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Comment by ultrastable | Hacker News Reader

I agree w/ you in principle, but it's also worth pointing out that drug rehab in the US (and globally, but the US is the worst out of the countries I know enough about to assess) is a joke, court-mandated especially, eg: https://www.washingtonpost.com/business/review-finds-many-wh.... putting aside the indentured servitude model, whether court-mandated or not, far too many rehabs adhere strictly to ineffective 12-step programs rather than harm reduction.

they're not necessarily worse than jail ofc, but they don't serve any useful therapeutic purpose either

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A good start to reform would be to stop making crime a profit center for corporations that provide prison and rehab services. Their interests are the lowest quality at the highest price, and they will lobby politicians towards that end even if it's not in the best interests of turning a criminal back into a productive member of society.

The government may tend to lack efficiency, but at least its lack of profit motive wouldn't completely taint the whole system.

true, although I think it's worth pointing out that private prisons aren't as big a driver of mass incarceration in the US as a lot of people think. the privatization of services like food or health within public prisons, or replacing mail or in-person visitation w/ extortionate electronic systems, is probably much more significant.

similarly most exploitative prison labor doesn't take the form of producing goods for private companies (like the Whole Foods cheese thing) but consists of using inmates to reducing staffing & other costs inside the prison, like making them work in the kitchens or laundry

edit: immigration detention is the notable exception - about 70% of immigration detainees are held in private prisons, compared to about 10% of prison inmates

moving towards evidence based, medication assisted rehab is a HUGE step in the right direction which does actually work - especially opiates. Soboxone, naltrexone etc. sadly seems like Meth/stims don't really have any good clinical stepping stones; it's an awful drug.

there's no neat middle ground like buprenorphine but meth & some other stimulants can be prescribed in the US, so that's better than nothing - at least helps w/ problems of contamination, dose ambiguity, health risks associated w/ smoking/injecting etc

totally. I'm very passionate about this, like probably most Americans who have families now touched by addiction.

I am 100% in favor of unscheduling all drugs and providing addicts under Dr. care actual pharmaceuticals. Including opiates. Even if they still inject it's still a LOT safer.

When are we going to see some of this settlement money expanding treatment?!

If anyone hasn't watched it, I highly recommend the new HBO doc from Gibney "Crime of the Century" shows some new evidence just confirms how evil Purdue is and specifically Richard Sackler.

They present evidence that the FDA employee who wrote the label wrote it in a hotel with Purdue employee.

This is HUGE. That label is what they used to market the original "Big Lie" that OxyContin “Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug” which is on the same level as cigarette companies being horrible and deliberately killing hundreds of thousands of us.

Second half focuses on the Kapoor's fentanyl corporate crime syndicate. at least he is serving a small amount of jail time. Sadly now corporations are moving on to Asia and Africa. It's disgusting and makes me so angry.

it's monstrous yeah. did you see the thing about McKinsey recommending that Purdue pay a rebate to pharmacies for every OD death, to assuage their concerns over dispensing large quantities of opioids? https://www.fiercepharma.com/pharma/mckinsey-consultants-pro...

one thing I don't think that's talked about enough re: the opioid crisis is labor injuries - imo people taking opioids in order to be able to work through injuries they've incurred on the job played a big part in it. doesn't diminish the guilt of the Sacklers et al, ofc, but it wasn't purely an overprescription problem

no thanks for the link. that's gross!

AND it seems worse incentive! dole out more, kill more people, and you're pharmacy will make higher profit.

Yes I agree just the general idea of 'needing' to treat all pain, and companies skirting workers comp time off is gross. Might as well dope up Amazon warehouse workers. Given them vyvanse and longer shifts... That's what purdue marketed and completely changed how Drs treat. That 1-10 face chart that is still in my Drs office was made and distributed by Purdue.

The hbo doc actually goes into the distributors. How one gov. prosecutor used the existing DEA law to order a stop on one factory warehouse for filling orders that were magnitudes larger than like last months, and are are clearly abuse or diversion.

But then this same prosecutor who had a great reputation for being tough got hired by these Pharma corps, and lobbied to change that law so they can't shut it down anymore. It passed congress unanimous consent. he used his position to say 'this isn't effective' and lie about what it actually did, and most LAs and members didn't bother to read it...

Drug rehab and harm reduction aren’t the same thing.

I'm aware of that. but some rehabs adhere to the harm reduction model & too many don't, which is why you get people ODing because their rehab thought expecting someone to stay fully abstinent after a month or two of inpatient was a better idea than putting them on suboxone while they got long-term psychiatric help. the 12-step approach is partly responsible for the abstinence dogma, hence my mention of it

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