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>> Researchers have pondered what could have caused this sudden turnaround, pointing to the end of the covid-19 pandemic or a rise in drug treatment. A new arti

>> Researchers have pondered what could have caused this sudden turnaround, pointing to the end of the covid-19 pandemic or a rise in drug treatment. A new article, published in Science on January 8th, suggests, instead, that a supply shock drove the decrease. The supply shock sounds right. I was volunteering at a state run institution, who had an addiction data science team, at the peak of the opioid crisis. I was developing ml models to predict patient dropout early in a 32 week program. The data and funding for such research was very scarce and it didn't go anywhere. Treatment for opioid use disorder with medication is highly effective for 50% - 90% who respond well to treatment. The problem with the bottom 50% was early dropout, due to the lack of dissemination of proper treatment protocols and stigma attached to medication for treatment (methadone). I stopped following the work, I became too sensitive, it was pretty depressing. The pandemic coupled with the increase in illicit fentanyl was just tragic in what it did to people. I remember reading the DEA research, where the precursor for fentanyl came from china and was manufactured and distributed from mexico. Mexico was also manufacturing high quality meth and displaced most of the meth labs in america, coming with increases in meth overdose during the same period. The fentanyl was so cheap compared to traditional heroin manufacturing. I'm glad the supply seems to have dried up. It was nuts, what was going on a few years ago.

20after4 8mo ago
I think that many methadone clinics are operating very unethically, to the point I would call it fraudulent. Certainly it's cruel to the patients. They essentially set up the patient to be a lifetime methadone addict. This may be an improvement over getting your fix on the street but it's still addiction dependence and it's expensive (profitable!). I'm unsure if it's just a few or a large fraction of them that operate this way. Maybe my data point is a unique outlier but here's what I saw: I had a friend who was going through the program in Springfield Missouri, approximately 10 years ago, and the clinic literally increased his dose every week or two. They also had strict controls to make sure the patients actually take the full dose (because otherwise they might sell some of it on the street). So they were left with just 2 options, either drop out of the program and find their fix elsewhere, or accept a gradually increasing dose of methadone, forever. It's a sick program that is set up to make sure patients gradually descend deeper into addiction while they rake in huge profits. It's not really any different from what the drug dealers on the street are doing except that it's even more exploitative and dishonest. The doctors had zero plan for weaning people off of the methadone and some people had been on the program for years, with correspondingly huge doses doled out to them every time they came in. This was 10 years ago, at the time it cost something like $50 per visit, paid by the patient or possibly medicaid. Edited slightly for clarity.
- deepsun 8mo ago
  Well, addiction or not, the main question is what medics call "quality of life" -- whether a patient can life their life to the full potential. There are millions of people addicted to caffeine, the most popular psychoactive substance in the world, but as it usually doesn't prevent them to live their life and "be a productive member of society", no one cares of treating caffeine addiction, save for religious societies. My point is -- is methadone addiction "better" than fentanyl in that regard? If yes, than that's ok.
  - lazarus01 8mo ago
    Agreed. Methadone is effective because it comes with lower respiratory fatigue. If you have a nasty addiction, methadone is the gold standard for treatment. It's really all that's available to ween people down. There are other medications for maintenance like buprenorphine and naltrexone. But you can't take those if you're in the throws of heavy addiction, you can die.
  - 20after4 8mo ago
    My complaint was about the forced increasing of dosage. They literally would not allow the patient to wean off of it. So yes, it might be an improvement over the shit on the street but it's diabolical that they force patients to continually increase their dose rather than gradually decreasing it. I have no idea if this is common or just this one shady clinic but my data point of 1 still stands. If there is one, then given that this would be very profitable, it's highly likely that there are other clinics with similarly unethical policies.
    - antonvs 8mo ago
      Was there some stated rationale for the dose increase?
      - 20after4 8mo ago
        Not that I'm aware of, it seemed rather arbitrary. The people who had been going to that clinic for a while all had massive doses, almost to a ridiculous degree. My perception was that it was to keep them hopelessly addicted. I was only peripherally involved as it was my friend who was the patient. He was very fortunate to have family with influence in the Mormon church - his family had the church send some local missionaries to help him - and they genuinely did help him escape that terrible situation.
AndrewKemendo 8mo ago
Even still today there is no reliable place to source black tar or China White or any of the traditional opium derivatives without having a fentanyl cut.
- t-3 8mo ago
  Isn't this more because the supply of poppy was cut off when the US pulled out of Afghanistan? Users want the good stuff, dealers buy the cheap and available stuff and pretend it's real.
  - metalman 8mo ago
    poppy/opium/heroin production has shifted to myanmar, but there has been less production, and the synthetics are much cheaper ,so that reduces profitability for poppy Afganistan, have set up addiction centers, where addicts are put, but it's cold turkey. Opium poppy production is bieng eradicated in Afganistan ,and penaltiys for drug smugglers and dealers will escalate, but a quick search shows the increadable synicism of the western press who are spinning it as "hardship for Afganinstans farmers"
    - lukan 8mo ago
      "hardship for Afganinstans farmers" Isn't it hardship when people with guns come to you and burn your fields?
      - metalman 8mo ago
        ok, lets talk about Palestine ,if thats what you want.
      - HPsquared 8mo ago
        I wonder how this compares to the common western situation of livestock culls. Presumably there is compensation in some cases and not in others (poppy cultivation being illegal). I suppose it's at opposite ends of a scale.
      - 8mo ago
greygoo222 8mo ago
The initial spike in overdose deaths were largely caused by government crackdowns on pharma drugs.
- monero-xmr 8mo ago
  You can live with a sustained opioid addiction permanently without major issues. That’s the entire basis of methadone clinics - controlled dispersement of opioids at a level that solves cravings and allows the addict to be functional. It is very sad we don’t allow pharmaceutical grade opioids to be given to addicts in a controlled way, it would eliminate the purity variance that causes overdoses, and prevent the poison mixed in to increase street profits from destroying bodies (tranq, etc)
  - specproc 8mo ago
    Methadone is available in the UK, on the NHS. I know at least one person who has been on it for decades. https://www.nhs.uk/medicines/methadone/ https://www.nhs.uk/medicines/methadone/
  - herbst 8mo ago
    In Switzerland they can get actual, state grown, heroin. Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even. And you don't SEE any issues like in the US (or UK) around here at all.
    - monero-xmr 8mo ago
      Imagine you are sitting in a room. Your child is in front of you. A scary man sits next to them. The man says: “Your child is a drug addict. They are addicted to opioids. I am the devil, without any care in the world other than making money. The choice is yours. Would you rather they inject clean heroin made by a pharmaceutical company in your country, or banish them forever as street addicts slavishly doing what it takes to score their fix?” When facing the devil I’m voting for my tax dollars to give them clean heroin made by my country. That is what every parent wants when faced with an addicted child
cavisne 8mo ago
Channel 5 did a good piece on "Tranq" which lets China skip the Mexican part of the supply chain as they can mail the finish product straight to the US. Since the article suggests there must have been a change in china to cause this it seems likely they just moved from fentanyl to tranq. https://www.youtube.com/watch?v=925wmb-4Yr4&t=1623s&pp=ygUPY2hhbm5lbCA1IHRyYW5x https://www.youtube.com/watch?v=925wmb-4Yr4&t=1623s&pp=ygUPY...
- _DeadFred_ 8mo ago
  Lots of people were getting fent analogs straight from China. Which had me wondering. The guys that I knew that ordered/distributed it (ex-marines that had pill addictions after Iraq/Afghanistan) would get different analogs randomly I guess, and would test each batch on themselves. Some were way more sketchy than others, and they ultimate caught a case with a body from a new batch. Could the less deaths be because of the analogs in production at the time?

20after4 8mo ago

I think that many methadone clinics are operating very unethically, to the point I would call it fraudulent. Certainly it's cruel to the patients. They essentially set up the patient to be a lifetime methadone addict. This may be an improvement over getting your fix on the street but it's still addiction dependence and it's expensive (profitable!). I'm unsure if it's just a few or a large fraction of them that operate this way. Maybe my data point is a unique outlier but here's what I saw: I had a friend who was going through the program in Springfield Missouri, approximately 10 years ago, and the clinic literally increased his dose every week or two. They also had strict controls to make sure the patients actually take the full dose (because otherwise they might sell some of it on the street). So they were left with just 2 options, either drop out of the program and find their fix elsewhere, or accept a gradually increasing dose of methadone, forever. It's a sick program that is set up to make sure patients gradually descend deeper into addiction while they rake in huge profits. It's not really any different from what the drug dealers on the street are doing except that it's even more exploitative and dishonest. The doctors had zero plan for weaning people off of the methadone and some people had been on the program for years, with correspondingly huge doses doled out to them every time they came in. This was 10 years ago, at the time it cost something like $50 per visit, paid by the patient or possibly medicaid. Edited slightly for clarity.

deepsun 8mo ago
Well, addiction or not, the main question is what medics call "quality of life" -- whether a patient can life their life to the full potential. There are millions of people addicted to caffeine, the most popular psychoactive substance in the world, but as it usually doesn't prevent them to live their life and "be a productive member of society", no one cares of treating caffeine addiction, save for religious societies. My point is -- is methadone addiction "better" than fentanyl in that regard? If yes, than that's ok.
- lazarus01 8mo ago
  Agreed. Methadone is effective because it comes with lower respiratory fatigue. If you have a nasty addiction, methadone is the gold standard for treatment. It's really all that's available to ween people down. There are other medications for maintenance like buprenorphine and naltrexone. But you can't take those if you're in the throws of heavy addiction, you can die.
- 20after4 8mo ago
  My complaint was about the forced increasing of dosage. They literally would not allow the patient to wean off of it. So yes, it might be an improvement over the shit on the street but it's diabolical that they force patients to continually increase their dose rather than gradually decreasing it. I have no idea if this is common or just this one shady clinic but my data point of 1 still stands. If there is one, then given that this would be very profitable, it's highly likely that there are other clinics with similarly unethical policies.
  - antonvs 8mo ago
    Was there some stated rationale for the dose increase?
    - 20after4 8mo ago
      Not that I'm aware of, it seemed rather arbitrary. The people who had been going to that clinic for a while all had massive doses, almost to a ridiculous degree. My perception was that it was to keep them hopelessly addicted. I was only peripherally involved as it was my friend who was the patient. He was very fortunate to have family with influence in the Mormon church - his family had the church send some local missionaries to help him - and they genuinely did help him escape that terrible situation.

AndrewKemendo 8mo ago

Even still today there is no reliable place to source black tar or China White or any of the traditional opium derivatives without having a fentanyl cut.

t-3 8mo ago
Isn't this more because the supply of poppy was cut off when the US pulled out of Afghanistan? Users want the good stuff, dealers buy the cheap and available stuff and pretend it's real.
- metalman 8mo ago
  poppy/opium/heroin production has shifted to myanmar, but there has been less production, and the synthetics are much cheaper ,so that reduces profitability for poppy Afganistan, have set up addiction centers, where addicts are put, but it's cold turkey. Opium poppy production is bieng eradicated in Afganistan ,and penaltiys for drug smugglers and dealers will escalate, but a quick search shows the increadable synicism of the western press who are spinning it as "hardship for Afganinstans farmers"
  - lukan 8mo ago
    "hardship for Afganinstans farmers" Isn't it hardship when people with guns come to you and burn your fields?
    - metalman 8mo ago
      ok, lets talk about Palestine ,if thats what you want.
    - HPsquared 8mo ago
      I wonder how this compares to the common western situation of livestock culls. Presumably there is compensation in some cases and not in others (poppy cultivation being illegal). I suppose it's at opposite ends of a scale.
    - 8mo ago

greygoo222 8mo ago

The initial spike in overdose deaths were largely caused by government crackdowns on pharma drugs.

monero-xmr 8mo ago
You can live with a sustained opioid addiction permanently without major issues. That’s the entire basis of methadone clinics - controlled dispersement of opioids at a level that solves cravings and allows the addict to be functional. It is very sad we don’t allow pharmaceutical grade opioids to be given to addicts in a controlled way, it would eliminate the purity variance that causes overdoses, and prevent the poison mixed in to increase street profits from destroying bodies (tranq, etc)
- specproc 8mo ago
  Methadone is available in the UK, on the NHS. I know at least one person who has been on it for decades. https://www.nhs.uk/medicines/methadone/ https://www.nhs.uk/medicines/methadone/
- herbst 8mo ago
  In Switzerland they can get actual, state grown, heroin. Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even. And you don't SEE any issues like in the US (or UK) around here at all.
  - monero-xmr 8mo ago
    Imagine you are sitting in a room. Your child is in front of you. A scary man sits next to them. The man says: “Your child is a drug addict. They are addicted to opioids. I am the devil, without any care in the world other than making money. The choice is yours. Would you rather they inject clean heroin made by a pharmaceutical company in your country, or banish them forever as street addicts slavishly doing what it takes to score their fix?” When facing the devil I’m voting for my tax dollars to give them clean heroin made by my country. That is what every parent wants when faced with an addicted child

cavisne 8mo ago

Channel 5 did a good piece on "Tranq" which lets China skip the Mexican part of the supply chain as they can mail the finish product straight to the US. Since the article suggests there must have been a change in china to cause this it seems likely they just moved from fentanyl to tranq. https://www.youtube.com/watch?v=925wmb-4Yr4&t=1623s&pp=ygUPY2hhbm5lbCA1IHRyYW5x https://www.youtube.com/watch?v=925wmb-4Yr4&t=1623s&pp=ygUPY...

_DeadFred_ 8mo ago
Lots of people were getting fent analogs straight from China. Which had me wondering. The guys that I knew that ordered/distributed it (ex-marines that had pill addictions after Iraq/Afghanistan) would get different analogs randomly I guess, and would test each batch on themselves. Some were way more sketchy than others, and they ultimate caught a case with a body from a new batch. Could the less deaths be because of the analogs in production at the time?