Im fortunate to live in an area dense with traditional taxis and Ubers, no Waymo yet.
I rarely take taxis, the exception is when I have to haul my gear to the studio for a jam session. I always take a taxi, because it’s cheaper and faster than using an app to call an uber.
On 80% of the trips, I end up having a nice chat with the driver and learn something new about humanity or myself.
I really enjoy these interactions, but I feel for the drivers, it’s a very tough job where most taxi drivers have to scramble to find places to urinate or do so in an empty bottle between their legs. There is not much dignity in the job. I feel a negligible segment enjoy it as a reliable career.
I wonder what will happen to the drivers if a large representation of the 1 million+ daily trips are displaced by automation?
I used to feel this way. In the early days of "ride sharing," I preferred Lyft and would sit up front so I could have a conversation with the driver, which they encouraged. It was really fun for a while, and I enjoyed meeting people from different walks of life. Over time, though, transportation became much more functional for me, and now when I take non-autonomous rides, it's more irksome than enjoyable when drivers strike up conversations.
Why the change? I think a big part of your experience is the fact that you "rarely take taxis." Once you're doing it daily or near-daily, the amount of smalltalk becomes more tiresome. Also, with kids and a busy life, I'm usually either looking to get things done or enjoy a rare moment to myself as I'm moving from place-to-place. I agree with OP that Waymo is a huge step up on those dimensions. There's no other human in the same space to feel awkward around.
The fact that they drive more safely and smoothly is a huge improvement, as well. Ironically, I thought this was going to be something I would hate about Waymo. "You mean it drives the speed limit and follows all the traffic laws? It will take forever to get anywhere." It took approximately one ride for my perspective to completely flip. It's so much nicer to not feel the stress of a driver who is driving aggressively or jerking to a stop/start at every intersection. It's not like you can tell them to just ease up a bit, either. When we ride with our kids, we feel massively safer in Waymos.
Yes, it will be disruptive, and I don't particularly love the dominance that big tech has in all of our lives, but I do think Waymo is a marvel, and I hugely appreciate it as an option. As soon as they can take kids alone to all their various activities, it will be yet another massive unlock for parents.
Driving to work is the most common way of commuting everywhere in the US except NYC. So in that sense, no, taking a taxi to work daily is not normal, just as walking, biking, and taking public transit aren’t normal.
When I worked in San Francisco I took Caltrain to the city, but I took Waymo from the train station to the office. San Francisco, like almost all US cities, has poor local transit coverage. In my case there was a bus that took a similar route, but it only ran every 20 minutes even during commute hours and wasn’t coordinated with the train, so if everything was running on time it would have been a 17 minute wait (plus an extra 5 minutes walking). I was busy and well paid enough that spending the extra $10 to save ~20 minutes of travel (and the uncertainty of when the bus would arrive, and how strongly it would smell like piss) was well worth it.
According to [1] the median Bay Area big tech worker earns $272k/year - or $130/hour.
According to [2] Uber drivers make $15 to $25 an hour, before expenses like fuel.
So while it's not normal it's certainly plausible that some people take taxis on a daily basis.
More broadly, as levels of wealth inequality rise in a given society, more people end up working in the personal service sector doing things like cleaning, food delivery, taxi driving etc.
As a former Lyft driver in SF I felt kinda weird when saw the bit about urination. Like, that's just not a problem. As a driver you just plan ahead as in any other job out there where you're not allowed to disengage at a whim. Pilots and surgeons don't pee in bottles, why would drivers? It's kinda funny when people try to empathize but come up with these creative scenarios of what's challenging. The parts that are bad are same as any other thing done for a living: money and dealing with other people. The job was shit when people were shit and/or when the money was shit.
I enjoyed it as a job, not a career. But that was in 2015.
Pilots and surgeons surely have easily accessible bathrooms as a part of their workplace, no? They’re also compensated significantly more and (IMHO) given a lot more dignity
In my city public bathrooms are extremely rare and it’s not trivial to find one. I’m sure taxi drivers are a bit more in tune with where they are out of necessity but even then it’s no guarantee they can find convenient parking/be in the right place/etc.
No. Not for some surgeons at least. Once you start cutting you may have to stay until the job is done so get good at holding it. In the The Way I Heard It with Mike Rowe podcast episode Dr. Rahul Seth talks about doing 12 hour surgeries. No breaks, no bathroom, constantly on his feet working.
Commercial pilots flying airliners generally have it a bit easier. As for military pilots flying tactical aircraft, well this song might give you an idea of what they face.
Yep. This is a really weird thread. The no bathroom piss in bottle thing is not a thing I encountered in my IRL XP. Never felt this imaginary problem, never affected my dignity.
Funny enough, I did later work on surgical training tech and went into O.R.'s. And yeah, everyone in the room stays until the work is done, no easy pee pee breaks. Back to back procedures. But then also nobody ever complained about that there either. It's a fun job.
Idk. I'd reiterate a point I was getting at: what makes any job less dignified is dealing with shit people and/or shit pay. Fwiw Bathrooms you can plan for same as you plan for getting hungry by packing a lunch.
> I really enjoy these interactions, but I feel for the drivers, it’s a very tough job where most taxi drivers have to scramble to find places to urinate or do so in an empty bottle between their legs.
Public toilets, their condition and their non-existence are an often-overlooked issue! It's not just highly problematic for taxi drivers, but also for parcel and postal delivery people... and it's not just relevant for workers either, it's also (IMHO) a violation of anti-discrimination laws.
Imagine you're old and don't have much bladder control or volume, or you're a woman who recently has given birth, or you got one of the variety of bowel related diseases, or you've got a child who is still dependent on diapers. Your range of free unimpeded movement is basically limited to where you have easy and fast access to a toilet or at the very least a place to take care of yourself/a child.
>I wonder what will happen to the drivers if a large representation of the 1 million+ daily trips are displaced by automation?
If it happens gradually enough, they will just find other jobs. After the transition, society will be producing more with the same labor force, and thus the aggregate utility will increase.
In the past when automation displaced many jobs, we did things like raise the age kids could stay in school. There used to be huge numbers of e.g. 14 year olds who previously would be expected to go to work that would now have the opportunity to stay in school. Kind of like a mini UBI as in the transition period they would usually get given food, healthcare etc at least minimally. What’s the equivalent now?
try talking to young attractive women on their experiences and you'll maybe appreciate this somewhat forced interaction less. my partner has been literally kidnapped multiple times (refused to take her to her destination and refused to let her out for over an hour), had drivers refuse to unlock doors until she gave them her number at least once every two months, and constantly has drivers take detours and longer routes to force conversation for longer.
the sooner we can stop subjecting people to having to interact with strangers in a semi-private setting just for basic needs like getting around, the better off vulnerable people will be
I think there will still be delivery services where you need someone to go into the restaurant and then up to the customers door. That’s going to stick around unless we get to a point where the restaurant is responsible to load up the Waymo and the customer is responsible for getting it out which probably won’t happen anytime soon. The whole delivery market was also mostly created overnight from something that didn’t exist before.
In Miami, there are several competing companies like Coco Robotics which employ human "pilots" to monitor a small fleet of robot delivery boxes where the restaurant deposits the food in the box and the box unlocks with integration into the app.
Just figured you'd want to know anytime soon was at least a year ago.
I’m aware of those but those only go 2-3 miles so they don’t work for the majority of suburban and rural Americans. Also they don’t have the convenience of delivery to your door unless they can start using elevators.
these things are all over the city i live in, too. absolute menace and an abuse of the commons. i've had them literally run into me more than once and i've started physically moving them out of my way when they stop in the middle of the sidewalk.
That's a pretty dismissive attitude for ~100 million professional drivers worldwide, making a living doing actual useful work on a forum where the vast majority of users do not do any useful work.
There is also a demographic cliff most of the world is currently going off, declining birth rates and labor shortages. Would you rather have a human nurse in your very old age retirement, or a human driver. Because we don’t have enough young people now for both.
So let's poach these people from the third world and...what about the third world? People can't just be made in factories like robots and self driving cars can. It seems inevitable that either we will have really sucky retirements (please die early grandpa, we can't take care of you!) OR (hopefully) automation will come to the rescue despite luddite protests.
Plenty of people from the third world are interested in moving, trying something new. We should all be free to try new things, but of course you he world isn't set up that way. Seems like we could match up dual needs. The western developed world is in the midst of a racist and fascist period, so not the best time to try this. We have competing changes, shortage of workers in many job areas in the West like the trades in the US, also shortage of jobs for young people in the west.
I'm all for immigration, but the world isn't producing enough people to make that a very viable long term solution. Eventually we have to reduce our demand for labor, especially when our civilization is lopsided for awhile with older people and not enough young people (a problem that will fix itself eventually as the old people die off, I guess).
I'm OK with robots driving cars like I'm ok with not needing an elevator operator anymore to use an elevator.
Artificially protecting jobs by holding back technology is terrible form. At best it’s short term before the economics become an order of magnitude cheap and at worst it’s hamstringing your economy so you’re left behind.
Be that as it may, I would argue there's a straight line from "it's okay to destroy this fairly-low-skill-career for the good of the economy" to the overall situation the US finds itself in today
I figure that’s the way of the world. We’ve gone from a majority low skill economy to a much more complex one over the decades. It will probably continue.
Huh? how can one possibly generalize whatever experience they have not only to one country but to “other countries”, i.e. to the world. I’ve taken taxi in many countries, in all continents, and my experience have been that the drivers are generally helpful. There are scams and bad experience, but that’s minority. That applies to any country, the US included
I’m surprised they don’t have opt-in LLM-based “chatty mode” where you can talk to the AI personality of your choice while riding. Obviously shouldn’t be the same AI that’s deciding whether to run over the child or crash into the oncoming train.
why would anyone need this when then can pull out their phone and use their LLM of choice, if they wanted. I expect some large percentage of social users will just facetime chat with their friends during the ride
I really enjoyed reading this story. I personally believe in subscribing to self concordant goals and working altruistically to cultivate the good Society.
I also agree with the statement above. But what the author leaves out is that good work that speaks for itself can also create insecurity for those that are in an intense competition for recognition.
People’s reality is entirely subjective, where even well intentioned people may reject ideas that don’t contribute to their interpretation of reality.
In my personal experience, when I came up with and executed ideas that made substantial impact and outperformed others, I wasn’t given proper recognition, mostly due to others insecurity and politics to support a subjective reality that everyone can agree to. Particularly leadership who were non-technical sycophants that cared more to please their master than to do the right thing for the company or even themselves.
Humans are complicated social creatures where ethics and altruism often lose to filling personal voids.
I do believe in the concept of the wolf, someone who has reached self transcendence that doesn’t need to subscribe to a subjective shared reality and can achieve personal satisfaction through mastery by exercising their will to do something they believe is intrinsically meaningful.
I disagree. Ideas don’t speak, and work doesn’t speak. People do. Being a 10x engineer isn’t just about having great ideas, it’s about having great impact.
Sometimes I hear ICs say with some pride that “I’m not interested in playing office politics”. I promise you they will lose out to the engineers who are able to self advocate, and coalition-build.
You look at gaining recognition for good ideas as a zero sum game that requires self promotion.
If you develop a good original idea that solves a problem and it gets implemented, you have created positive impact without self promotion. If you're not concerned with public perception, then the discussion stops right here.
Someone can take credit for your idea to gain perception that it was their original idea. But in the end, someone who self promotes that can't come up with original ideas will eventually lose their believability factor and will be unable to promote themselves much further.
The crux is in the “and it gets implemented” part. Teams have a limited bandwidth, so what gets implemented absolutely is a zero sum game, that’s why backlog prioritization exists. In order for your idea to get implemented, you have to advocate for it, and convince others to do the same.
Writing great code and delivering useful side-projects can make you a 2-5x engineer. If you want to be a 10x engineer, you have to scale your impact beyond what you can do alone
Edit: maybe your great idea is actually something that you can implement on your own, such as a test suite or a tool. You still need to change other peoples behavior. You need to convince people to try it.
I'm speaking specifically to the example given by the author.
He was approached by an engineer that saw a critical flaw in the software that goes beyond simple "backlog prioritization".
The engineer "quietly" escalated his concerns by showing a thoughtful approach to fixing a global problem that goes beyond his assignment, that if left unsolved can cause problems for everyone.
Given the managers experience, he understood the engineers intrinsic motivation to do good (not biased in self promotion) and believed that the idea would speak for itself and gain the confidence of other engineers, which it did.
This approach is antithetical to what you described. The engineer did not advocate for himself or his idea, he identified a bigger problem that was far more important than his assignment. He brought the idea to leadership out of concern, to deal with conflicting priorities above him. He was not caught up in politics or transactional thinking.
The message the author is trying to convey, people with significant talent that have higher order values, are not concerned with labels such as "wanting to be a 10x engineer". They just focus on what they believe are the most important problems that they can solve that benefits everyone, not just themselves.
These people are truly rare and your argument that playing politics is necessary to promote ideas, proves how rare it is to come across these people.
Engagement is prioritized over quality on most mediums. I find user generated content on social media absolutely abhorrent.
Thank goodness for hacker news. I can read something, share my views and in some cases, my views may be based on some weak intuition and I learn from polite correctness.
I was wondering what preclinical models meant. It would be more accurate to call it animal models. I read roughly 3% - 5% of compounds move from preclinical cancer therapies to fda approval. That’s a tough success rate.
I’ve personally found meditation, exercise and healthy food intake are more effective for self regulation and coping with tough emotions over medication and supplements.
Each human being is unique, as is the recipe for sustained positive metal health.
I think it’s helpful to consider and experiment with different ideas and strategies.
I strongly disagree there is one single solution that can provide significant lift for a large population.
It’s great to be useful as living for your purpose is the best way to achieve life satisfaction. But it’s important to establish boundaries and avoid developing codependency and not to define yourself through the perception of your acts towards others. Having a skill that helps others gives you a sense of mastery. The fact that you have this skill and apply it in good faith should be enough to establish a good sense of self without feedback from others.
I love being an engineer and solving problems that I’m good at, which are problems too complex for most people to approach. But not everyone feels that way, some or most people don’t care or don’t understand the motivation, as they may have different motivations of their own. Learning to accept that and be confident without validation from others is very tough but possible, as you apply yourself consistently with focus and clarity, you gain a stronger sense of purpose. You are never fulfilled, but continue to pursue anyway, that is the trick I learned for myself. The trait is called equanimity and is more of a sustainable attitude vs a feeling, that is transactional. It’s easier as you get older and comes with maturity.
Yes, equanimity is a great quality to possess. It means that you never get too high or too low. When things are really going your way, you know that things can change for the worse. Yet you can be content. When things are not going your way, you know that things can change for the better. And you can be content.
This doesn't mean that you don't try to achieve anything. It means that you can still be content whether you succeed or fail.
No problem! Happy it was helpful. I learned about equanimity last year in a book I read about the science of self actualization, how to reach your unique potential.
I believe the concept of public decency is entirely cultural and has less to do with courage.
Where I live, if someone is being loud in public, you usually keep to yourself. So long as they are not being overtly offensive or profane.
In other countries, like the Netherlands for example, people will have no problem telling you to be quiet or verbalize any violation of cultural norms. I believe it's like that in Germany and Scanda as well, from what I hear.
> But I can honestly say that in the past 25 years I have never, ever seen them saying anything remotely like this to another Swede.
Let me guess, you live in Stockholm? :)
As a Swede, I have definitely seen Swedes (usually older people) telling-off other Swedes and I even do it, recent examples: driving/parking like an asshole, being obnoxious, walking in the bike lane, not looking where they are going. I don't care if they're a Swede or a martian, it makes no difference to me.
It is for this reason I am grateful to be a gen xr. I was at the end of my 20s when social media blew up, so it wasn’t a meaningful part of my personal development. I cannot bring myself to look at IG and the hot mess it serves up daily. A hyper focused lens on the potential of human desperation and stupidity.
I don’t hate on the younger generation, I feel bad they grew up with this shit and try to be a positive influence.
I see people of legit talent from doctors, to chemists and musicians dedicate themselves to posting content. What people don’t understand is survivor bias. For every success story you read about, how many people are going in reverse and not experiencing social mobility (and get depressed from it).
>> 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.
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)
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.
> Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even.
Least problematic is too strong of wording. Consistent opioid use will take a large toll on the body and mind. A therapeutic level of dosing could possibly be better than severe chronic pain depending on the situation, but even chronic pain patients have to deal with a range of negatives and side effects that are only tolerable because they’re less bad than their severe chronic pain.
Chronic opioid use induces a lot of changes in the body and mind. The initial euphoria isn’t sustainable, as everyone knows, but long term use induces even further changes that predispose users to deeper depression and can even begin to augment pain signals.
Opioids are in a class of drugs that are unusually deceptive because users who more or less control their dosing will talk themselves into thinking they can do this forever without real negatives. They can go for years before the cumulative negatives become too obvious to ignore.
For addicts deep in cycles of rehab-relapse extremes, going to a maintenance program and achieving stability is definitely better than continuing the cycle indefinitely. However it comes with a high price relative to sobriety. I think it’s important to not downplay the effects of being on opioids for years and years.
Your response reads like status quo par for the course.
The same thinking that fueled the "Just Say No" and "this is your brain on drug's" campaigns in the 80s/90s. Because we all know that cutting off access via stone cold sobriety and absolute illegality under the law is the right solution.
Straw man response. I didn’t say anything about that.
I’m trying to counter the idea that a consistent heroin dependence is the “least bad substance” when there are clearly numerous drugs that are much less toxic over the long term.
I said nothing about best techniques for dealing with people who have addictions. My goal is to avoid having being read these comments and think that because they’re smarter they’ll be able to handle and benefit from a stable opioid dependence. It’s exactly how one of my friends got started
The comment was about heroin. Were you offered heroin?
Is cocaine and marijuana available from the government too? If not, what relevance is your comment?
Was this the first and only time you were waiting at a bus stop in Switzerland? If so, perhaps a notable story, if not then we'll need more information to conclude how bad this thug problem really is in Switzerland.
Langstrasse is as close to a red-light district as you'll find in Zurich.
It's gotten a lot better over the last couple of years, but stating that you were offered drugs there is like being offended that you walked past a casino in Vegas.
Lmao as a kiwi living in UK it's definitely a bad thing. Can't go on a night out in London without half dozen dudes trying to sell you coke. Same dudes who are waiting in alleys waiting to mug people when they get the chance.
If you ever see >1 person just standing around and not walking somewhere in London early in the morning just stay the fuck away from them. And if they start heading your way, run.
I know how annoying this can be, especially in some countries this behaviour is often directly associated with criminality. Here in Switzerland dealers are often (not always) just that, they make enough to not bother with anything else. They don't look like "dirty" junkies, they don't bother stealing from tourists, they basically don't look for any extra attention when the business is rolling anyway.
Survival bias: the police would come down on them on hard if they were scene as disrupting social order. They have to not look dirty to survive, Swiss police are no joke.
Been mugged twice in London, police weren't interested at all, even with the one where I was assaulted pretty bad.
Got my car totalled on the m40 by a teen with a license of 6 months who was clearly on his phone - that one I was for sure lucky, could've easily been the end of me. The police? Didn't even show up. My police report that I filled out while still shaking got a response letter of "We don't care m8".
Is it too long, too little or what? Red light districts, official or not are the place to get drugs in european towns. Langstrasse is basically an official place for that, at least the most official Zurich has.
If you think cocaine and marijuana are comparable/interchangeable with heroin, you might want to educate yourself on the topic a bit more before trying to make a quip.
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
Its definitely easier to beat addiction if you aren't living on the street, selling everything you have and are injecting one of the most horrible shit substances but instead you are using a clean, safe alternative that is provided by the state together with prevention programs (which is usually the model for this) - how is it a false dichotomy?
Or are you someone who assumes you just need to "use willpower" and "stop" being an addict?
I assure you its not so easy with opiates.
Hordes of American soldiers were doing heroin in the Vietnam war.
When they came back to America we were expecting a massive addiction epidemic. It never happened. Overall, all the soldiers who came back lost the addiction.
Little known phenomenon about addiction that can’t be fully explained yet. What you say is true, but the person you responded to, what he says has an aspect of the truth as well. Look into it.
> Despite initial fears, high substance abuse rates during the war did not entirely translate to enduring addiction issues post-war. A year after returning home, only 10% of Service members initially detected as drug positive reported using opiates after detoxification, and just 7% reported re-addiction
> VA initially found itself unprepared for the sudden increase in drug cases.
You’re wrong, and the “historical record” you’re citing is actually the same record the NPR piece is summarizing.
What that NPR piece is pointing at is the Lee Robins follow up result that became famous precisely because it violated the folk story of heroin addiction being inevitably chronic. A later review of Robins’ findings summarizes it bluntly:
In Vietnam, high heroin use and dependence. After return, only about 10% tried heroin, and only about 1% became re addicted in the first year.
Now compare that to the VA history page you linked as a “gotcha.” It says the same thing in slightly different numbers:
One year after return, 10% reported opiate use, and 7% reported re addiction.
So no, “not entirely” and “7%” are not a refutation. They are the punchline.
You can argue about whether it is 1% or 7%, depending on definitions and measurement, but the qualitative point survives trivially: it was nowhere near the relapse pattern people expected for heroin addiction, which is why NPR is telling the story in the first place.
Your OUP line about some vets shifting to other drugs is also not the contradiction you think it is. “Some people continued using substances” does not falsify “heroin dependence largely remitted when the environment changed.” Those are different claims. If anything, substitution strengthens the “context and cues matter” thesis, because it implies the Vietnam setting was uniquely good at sustaining heroin use, not that heroin had permanently rewired everyone’s brain.
Also, “VA was unprepared” is about bureaucracy, not epidemiology. The VA being behind the curve tells you the system wasn’t ready for the volume of cases showing up at the door, not that “everyone stayed addicted forever.”
If you want to be precise, the correct statement is:
Most soldiers who were using heroin in Vietnam did not remain heroin addicted after returning home, and relapse was low relative to expectations, which is exactly why this became a canonical example in the first place.
lol what? My dad was in Vietnam, came back with drug/alcohol problems that he never shook. Whatever study/phenom you are referring to, I imagine is inflated or misrepresented. Think about culture in the late 70s and 80s, that alone debunks this...
There is also very often a psychological aspect, which explains why some addicts are able to stop "cold turkey" if the psychological/contextual aspect of their addiction changes.
Oh for sure, I agree with that. Like smokers and the habit of touching something to the lips, inhaling. But at its core it's still a chemical dependency.
Usually the fastest and most effective way out of an addiction is medication assisted treatment, which means having a doctor control your dosage with a clean supply of the drug or a less addictive substitute that targets the same receptors.
More often than not, there isn't. Your brain chemistry is just messed up and dependent on the drug. Ask any ex-addict about their cravings.
The ones who manage to make it out, usually have something to live for (and the will to live for it), but a lot of people have no money, no job, no career, no family, no spouse, no kids, and no good memories of life, and even if they did, there's no guarantee they'll beat the substance. Sadly for these people, it's very likely they won't see a way out of addiction.
The consensus is that "hitting rock bottom" is the only way to help an addict. But many hit rock bottom and never get up again, or don't have anything to climb for.
The problem is not the opioids themselves as a chemical. They are tolerated well and have minimal side effects. The main issue is that street opioids are of uncertain purity, and cut with toxic chemicals. This causes overdoses when a batch is too strong, and various health issues from the harsh toxins.
A properly managed opioid addiction can be permanent. For a decade millions of Americans were addicted to opioids (OxyContin, Vicodin, etc.) prescribed by doctors. When the state cracked down they were forced to go on the street to get their medicine, which is when the opioid crisis exploded
That's completely counter to the very well-researched and reported, and proven in court, narrative that people suffered greatly from opiod addictions due to those doctor's prescriptions.
And we learned zero from the change after shutting down the Purdues. The electorate just wants to see drug users punished, not treated. Even though treating cheaper, more humane, and has way better outcomes.
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.
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?
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.
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.
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.
To answer my own question: what you described sounds like part of the standard recommended protocol, and it seems likely your friend misunderstood or misrepresented that.
I'll explain with liberal quotes from the document linked below. Dosages start out low to avoid risk to the patient, because "the most common reason for death or non-fatal overdose from methadone treatment is overly aggressive prescribing/dose-titration during the first two weeks of treatment."
Because of this, "methadone induction and titration MUST be approached slowly and cautiously. It may take several weeks to address opioid withdrawal
effectively. It is important to be upfront with patients about this requirement and to discuss ways to cope with ongoing withdrawal and cravings, to maintain engagement in treatment."
The dose increase is described in the following paragraph:
"...methadone can be initiated without the prerequisite presence of opioid withdrawal. This may be preferential for some patients. The patient’s dose should be titrated with a “start low and go slow” approach, based on regular clinical assessment, until initial dose stability is reached – see specific recommendations below. A stable dose is achieved when opioid withdrawal is eliminated or adequately suppressed for 24 hours to allow patients to further engage in ongoing medical and psychosocial treatment. The ultimate goal is to work toward clinical stability."
In other words, for patients who are continuing to take other opioids, the methadone dose is increased over time to make it easier for the patient to reduce that other intake. Dosage is based on interviews with the patient.
Addicts are very good at subconsciously coming up with rationales for remaining addicted. It's much more likely that your friend found himself in that trap, than that he was going to an unethical clinic trying to keep him addicted "forever". That would be a major violation of the law and breach of medical ethics, and would be likely to come to the attention of regulators if it was a recurring pattern.
> They literally would not allow the patient to wean off of it
If true that clinic needs to be reported. Patients have a right to taper down and exit treatment.
When a patient enters treatment at an OTP (Methadone clinic) they start with a small initial dose that is increased over the initial 30-60 days of treatment. Some clinics do this somewhat aggressively because they are trying to get the patient up to a "protective" dose. Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.
So that maybe why the clinic was firm about trying to increase you friends dose.
OTPs are also required to offer counseling, the idea being methodone is used to address the physical aspects of addiction, and counseling is use to address the psychological/emotional side of addiction. Help patients build coping skills, figuring out what their triggers are, and find ways to stay out of those situations, etc. Some patients are instrested in that and eventually getting off of Methadone, some aren't. Some clinics provide really great counseling, some don't. The "dose and go" clinics are definitely a problem in the industry.
> Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.
How does this work? Naively, I'd expect addicts to up the dose of the "other substances" if they can't reach their high. Or does methadone outright "block" the other substances' effects?
It's possible my friend wasn't telling me the whole story or just misunderstood the program. I don't think he was actually trying to stay addicted though because after a few weeks on methadone (with increasing doses and doctors telling him that he would always be an addict for life) he decided to take the more extreme route of getting clean by quitting cold turkey. He moved to a different state and cut ties with every possible source he had to acquire the drugs.
And yet, you're comfortable accusing the people trying to cure addicts of some diabolical plot to ensnare them into permeant addiction in order to make money off them forever. Maybe next time you'll think before you propagate nonsense.
I still think that this was a shady clinic. Why would they have people on the program for many years and give them ridiculous doses instead of weaning them off of the program?
This is certainly possible, but it sounds more like what AA tells its clients. Doctors are less likely to say things like this, because it can have consequences for them.
Going cold turkey like you're saying he did is fine if (1) it doesn't kill you and (2) you're able to do it. For many people, it's just not very practical.
I don't think it's a good idea to demonize medical professionals for doing their jobs to the best of their abilities in the face of enormous challenges. That's the kind of thing that the conspiracy theorist and anti-science Robert F. Kennedy Jr. does, and it's not helping the US in any way at all.
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.
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.
In Switzerland there is state grown heroin because it should be even less quality of life inferencing than most other alternatives. They do this for a long while now and it works, most people have jobs and you couldn't tell they get daily heroin in the best quality you could imagine (for free)
Dude, caffeine ain't no heroin. I drink 2-3 coffees a day and skipping this (ie traveling on vacation, easily for a week or two) does 0 to my body, mind or sleep. I just don't feel the effect at all, I drink it purely for the taste.
There is no human in this world who could say something similar about heroin.
Sure, but your case is 1. There are many people addicted to caffeine, and it did affect their sleep and mind. (Writing this sipping my mandatory coffee :)
If people were aware in how many ways caffeine messes up a lot of people there would be. Exhaustion, migranes, anxieties, twitching, insomnia, mental issues to name a few. Most never attributed to caffeine but mysteriously going away after a person manges to kick the habit.
Your argument seems to be missing the fact that methadone clinics are serving people with an existing addiction. They didn’t create that addiction, but they can fill the desire created by that addiction in a safe manner.
The ideal situation is the client leverages methadone into a recovery/remission from addiction - but that can be incredibly hard for them to do.
If someone is addicted to ice cream, and the most effective treatment is to replace that addiction with spinach(scientifically supported), would anyone have this problem? I doubt it. People’s knee jerk reaction to any kind of “”””drug enabling”””” treatment is infuriating.
I know multiple people personally who have had their life saved by methadone. Yes that makes me biased but it also justifies the bias (alongside the many medical professionals advocating for it)
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.
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.
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"
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.
I rarely take taxis, the exception is when I have to haul my gear to the studio for a jam session. I always take a taxi, because it’s cheaper and faster than using an app to call an uber.
On 80% of the trips, I end up having a nice chat with the driver and learn something new about humanity or myself.
I really enjoy these interactions, but I feel for the drivers, it’s a very tough job where most taxi drivers have to scramble to find places to urinate or do so in an empty bottle between their legs. There is not much dignity in the job. I feel a negligible segment enjoy it as a reliable career.
I wonder what will happen to the drivers if a large representation of the 1 million+ daily trips are displaced by automation?
reply