'd begun to teach me about her world, I decided she didn't actually like it that much, and began to express disapproval at her self-medication strategies. She tried sticking with her old drug world, but she liked me more than the drugs. At about six months we had a nice time frying donuts (coconut oil is a treatment for compulsive alcohol use, and makes for tasty donuts). Two days later she called to say that she "wished [she] wasn't a drug addict". The next day, "I SHOULD ONLY USE SUBSTANCES WHICH ARE LEGAL! Alcohol is legal, [tcj_phx]..." (me: doh! progress, I'll take it), the following day, "I hate methadone, I hate everything about it..." Essentially what I did was a months-long pace... then lead (hypnotic technique).

The most important interventions to end the present "opioid epidemic" (artificial) is to provide a legal supply of clean heroin, safe injection sites, and protecting addicts from the criminal justice system.

[0] https://news.ycombinator.com/item?id=16023802

(Yesterday's post about adoption-trauma is relevant too: https://news.ycombinator.com/item?id=16443667 )

jatsign2• 8 years ago

Loved the way the article was written. I read a lot of long-form articles and have a few favorite writers. Is anyone aware of a service that will track individual writers and give an alert when they post something new? Sort of like an RSS feed for an individual writer, regardless of where their new article is posted.

maxerickson2• 8 years ago

Twitter.

No, I'm serious.

If you don't want the tweets, just filter links out of tweets. But the part where writers promote themselves on Twitter is true enough.

jatsign2• 8 years ago

Not a bad idea, but the first writer I checked, Dexter Filkins, doesn't seem to use it. :\

The most reliable method might be to grab RSS feeds from a lot of online magazines like the New Yorker and parse the Author field. But that'd be a lot of manual work since the feeds change format sometimes...

DyslexicAtheist• 8 years ago

We consume 99 percent of the world’s hydrocodone and 81 percent of its oxycodone.

this is quite a mouthful and horrid if true. would like to see some sources for this claim

paganel• 8 years ago

Don't have any sources available, but as an European it's strange how prevalent opioids are in the States for what are seen as "regular" medical interventions. I remember having a discussion with a US redditor, telling him/her that even though I had 3 or 4 teeth extracted during the last 10 or so years I've never been prescribed opioids (the extractions were done by different doctors, in different clinics), I've always managed the post-extraction pains with Nurofen-like drugs and I was quite ok (and I don't think of myself as a particular "pain-resistant" guy, quite the contrary). There were other redditors in the same thread (I remember one from Germany) who had had the same experiences as me. So, all things considered, these numbers don't surprise me at all.

PuffinBlue• 8 years ago

The NYT actually ran another story on exactly this topic - difference in European/US approach to pain management, but more from the patients perspective, it's really good reading too:

https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...

Title was: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

It made the top spot on HackerNews too:

https://news.ycombinator.com/item?id=16252372

lewis500• 8 years ago

This whole piece is a good example of how fine writing can hoodwink you. Garbage analysis from start to finish.

"Unlike in Europe, where cities and towns existed long before industrialization, much of America’s heartland has no remaining preindustrial history, given the destruction of Native American societies. The gutting of that industrial backbone — especially as globalization intensified in a country where market forces are least restrained — has been not just an economic fact but a cultural, even spiritual devastation."

From time immemorial, people---especially cultural critics and journalists---have blamed social phenomena on culture, the era's degradation, political changes or something else they are interested in anyway. It flatters you for your command of politics and history: turns out all that stuff you read about because it interests you is actually solidly causative in explaining something important. What a nice coincidence.

I am pretty sure that when the history of this era is written by real social scientists, what they will decide is much more technical and boring...having little to do with the topics that capture our attention for other reasons (manufacturing jobs and trump's election in this case). For example: a bunch of new opioids had been invented, which insurance paid for and doctors prescribed. Large amounts of heroin were available at low prices from increasingly competent and seamless sellers. In what world would these phenomena take place and the amount of addiction not increase?

I used to live in England. There is not as much of a crisis there although there is plenty of economic hardship, loss of manufacturing jobs, etc. The difference is that the NHS won't pay for everybody to load up on a thousand pills, and England is an island where you can't easily smuggle in tons of heroin.

Sometimes the article really veers into the absurd. Consider this passage:

"A huge boom was kick-started by the Civil War, when many states cultivated poppies in order to treat not only the excruciating pain of horrific injuries but endemic dysentery. Booth notes that 10 million opium pills and 2 million ounces of opiates in powder or tinctures were distributed by Union forces. Subsequently, vast numbers of veterans became addicted — the condition became known as “Soldier’s Disease” — and their high became more intense with the developments of morphine and the hypodermic needle. They were joined by millions of wives, sisters, and mothers who, consumed by postwar grief, sought refuge in the obliviating joy that opiates offered."

Right here Sullivan offers a total explanation for why everyone got addicted to painkillers: the government was literally manufacturing them and giving them in massive quantities. But that's not literary enough, so he turns around and fabricates something out of whole cloth:

"the epidemic of the late 1860s and 1870s was probably more widespread, if far less intense, than today’s — a response to the way in which the war tore up settled ways of life, as industrialization transformed the landscape, and as huge social change generated acute emotional distress. This aspect of the epidemic — as a response to mass social and cultural dislocation — was also clear among the working classes in the earlier part of the 19th century in Britain. As small armies of human beings were lured from their accustomed rural environments, with traditions and seasons and community, and thrown into vast new industrialized cities, the psychic stress gave opium an allure not even alcohol could match."

Ah so it was the "psychic stress" of industrialization. So losing manufacturing jobs causes addiction, but also so does gaining them. Interesting that manufacturing jobs are such a powerful explanation in an era when our president is constantly banging on about manufacturing jobs. Suppose we hadn't industrialized at that time; I'm pretty sure people still would have gotten addicted given how many free opiates they were getting. In that case Sullivan probably would have said, "The rural isolation of Americans...the soul-crushing vicissitudes of farming born alone...caused Amercians to take refuge in opiates."

Also worth remembering Andrew Sullivan is serially wrong.

refurb4• 8 years ago

I took the same thing away. Basically taking the preconceived notion that capitalism is bad and using poetic writing to tie every social ill back to it.

I hope that people don't look to this article as a serious review of history.

filipsch• 8 years ago

It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy.

Pretty strong statement

sgentle• 8 years ago

Rather than place the blame on a lack of structure, community or spirituality, I see this as just a natural consequence of a system optimised at every turn for economic output.

I've heard a lot about a singularity doomsday scenario where a paperclip-maximising AI realises people are much less useful as paperclip constructors than they are as paperclip ingredients. Surely it can't be so hard to see that the productivity-maximising AI that we've cobbled together out of economic rather than electromechanical components is slowly realising it doesn't need us anymore either?

The truth is the economy soon won't have any use for poor whites other than consuming the output of rich whites. The last bastions of unskilled and semi-skilled labour are being automated or sent overseas (to be automated there). I'm really curious to see what America's 3.5 million truck drivers do when they lose their jobs over the next ten years. I guess we'll teach them to code?

But don't feel too sorry for them; the rising tide of productivity caught poor blacks before that, and all the hamster-wheeling busywork of the middle class is up next. Managers and decision-makers will stay above it right up until they realise abstraction cuts both ways. It'll just be the quants at the end, tweaking the last few parameters and getting the lights on the way out.

I think most of the world at least tries to keep the economic AI from being in charge of everything. It's hard because it keeps buying our politicians, but even so there's a sense that it should be serving our values, not the other way around. We might work with it, respect it even, but we don't trust it.

The USA is pretty strange in this sense, because somewhere along the line a huge chunk of the population got convinced that if they just leave everything to the paperclip AI it'll take care of them. And, for a time, it will, and the people who work hard to make paperclips get rewarded, and the people who start paperclip factories get rewarded more still. But, inevitably, you're not a paperclip, and your value is incidental in this system.

Faced with that, then, your only options are to find a system where people have value independent of their productivity, make being valueless palatable, or just go die quietly somewhere. It's probably not so surprising that, in the absence of the former option, the latter two are becoming increasingly popular.

And, I guess, not so surprising that the paperclip worshippers are particularly unconcerned with mental health and sensible drug policy. Still pretty gross though.

DenisM• 8 years ago

The third option is protests of various forms. The most polite one is throwing a brick trough the window of society by electing some loose-cannon politician. The brick went obviously unheeded, and I’m worried of what will follow.

Capitalism has succeeded in its primary goal - amassing resources for capital-intensive projects. We’re done, we have so much capital companies sits on hundreds of billions of dollars. Something new will be needed for the next step.

majormajor3• 8 years ago

A loose cannon that wasn't, at heart, as corrupt and greedy a capitalist as anyone might be more effective.

But actually, I think the Trump loose cannon wasn't sent because of anger against capitalism, but rather misplaced anger against things like immigration, diversity, and a move away from traditional religious views. Capitalism is seen as A-OK, it's just that The Liberals have rigged the system against Good Honest People.

twentythree• 8 years ago

I love the concept of "a system where people have value independent of their productivity."

I worry that the increasing focus on a meritocracy (especially in tech) ignores the fact that it devalues anyone who for whatever reason -- lack of education, lack of natural ability, or just lack of motivation -- doesn't contribute enough to be considered important. It's probably an improvement on the system we had before, where you were valued for being part of the right community or the right family, but I hope this isn't the end goal, and that we can eventually get to a state where we consider everyone inherently valuable.

danieltillett2• 8 years ago

The basic problem is that meritocracy beats every other political system. The reason meritocracy took over is not because it is morally better, but because non-meritocatic societies fell by the wayside under the boot of meritocracy.

Hopefully in the post-scarcity society coming we can come up with a better approach not focused on people’s productivity.

slfnflctd2• 8 years ago

curious to see what America's 3.5 million truck drivers do when they lose their jobs over the next ten years

That is a rather optimistic projection of the rollout of Level 5 autonomy. The total number of heavy trucks sold worldwide was less than 400k in 2014, and no one has full Level 5 yet (if it can even be done large scale at a profit), so I would adjust those expectations. Most 'displaced' truckers should be able to find work unloading automated long-hauls into smaller short-hauls and driving them during a lengthy transition period.

your only options are to find a system where people have value independent of their productivity, make being valueless palatable, or just go die quietly

Points 1 & 2 are somewhat interconnected. If I add up the retail value of all my non-paid work, it comes to far more than I make at my day job, and I suspect this is true for many others. Much of what our culture calls "valueless" - because no money is involved - does actually have value, and this will become more clear as time continues to reveal how difficult automating everything really is.

We have already seen this, for example, with people posting what used to be called home videos (no revenue) to YouTube and stumbling into large amounts of ad income, and I believe we'll see it in more areas. It may increasingly be a 'gig economy', but it's happening slowly, and some of those gigs are turning out to be pretty good.

CoffeeDregs• 8 years ago

Most 'displaced' truckers should be able to find work unloading automated long-hauls into smaller short-hauls and driving them during a lengthy transition period.

If a million truckers lose their long-haul trucking jobs, how do a million short-haul trucking jobs simultaneously come into existence? Many long-haul truck already go to distribution centers on the outskirts of metro areas so the long->short-haul transfer systems already exist.

panarky• 8 years ago

The global economy already produces enough for every man, woman and child.

The surplus increases every year.

Every year, fewer and fewer people need to work full-time in mind-numbingly boring jobs to produce what the population needs.

So why do we keep up the fiction that everyone needs to waste their lives doing unnecessary work?

It's time to imagine how we could achieve a post-work society where more people could realize their potential, instead of being tied down to meaningless, mindless and unnecessary drudgery.

andrewjl3• 8 years ago

Easy answer, the narrative embedded into our worldview (and in the worldview of many if not most decision makers) is that without work and the kind of structure it brings, people cannot be functional members of society. It plays itself out both externally and internally.

gph3• 8 years ago

The global economy already produces enough for every man, woman and child.

But does it produce enough for every man, woman and child in a sustainable manner, and will it be able to keep up with the Malthusian population growth that would continue unabated if every person on earth was perpetually guaranteed to get "enough"?

The answer to both of those is no. While there is certainly a lot of inefficient busy work amongst the workforce of developed nations, to say that most people on earth waste their lives doing unnecessary work is an extraordinarily myopic claim that's been bandied about since that one guy wrote an article about BS jobs. Everyone latches onto that meme and assumes the majority of work being done is absolutely worthless, but they really have nothing to back that up except their own personal experience as a middle class corporate drone.

pdonis4• 8 years ago

I think you are drastically underestimating the amount of necessary work required to keep our civilization running. It's not just a matter of producing necessities--food, clothing, and shelter. The tools needed for people to "realize their potential" take work too. For example, the medium through which we are having this conversation, which is the most potent tool ever invented to help people realize their potential, took a lot of work to build and takes a lot of work to maintain.

smogcutter3• 8 years ago

Enter UBI: an allowance from our masters, so that people can continue to consume when there's nothing left for people to produce.

calt• 8 years ago

Or perhaps UBI can set people free to live as they see fit, cultivate themselves spiritually, artistically, and communally without needing to consume nearly as useless garbage.

guntars• 8 years ago

I like the comparison of the economy with an optimizing AI, but the value function isn't max(paperclips), but whatever people will pay for. So it's not really the fault of the AI that people have fucked up priorities - the AI itself is value neutral.

If you can get a large enough group to say: "Enough, the AI doesn't represent our values, let's change it!", it will already have happened because the same people will have already changed their buying habits.

hateful• 8 years ago

I love this comment so much I want to print it out on a sheet and sleep under it tonight.

joslin01• 8 years ago

Well thought out. I have a similar disposition, which highlights the culture surrounding our smart-phones -- largely social networks such as Instagram & Snapchat. In one mode, they help people stay connected, and yet in another mode, they create create an ego-obsession (both of oneself and of others). This is the first part in feeling separated, alienated, or just generally inferior in a quasi social-network.

The second part is the ease of getting pleasure on demand. At any part of the day, most are free to look at the internet of anything ranging from funny pictures to pornographic pictures. They can turn on netflix, play video games, and do just about anything from the convenience of their smart phones. You can see this on just about any subway; a room full of people each engulfed in their own personal world driving their pleasure centers.

When you bring these two together (feelings of inferiority / detachment to those around you AND pleasure on demand), you get a person whose general approach to life is like that of a drug addict. They crave simple pleasures and justify it because they feel like shit. They also feel as if they're alone in this world, and so who cares? Of course this is all subconscious and part of a habitual perspective, but this is the kind of world we're growing up in America. Pharmaceuticals have significant power here and want to convince you they can fix you with a pill. Maybe they can. But what I'm trying to highlight is that we now have a mentality of always looking around for a "fix". I find very few people who can last a whole subway train just looking at the window pondering or who can strike up a conversation with a stranger for the hell of it. We're becoming way too engulfed in a pseudo personal world, and smart-phones are driving it.

No, I'm not trying to start a crusade against smart phones or even taking any stance at all. This is just how I see the problem currently. I want to believe technology can help fight it by bringing more people together for social events, but where's the advertising money in that? And who cares if you're not profiting? This pursuit of profits above all else has created a very shallow society and I would argue the drug epidemic is a reflection of it.

byproxy• 8 years ago

You may want to give "The Religion of the Future" by Roberto Mangabeira Unger a read. I'm nearly through with it, myself, and he lays forth many of the same thoughts present in this post while attempting to describe a new spirituality.

philipkglass• 8 years ago

Sullivan starts out highlighting how America is exceptionally afflicted by opioid abuse, but goes on to unconvincingly weave a bunch of unexceptional factors into his explanation.

Smartphones, TV, video games, online porn: they're in every developed country. They can't be the explanation for what's different about America. Decline of religiously-derived meaning? Most developed countries' populations place less importance on religion than Americans. Factory jobs squeezed by automation and cheap offshore labor? Canadian manufacturers have access to the same robots as American firms, and Canada has been a member of the World Trade Organization as long as the US has.

Inter-temporal comparisons also show that it doesn't make sense to blame the American opioid crisis on the decline of manufacturing jobs. The number of American manufacturing jobs peaked in the 1970s. "Rust belt" became a common term in the 1980s. But the opioid crisis is much more recent.

arprocter2• 8 years ago

Sullivan is a conservative, gay, catholic, British expat; so his conclusions come through that lens

rl3• 8 years ago

As an aside, the cover illustration would serve as perfect art for a proper Cannon Fodder remake.

microcolonel2• 8 years ago

I read this article the other day, and it presents a convincing possible avenue for explaining the current uptick in opioid abuse.

https://www.acsh.org/news/2018/02/14/dear-cdc-what-will-you-...

jdtang13• 8 years ago

Really brilliant and well-written article. The analysis of the uniqueness of American society is really well-done as well. American hyper-individualism, work ethic, and atomic self-oriented lifestyle leads people to seek their own meanings, which leads to tremendous suffering when community network is destroyed and when there's no available work to do.

JudasGoat• 8 years ago

As a Heroin addict that hasn't used in over 5 years, I believe the emptiness of Materialism was as instrumental in my addiction as the richness of spirituality has been in my recovery.

mikevp• 8 years ago

Personally, I just don't "get" the high of opiods. My experience has been entirely medical -- morphine after surgery, and the usual vicodin/percocet/whatever pills after injury or tooth extraction.

Different people react to them differently. Some people, like me, they make physical pain recede, but nothing else. Some people, they make feel groggy or sick, and they don't like them. (My grandmother was like this -- she disliked the grogginess from the Brompton's Mixture more than she disliked the pain of her terminal cancer. She only took it once or twice.)

And some people, one dose and it's "Where have you BEEN all my life!!!!"

An interesting line of research might be -- why the difference in reaction to opiods? Why do some people get the "WOW! I LIKE that!!" reaction, while others don't?

diogenescynic• 8 years ago

Considering how overpopulated the planet is, this is probably a necessary evil.

bandrami• 8 years ago

Unfortunately Sullivan ignores one huge factor: the deliberate and deceitful marketing of opioids to doctors by pharma companies as effective and safe for chronic pain management despite the fact that studies have repeatedly failed to show it is either.

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