Down Here, They Sometimes Call It 'Boy' | Hacker News Reader

Down Here, They Sometimes Call It 'Boy'

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65 pointspelt55 comments

I was on heroin for a few years and I live in the UK. I had managed to keep it hidden for maybe 18 months but eventually it become obvious and my mother started organising help.

Within a week we had some people from the local drugs outreach charity turn up at the house with free Naloxone IM kits and they trained us how to use them. A couple of weeks after that I was assigned a counsellor whom I would meet regularly and talk to over the phone.

A few months after that I finally got into an NHS programme (which was mostly useless, it was all just preaching which doesn't work for me).

In the UK we can pick up injection kits in chemists for free. They include: needles; sterile water vials; cooking spoons; micron filters; a sharps disposal box; and packets of citric acid (the heroin we get in the UK needs an acid to dissolve in the water).

Heroin addiction is a public health problem, and the healthier the public is, the better off everyone else is. The fact that you have to pay for treatment in parts of the US is unbelievable to me.

Having access to naloxone and injection kits for free surely saved me from getting a blood-borne infection, and the counselling from the charity really helped.

On a global level we need to stop treating addiction as a crime but as a health problem. No one wakes up first thing and thinks "Hmm, I think I'll try shooting heroin today". There are almost always deep-rooted issues that the addiction hides, because being addicted to heroin is essentially a full-time job. You just don't have time to address what is causing you to need to feel numb.

It's good that you can get all that sterile equipment to inject safely. To me the weird bit is that you're necessarily using it to inject very non-sterile heroin with unknown adulterants that you've bought from a (by definition) criminal enterprise. I hope that at some point doctors are able to provide opiates for addicts as further harm reduction.

I know there's been some emergency COVID policies put in place in parts of Canada that allow morphine to be prescribed for that purpose (and possibly hydromorphone, but not heroin since Canada unlike Britain doesn't allow medical use of heroin).

The big risk is sharing needles.

> No one wakes up first thing and thinks "Hmm, I think I'll try shooting heroin today".

I couldn't help but remember the story of SpontaniousH on reddit.

https://reddit.com/r/MuseumOfReddit/comments/68srty/spontane...

> I've heard so much about it and how crazy addictive it is and seen it in the movies and TV (I'm thinking The Wire here, one of my favorite shows) and it really started to intrigue me. I've always wondered what it would be like to do Heroin. Out of no where I say I'll take the H and we do the deal there.

In his later posts, he admits that was just a story he was telling himself and he was indeed using heroin to avoid dealing with deep rooted problems within himself.

Damn, that's a heavy post. If you follow the timeline you see him go from "I'm just trying this once" to addiction and his recovery many years later.

> There are almost always deep-rooted issues that the addiction hides,

All crime is a consequence of deep-rooted personal issues.[1] Part of the purpose of making something a crime is to put somebody on notice about when personal choices are likely to result in intolerable injury to the public and, hopefully, induce them to reassess their needs and expectations, including recognizing their need for help. And that's the logic of making drugs like heroin illegal.

I think I understand your point, but it's a point that is really difficult to articulate coherently. There are many subtleties in arguments that propose more compassionate--for lack of better phrasing--public responses to addiction. And it starkly exposes some paradoxes at the heart of human legal systems, including notions of volition and accountability. I think that's why it's such a difficult public policy issue. But if don't appreciate the inherent tensions at play we'll never understand why the other person doesn't agree with whatever proposal we put forth.

[1] Where issues == dysfunction, otherwise we're just restating a more general truism that all behaviors are consequences of each person's history and state.

I think you bring up a good point. So what if the consequence for these crimes (any crimes?) was compulsory treatment? That needn't include being imprisoned except for where it's absolutely warranted.

My former coworker was a recovering addict who was also a addiction counselor. He perspective was that the addict has to want to be there for anything to happen.

If you cigarettes from a smoker or booze from a drunk and the outcome isn’t walking away from the addiction.

In contrast I've heard several counselors and specialists interviewed on the radio who say compulsory treatment is a useful and necessary tool. Some of them even lament the latest round of decriminalization measures in cities like SF because it leaves no recourse whatsoever for compulsory treatment. (And, yes, some of these people are counselors in SF. And, yes, some sort of civil commitment would be better than abusing criminal law, but civil commitment is a less politically likely option.) Before full, de facto decriminalization of drug use, SF already had shifted most cases to specialized drug courts which couldn't send anyone to jail, but could only force people into treatment--and AFAIU only did so if advised by addiction counselors.

Moreover, because SF and similar cities have so fully decriminalized drug usage, and done so asymmetrically to surrounding jurisdictions, they attract addicts to the city (it's not just the weather or social services). Whether or not you think compulsory treatment is ever effective or morally justified, surely one must admit that the last thing any addict or at-risk person needs is such a permissive environment, where they can surround themselves with others suffering from the same affliction and who will give them license to let go, hit rock bottom, and stay there indefinitely. SF has such a concentrated drug problem partly because it's like some platonic ideal of an enabling environment for codependent, drug-centered relationships.

My family has a long history of alcoholism, including both my parents. My grandfather was a regional AA president or some such, though long after he had destroyed his family. I've seen addiction up close and personal. I've been in foster homes and met kids from families destroyed by drug addiction, or who turned to drugs themselves. I've seen how enablement works, how my mother's alcoholism, while never going away, ebbed and flowed, yet at least for her was invariably precipitated by her alcoholic "friends" coming over or inviting her to drink with them. In the aftermath of a long binge we'd be lucky if she only lost her job; on more than one occasion we ended up on the street, though thankfully we never had to sleep on the street.

Over the years I've also met several very intelligent and otherwise perfectly functional alcoholics who chose to give themselves over to alcoholism. (At least one walked away from his life as a well-paid chemical engineer.) It's what they wanted and they literally said as much. They were perfectly capable of scraping together a lawful subsistence, and did so, though in one case that didn't always include regular electricity and running water, which they were fine with. I'm not sure what it means for an alcoholic to "choose" to live like that, but from my perspective if "choice" has any meaning it applies to those particular people just as much as it applies to me or anyone else. But the contrast between people like that, and people like my mother (or especially like my next door neighbors' daughter, someone whose drug addiction is so thorough she has given herself over to the streets and her codependent addicts and won't even entertain offers of help from family or the city) tells me that there's plenty of legitimate need for various forms of compulsory interventions, including short- and long-term treatment. My mom was forced into compulsory treatment once for 3 months. She lapsed a year or so later but if you ask her I'm sure she'll tell you that that experience was important to hastening the day she had her last drink, even though her darkest days were after that stint in the hospital.

There's a dangerous narrative in our culture that beating addiction is about hitting rock bottom so you can come to the realization about your problem and then seek treatment. I have no doubt that such is the experience of many addicts, but it's hardly universal. Other not uncommon experiences are repeatedly cycling through rock bottom for much of, most of, or all of your life, never once seeking treatment; or hitting rock bottom and staying ay rock bottom until you die. There are people who manage to sustain a heavy substance abuse habit but otherwise seem to live a normal, functional, middle-class lifestyle; maybe perfectly contented or maybe hating themselves and wishing someone would discover their secret and force a reconciliation, through legal compulsion or otherwise. Compulsory interventions don't have to cure people to be effective. They can be effective just by breaking whatever cycle they're stuck in. And no intervention need be used as matter of course.

There are countless dimensions at play when it comes to addiction and addictive behaviors. Everybody has their own stories and their own opinions, both addicts and those around them. There aren't many clear answers to even the simpler aspects, but in my experience and opinion categorically excluding options like compulsory treatment is one of the few wrong answers. It's premised on a similarly flawed and overly simplistic concept of volition as that behind excessively punitive responses. Certainly compulsory treatment can be done wrong, and perhaps in many contexts (e.g. many U.S. jurisdictions) the capacity to do it effectively and judiciously doesn't exist. But that's a different kind of argument.

>All crime is a consequence of deep-rooted personal issues

That is a blanket statement. Yes, i agree with the most crime being like this, and especially almost all or maybe all violent crime, but quite some crime is completely rational. I would commit a crime if it provided a clear benefit outweighing the risks, it's OK to do - it's government's job to organise laws and enforcement system in a way the set of "rational" committable crimes is minimised.

> I would commit a crime if it provided a clear benefit outweighing the risks, it's OK to do

Whoa, that's not OK in any meaningful way and I presume you meant it differently compared to how it came out. There are plenty of situations where nobody sees you yet I presume you don't murder folks for 50$ in their wallets, ie somewhere high on the mountain. Its called being sane moral person, pretty low bar for existence in society.

Not the OP, but "crime" covers a lot of things and there are victimless crimes out there.

Is it immoral to grow and smoke weed in prohibionist parts of the USA? Is it immoral to have out-of-marriage sex in Saudi Arabia?

In my opinion, the body and mind tell a person exactly what they need to be happy. If we could murder people that offended us, or force sex from a mate we desired, took what we wanted etc. life would be a bed of roses. I genuinely believe the person would be absolutely content. The problem is this is inconsistent with how to live as a society and this is the root of all human suffering.

> Heroin addiction is a public health problem, ... The fact that you have to pay for treatment in parts of the US is unbelievable to me.

> Having access to naloxone and injection kits for free surely saved me from getting a blood-borne infection, and the counselling from the charity really helped.

Naloxone and Suboxone are so tightly controlled in the US that many addicts who want to get clean go back to heroin to self medicate (and many die). Why? The DEA bars any kind of relaxation and the private prison companies and the prison guard and police unions fund candidates that oppose any sympathy for addicts.

It’s capitalism all the way down.

> There are almost always deep-rooted issues that the addiction hides

William S Burroughs wrote, at the end of "The Naked Lunch":

"Statistically, the people who become addicted to morphine are those who have access to it: doctors, nurses, anyone in contact with black market sources. In Persia, where opium is sold without control in opium shops, 70 per cent of the adult population is addicted. So we should psychoanalyze several million Persians to find out what deep conflicts and anxieties have driven them to the use of opium? I think not."

Similarly, historical opium addiction in China was largely a function of supply.

I think there's a bit from column A, a bit from column B, and WSB's scoffing at the idea of "psychoanalyzing Persians" does seem a bit... dated (what a concept, that a large number of people might have anxieties and deep conflicts). And I whole-heartedly agree with you about the "health problem not a crime" issue.

However, I often think about that remark of WSB's in connection with some of the more radical ideas about legalization (as opposed to decriminalization/depenalization).

Alcoholism was extremely common in the past from where I come from. High society acceptance as long as the person didn't wreak too much havoc. It has been idolized in folklore songs, books and stories for children. Just part of the life. Kids drank sometimes too.

Fast forward today - access to alcohol is even better (apart from minors). Yet society doesn't spiral into alcoholic madness apart form few fringe individuals. Maybe education about the inevitable addiction is better? Or people are smarter than peasants 200 years ago? Or whole cultural mindset about getting wasted as part of being social in nearest pub shifted.

Or maybe alcohol isn't quite as addictive and destructive as heroine and other opiates?

That probably depends on the target population as well.

Alcohol seems to be very destructive in Native American communities.

I'd hazard a guess that alcohol is a lot less addictive than heroin, although full-blown alcoholism and withdrawal is no joke.

I think we also have a lot of customs around alcohol to mitigate the level and constancy of drinking required to get addicted. Lots of jokes about "it's 5pm somewhere" or "the sun is over the yard arm", "no drinking on a school night", etc. I think there are generally enough taboos around day drinking or being constantly drunk that most people are nudged away from veering into physical addiction.

I think it’s very true that availability and norms will have a lot to do with drug use, and heroin often doesn’t give a second chance to people who are experimenting.

However the with regard to the idea of ‘deep seated issues’ affecting addiction, I believe this is also true.

We have communities here that provide the opportunity for perfect control of substances - they’re remote and access to them is strictly controlled.

There was widespread alcohol addiction in these places. So alcohol was banned, and these places became ‘dry’ communities.

Lacking alcohol, the people turned to inhaling petrol fumes, which created a large social problem.

Eventually, an ‘un-sniffable’ petrol was created to solve this problem. Then the people turned to paint and glue.

It’s recognized that the people in those communities have suffered a deep, inter-generational trauma, which is what drives people to seek ‘numbing’ relief from substances.

However, it’s the belief that reducing availability of substances will solve substance abuse that’s kept the fundamental problems these people have, from being addressed.

> It’s recognized that the people in those communities have suffered a deep, inter-generational trauma,

Really? What about the Jewish people, who have been subjected to extremely high levels of inter-generational trauma. Yet they don't fall prey to particularly high levels of alcoholism or drug addiction.

Sure, current poverty can predispose some to addiction, but the idea of "inter-generational trauma" being a massive risk factor is unproven, to say the least.

I think you're taking the wrong point away, which is that the causal implication here runs from "wide availability of a substance -> addiction to that substance".

It doesn't say anything about whether a traumatized group will or won't take to substances; it just denies that all addiction is the result of trauma.

The other open question here - I assume you're referring to remote Indigenous communities in Australia - is whether people use substances strictly out of trauma or also out of boredom. The degree to which Indigenous lives are rendered both traumatic but also incredibly boring is shocking. If you've gotten a low quality education, don't have a job and your traditional way of life is no longer viable (it's quite likely you haven't been taught it), how are you going to pass the time?

You have to pay to give birth in the US, like the government doesn't even care about the most fundamental act of creating more citizens, so not funding heroin treatments is no surprising in the slightest

> I was on heroin for a few years and I live in the UK. I had managed to keep it hidden for maybe 18 months but eventually it become obvious and my mother started organising help.

I think it's incredibly brave for you to share this, I appreciate you for your honesty and authenticity.

It's very beautiful to me when the universe helps people who've gone through incredibly difficult times to speak their truths out loud, and become advocates for change. I believe this act can help to shine a light in the darkness for others going through similar challenges (for the first time).

> On a global level we need to stop treating addiction as a crime but as a health problem.

100% agree. I believe society would benefit from an expanded definition of the word 'addiction' too:

"Addiction is manifested in any behavior that a person craves, finds temporary relief or pleasure in but suffers negative consequences as a result of, and yet has difficulty giving up. In brief: craving, relief, pleasure, suffering, impaired control. Note that this definition is not restricted to drugs but could encompass almost any human behavior, from sex to eating to shopping to gambling to extreme sports to TV to compulsive internet use: the list is endless.

“I’m not going to ask you what you were addicted to,” I often say to people, “nor when, nor for how long. Only, whatever your addictive focus, what did it offer you? What did you like about it? What, in the short term, did it give you that you craved or liked so much?” And universally, the answers are: “It helped me escape emotional pain… helped me deal with stress… gave me peace of mind… a sense of connection with others… a sense of control.”

Such answers illuminate that the addiction is neither a choice nor a disease, but originates in a human being’s desperate attempt to solve a problem: the problem of emotional pain, of overwhelming stress, of lost connection, of loss of control, of a deep discomfort with the self. In short, it is a forlorn attempt to solve the problem of human pain. Hence my mantra: “The question is not why the addiction, but why the pain.”

And the source of pain is always and invariably to be found in a person’s lived experience, beginning with childhood. Childhood trauma is the template for addiction—any addiction. All addictions are attempts to escape the deep pain of the hurt child, attempts temporarily soothing but ultimately futile. This is no less true of the socially successful workaholic, such as I have been, than of the inveterate shopper, sexual rover, gambler, abject street-bound substance user or stay-at-home mom and user of opioids." [1]

Also I love this talk about alienation: https://www.youtube.com/watch?v=TIjvXtZRerY / https://www.youtube.com/watch?v=Hs39tNLQss8

[1] Gabor Maté, https://drgabormate.com/opioids-universal-experience-addicti...

Once upon a time, I smashed my kneecap into about 5 pieces. I wish I could say it was playing rugby or football or mining or something but it was disc golf (?!?!?!). Was on hydro for weeks, I think. I don't remember much about it. I do remember that stuff making me feel way better than any human really should.

I also remember the day I sat in the surgeon's office and we had the weekly "what's your pain level?" conversation. And I knew good and well that the pain was basically gone. And he knew I knew it. And he knew I really, really wanted more of those pills. And he asked if it might be time to switch to Tylenol and sort of gave me a certain, probably well-practiced, look. The one where an eyebrow does that thing.

I remember taking stock of the situation, looking longingly into the abyss, and turning back. That doctor fixed my knee, but, more importantly, probably saved my life with a 2-minute conversation.

Thanks doc!

Read this when it was in National Review 4 years ago [0]. If you enjoy this, you might also like:

"Chaos in the Family, Chaos in the State: The White Working Class’s Dysfunction" https://www.nationalreview.com/2016/03/donald-trump-white-wo...

"I am cancer" https://www.nationalreview.com/2017/05/underclass-character-...

These are all variations on a theme, which is the rot at the heart of rural America.

[0] https://www.nationalreview.com/2016/02/heroin-prescription-p...

Even if people are not interested in the theme, they should read the guy. He can write.

Do we keep getting this wrong because of perverse incentives, malice, or just plain stupidity? Was it not expected that clamping down on legal opioids would cause an illegal market to flourish? We've been doing this sort of thing for decades now. We know what's going to happen. No need to do research. There's a mountain of empirical data.

What alternatives were considered? There has to be a better approach.

I think it's a combination of all of the above. Politicians who see drug abuse and ignore experts when making policy. Politicians turning a blind eye thanks to lobbyists.

You don't need to look far to see folks who think they know better than medical experts, or who are motivated by greed and corruption.

The kinds of politicians these uneducated, white, rural people are voting for are surely not the kind to push for compassionate, evidence-based solutions to the addictions ruining their communities. They have only themselves to blame for their towns' blight.

Ironically as I started to read this I was holding my Oxycodone vial and contemplating taking one. And now I am.

At least my impulse is because of post-surgical pain, and hopefully will fade with the pain.

FWIW about eight years ago I was involved with a local group that was drawing focus to the young people in our small rural/suburban community that were addicted to heroin. Through the course of a year we had eight of these young adults come and essentially give their addiction testimony.

To a person the story was this:

- high school sports injury

- prescription for oxycodone

- oxycodone dependency develops

- physician cuts off supply

- kids start buying pills in school

- one of their sources introduces them to heroin

Every single one of them. The exact same story. It was unbelievable.

I only say that to say that placing some controls around how you approach the oxy isn't a bad idea. Good luck and I hope you get feeling better soon.

> - prescription for oxycodone

or Codeine or Hydrocodone

Those high school football back injuries are tragic

Most likely.

It's not the drug that feels good; it's the respite from pain, and that only by contrast. Lacking that contrast, the drug induces only a profound, if temporary, physical and emotional numbness. It's not pleasurable, because it's not anything; it's as close as anyone alive can get to being dead. Unless that's something you want, you need have little fear of prescription opiates - just as much as is consistent with a healthy respect for, and avoidance of, the risks that come with their benefits.

That certainly hasn't been my experience, and I have a quite extensive history with opiates. They feel fucking awesome. But obviously the pleasure received is different for different ingestion methods, and also different types of opiates.

I think there's more variance to it than just that. I wouldn't call my experience with them "extensive", but neither am I a blushing naïf, and I've never found them to be pleasurable for their own sake. Granted, this may in part be due to the fact that my only encounter with heroin was as part of a luckily failed attempt at sexual assault, but it's not as if I've never tried prescription opiates for recreational purposes, and I'm told by those who should know that IV Dilaudid, which I was once given during an ER visit for what turned out to be a stuck kidney stone, is comparable to heroin in its effects and subjective experience. Later in the same visit, I was offered a second dose, but turned it down; something about the CT contrast I'd been given had by then moved the stone and alleviated the pain, or maybe it had just moved on its own, and I found nothing in the effects of the drug to desire for its own sake.

On the other hand, I've known people who haven't been so lucky, and have ended up badly hooked. I suppose I shouldn't have spoken so positively about what opiates are like, when I can only really speak with confidence about what they're like for me.

i think your experience is idiosyncratic; for most people, opiates feel very pleasurable

There is substantial genetic variation in responsiveness to opiates. For some (an estimated 1% in Norway, at least [0]) the standard dosing comes with all the side effects and none of the benefits.

When I was recovering from sinus surgery, my wife handed me oxy on the prescribed schedule, and it was worse than nothing — pain still there, plus brain fog and massive constipation. Tylenol worked an absolute wonder, though.

Pain is a bitch. I hope we come up with something better than these blunt instruments soon.

[0]: https://partner.sciencenorway.no/forskningno-norway-ntnu/gen...

For what it's worth, it's not that they don't suppress pain when I take them. They do, quite effectively; it's just that I don't find anything else about the experience to be at all pleasant.

To your point about genetic variation, I'm told I have an unusually high pain tolerance; at that same ER visit, when the doctor came in to discuss the CT results showing the size of the stone, she expressed some surprise that I hadn't done any screaming. My mother tells me that she's the same way. So maybe it's something to do with that? I really don't know. In any case, it's clear from the responses I've gotten that to generalize from my own experience here is unwise, and I won't repeat the error.

Have you used? Because you’re wrong.

This is very specific to the person and cannot really be generalized.

I LOATHE opiates. I mean really hate them. They make me feel like my brain is encased in concrete and they do nothing for my pain until you hit the hydromorphone level. And all hydromorphone does is suppress the pain enough that I go "Thanks. <snore>" and finally pass out. Lather, rinse, repeat every two hours until the surgeon finally cut me open.

However, that experience is not universally shared. I have met people just like me, but I have also met people who just LOVE oxycontin (which has zero upside for me--I'm still in pain and I can't think).

Addiction is very personal and specific.

I don't know if that is consistent. The first time I ever had vicodin (which isn't really that strong a drug in the grand scheme of things, I guess), I felt good. Not just no pain, but more relaxed, carefree, happy than I can remember ever feeling naturally.

My immediate reaction was to say out loud to my girlfriend "Umm, not taking any more of this, because oh my god this is way too good." Oddly enough, since then (it's been 20 years now, I've had vicodin a few times) it doesn't ever have the same effect. Just that once. Now it's just pain relief. Which is a relief.

they say the same about heroin - first one is the best, the rest is an effort in vain to try experiencing it one more time

I don't know the details of your surgery but I've been prescribed narcotics three times post-surgery and have always halved my prescribed dosage after day 2 and stopped completely by day 5. Then we bring the extras To get destroyed at a drug drop off (local pharmacies offer this here)

I was also very cautious when given opioids after my wisdom teeth extraction. As it turned out they gave me painful, uncontrollable hiccups that persisted for days and days. The experience was extremely unpleasant, but also a bit of a relief, as I knew there was no chance I'd keep taking those pills post-recovery. I learned later that opioid-induced hiccups are rare, but not totally unheard of:

https://pubmed.ncbi.nlm.nih.gov/10202603/

My experience is a weird reverse. I took one after the anesthesia wore off day 1, from then on only took Tylenol because the pain wasn’t that bad and I didn’t want the nausea.

Unfortunately night of day 3 pain was worse so I tried the Oxycodone again (it’s mixed with Tylenol so have to choose one or other). No nausea and an impressive night of sleep convinced me to start taking the opioid at nights and Tylenol for working hours.

But now it’s the night of day 5 and two hours after taking OxyCodone has barely kicked in and not enough to sleep. I don’t know if it’s having an interaction with something I ate it my other medication (taken minutes before). But I can see why people up their dosages.

Some studies have shown that taking tylenol and ibuprofen together has equivalent pain reduction to oxy.

> But I can see why people up their dosages.

I would suggest you REALLY self assess carefully - are you not sleeping because of actual fresh pain? Or are you not sleeping because your body wants a nice fuzzy cloud of opioids to crash on?

Your first night of sober sleep is going to be a bit tougher no matter what, I suggest you try acedominophen and ibuprofen alternating to cut the surgical pain but you'll still need to get through the lack of narcotics

It was the pain, finally fell asleep 3 hours in without taking another. Took one after 4 hours of sleep to help me sleep more but switching to Tylenol in an hour when it expires.

"what’s killing what used to be the white working class isn’t diabetes or heart disease or the consumption of fatty foods and Big Gulps that so terrifies Michael Bloomberg, but alcohol-induced liver failure"

I never drank much, only 1-2 a month at parties. But man, I'm so glad I quit drinking due to the pandemic...

I come from a working class family and many of my grandparents generation died from that.

lol, and now I dreamt I started drinking again.

I hate my brain :D

“Nobody cares, because of who is affected”

My respect to the author for this careful and courageous article. Writing about the problems affecting working class white men in today's climate might warrant censure in some circles.

To the matter at hand, one of my concerns is that the Sackler family will enjoy long, peaceful lives. I hope justice intervenes.

I agree with you about how taboo it is among a certain type of journalist to write about the considerable problems of poor and working class whites.

But in light of your comment about the Sackler family, I'll add another opinion that is unpopular these days: people with severe chronic pain deserve appropriate treatment. And they shouldn't be denied access to that treatment (like they are now) because addicts and corrupt doctors misused the product. Addicts deserve sympathy and compassionate treatment, but we shouldn't ban an entire class of useful medications because of the addicts' misuse (eg, we don't ban cars because some people drive drunk).

If you've never known serious chronic pain, all I can tell you is that it's a different world than the one I knew before I got sick.

You've got to be kidding me. I don't think I've ever seen such a sudden wave of compassion for the victims of drug addiction in the US before the recent opioid epidemic - my jaw was on the floor seeing the number of politicians, including conservative ones, who started embracing the language of "sickness" rather than "moral failure" for drug addiction at this time. Compare and contrast the reportage on the crack epidemic.

To be clear, I'm not calling for a return to the bad old days, but it's in incredibly poor taste to pretend that there's some kind of conspiracy against "working class white men". Sure, we can weasel out with "in some circles" - I'm sure there's some nutter somewhere who thinks somehow this is all just desserts for being white or voting for Trump, etc. But that's a fringe viewpoint.

re Sackler family, although I wish them long, peaceful lives, I would like a considerable portion of those long, peaceful lives to be spent in some sort of Federal facility.

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