The Opioid Epidemic and the Face of Long-Term Unemployment

UserFriendly flagged a must-read story at Bloomberg, This Is the New Face of American Unemployment. It seeks to give a better picture of long-term un and underemployment through five profiles, each chosen to illustrate a widely-reported impediment: low mobility, criminal records, disability, labor shortage, and “mature workers”.

However, when you read the stories carefully, they actually depict two overarching problems: discrimination and the far-ranging impact of the opioid epidemic.

And separately, the story has buried in it a factoid that indicts the performance of our ruling classes: “Nearly half of U.S. children now have at least one parent with a criminal record.”

The most gripping story is the first, that of Tyler Moore of Mingo, West Virginia, who is meant to stand as the poster child of “low mobility”. But the reason it would be better if he could get out of Mingo is that the town and area are collapsing due to the closure of coal mines, which had been the anchors of the economy.

And it isn’t that Moore is not willing to go, even though he would prefer to remain near his aging father. It’s that the only thing that has kept him alive is family and community safety nets.

Even though the story doesn’t dwell on it, it is not hard to discern that Mingo is awash in drugs and despair. From Bloomberg:

The 23-year-old had run out of options. He’d applied for dozens of jobs within an hour and a half of his hometown of Lovely, once a coal-mining stronghold. Instead of opportunities, he had found waiting lists.

“Minimum-wage jobs, fast-food restaurants, Wal-Mart, anything like that, a lot of them has already been took,” he says in an Appalachian drawl, explaining that the backlog just to interview was as long as a year. “There are no jobs.”..

His problems started in earnest in 2014. He had been living on his own for several years, having moved out at 18 after dropping out of high school, obtaining his GED, and going to work in security at a coal company. Moore is gay in an intensely conservative region, and he said he left school because of bullying.

Moore lost his job in late 2013 after smoking marijuana and failing a drug test. Though he found temporary work as a remote customer service representative, he lost that one when his mother died of a drug overdose in 2014 and he had to plan her funeral.

Deeply depressed and unemployed, he moved into an old Airstream camper propped on cinder blocks behind his father’s house, at the entrance to the litter-strewn trailer park that the older man owns in the misty hills of Lovely. There, surrounded by long-unemployed neighbors and rampant drug use, Moore began to abuse his medical prescriptions. “I guess I used it as my crutch, in a way,” he says…

Moore began getting in fights while drugged and was arrested twice. When he landed in jail for several months, he realized things needed to change. He graduated from a rehabilitation program in September, one year, one month, and 15 days after that last altercation. Since then, he’s deepened his friendship with Sister Therese Carew, a Catholic nun who ministers to the region, and dedicated his time to job seeking…

To employers outside the area, the fact that Moore is neatly groomed, soft-spoken, and polite can’t mask his history. What’s more, he’s the first to admit that the math skills he learned in the local public schools—where only eight in 10 students graduate—aren’t up to par, and his speaking patterns are colored by regional grammar.

“Colored by regional grammar” is a polite way of saying, “is indelibly from the wrong side of the tracks and therefore won’t even be considered for most customer-facing jobs.” Class was also key to his decline. How many middle and upper middle class people regularly smoke marijuana, use cocaine, and abuse prescription drugs like Adderall or Valium with no career consequences?

As Nobel Prize winner James Heckman has found, a GED isn’t equivalent to a high school diploma. GED holders do worse in terms of lifetime earning that high school graduates. Heckman posits that the socialization of going to class makes a difference in being able to hold jobs.

The second profile, of David Wolf, is another case of past drug use (Oxycontin, Percocet, and Vicodin, which he started taking after a car accident) making it well-nigh impossible to find work:

In 2012, Wolf was convicted of faking a name and Social Security number to get prescription painkillers. Now the 40-year-old father of three and former Marine, who has an associate’s degree from St. Petersburg College, has struggled to find employment. He’s received so many retracted offers that he’s lost count.

“I get more interviews that I can shake my stick at, but again, it always comes back around to the denominator of being a felon,” Wolf says from his small, one-level ranch house in a Tampa, Fla., suburb, where religious imagery and family photos decorate his walls. “For many, many years, I pretty much got whatever job I wanted. I was able to do anything I felt like doing. It’s really been a humbling experience.”…

“They wouldn’t even hire me to sell Christmas trees at a Home Depot through an employment agency,” he says. “A lot of times the hiring managers feel like they have their hands tied, due to company policy. It’s something that really needs to change. Not only can I not get a job, but I can’t get a job with a living wage for my family. I have three children. I have a wife. I’m not a bad guy.”

The employer who can’t find enough workers says it’s more a problem of drug use than skills:

At a 200-foot-long steel-rolling machine in Scottdale, Pa., two workers in yellow hard hats monitor screens filled with flashing numbers as they refine rough wire into pencil-thick rod calibrated to a thousandth of a millimeter. This work takes years of training, and MLP Steel Chief Executive Officer Jeff Pfeifer struggles to find employees to fill the job.

Years ago, he spoke on local radio news about the shortage of skilled workers, bringing a line of 100 job seekers to his gravel parking lot.

“Two-thirds of people who came in to interview failed the drug test,” Pfeifer says, shaking his head. The company had to pay to test the applicants, so “it got to be a very expensive radio show.”…

“We’re not out there with shovels and coal anymore,” Pfeifer says. “We’ll just about hire anybody that we can get our hands on if the person comes in drug-free and they show up for work on time.”

The complicated jobs, which pay $12 to $20 an hour, plus health care and benefits, require sober workers. Sitting in his office behind a wide wooden desk strewn with manila folders and steel samples, Pfeifer explains that his company has a zero tolerance policy: If you’re using drugs, you’re out.

Readers who know the area please pipe up and tell me whether the wages are competitive; the fact that it includes health care, that MLP is willing to train, and has lots of applicants show up says it might be. But I’d be curious to know if he’s still offering too little for what he expects (as in if the de facto requirements are harder than just being clean and reliable).

The other two examples, also worth reading in full, are of an artist with cerebral palsy and a former senior tech worker over 55, neither of whom have been able to find work. As one reader pointed out over the weekend, while sexual and ethnic discrimination are policed to a fair degree, age discrimination is treated as perfectly acceptable.

The bigger point is that neoliberalism treats individuals as able to make their own way, when people are products of their families and communities. And we have entire sections of the country being laid waste by the combination of economic distress, poor education, weak social safety nets, and despair. And regulatory neglect made a bad situation vastly worse. This damage greatly compounded by Purdue Pharma, the maker of OxyContin, targeting less well educated doctors in areas with a lot of manual workers who would suffer from accidents and long-term orthopedic pain. On top of that, Purdue sold what was an alleged longer-term formulation, and when patients would report pain when the dose ran out after 8 hours, the MDs would be told to increase the dosage. From the Los Angeles Times:

The drugmaker Purdue Pharma launched OxyContin two decades ago with a bold marketing claim: One dose relieves pain for 12 hours, more than twice as long as generic medications….

On the strength of that promise, OxyContin became America’s bestselling painkiller, and Purdue reaped $31 billion in revenue.

But OxyContin’s stunning success masked a fundamental problem: The drug wears off hours early in many people, a Los Angeles Times investigation found. OxyContin is a chemical cousin of heroin, and when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug….

The Times investigation, based on thousands of pages of confidential Purdue documents and other records, found that:

• Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief.

•  Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.

• The company has held fast to the claim of 12-hour relief, in part to protect its revenue. OxyContin’s market dominance and its high price — up to hundreds of dollars per bottle — hinge on its 12-hour duration. Without that, it offers little advantage over less expensive painkillers.

• When many doctors began prescribing OxyContin at shorter intervals in the late 1990s, Purdue executives mobilized hundreds of sales reps to “refocus” physicians on 12-hour dosing. Anything shorter “needs to be nipped in the bud. NOW!!” one manager wrote to her staff.

• Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn’t last 12 hours. That approach creates risks of its own. Research shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death.

• More than half of long-term OxyContin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times…

Experts said that when there are gaps in the effect of a narcotic like OxyContin, patients can suffer body aches, nausea, anxiety and other symptoms of withdrawal. When the agony is relieved by the next dose, it creates a cycle of pain and euphoria that fosters addiction, they said.

OxyContin taken at 12-hour intervals could be “the perfect recipe for addiction,” said Theodore J. Cicero, a neuropharmacologist at the Washington University School of Medicine in St. Louis and a leading researcher on how opioids affect the brain.

This story ran in early May last year. Was there a Congressional hearing? Were any efforts taken to attempt to curb this abuse? Could the failure to act have anything to do with the fact that the Sackler family, which owns Purdue Pharma, has been a very large donor to medical schools and art museums?

The key is that the ravaging of swathes of rural America wasn’t simply the result of economic misfortune. Sustained looting in the form of being targeted by a predatory opioid producer made a bad situation vastly worse. And the coastal elites call the victims deplorables when that label fits much more properly on the Sacklers and the experts that helped them perfect their lucrative strip-mining of working class communities.

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  1. Moneta

    A complicated job at 20$ an hour? Still can’t have an easy life with those wages… therefore higher chance of dependency.

    The thing is that there is a point of no return… then it comes down to helping the children which is hard when the parents are ostracized. Depressing.

    1. Anonymous

      $20.59 an hour is the average wage at the Boeing plant in SC. For their (unionized) plant in Everett, WA, it’s $30.67 an hour, and will rise to $32.05 an hour in September. (Given the difference in the cost of living in WA, vs. low country SC, and the fact that union dues would undoubtedly come out of wages, it’s no surprise that workers in SC voted overwhelmingly against a union last week.) My point is that $20 an hour is not terrible, especially if you get benefits. And it is quite close to the wages offered at America’s premier manufacturers. I would say that the average college professor in Ameica makes less than that.

      1. Uahsenaa


        I’m sure the union vote had nothing to do with the piles of cash Boeing spent on TV ads or the not-so-veiled threat to offshore jobs to China if they unionized.

        Boeing also held meetings with management and suggested that organizing could lead to jobs being offshored to China. Postcards depicting an empty facility and piles of household products representing the cost of union dues were also used.

        Union representation increases wages across the board, regardless of cost of living, which is always relative anyway. Not to mention union dues nowadays are a pittance. If unions weren’t effective at improving conditions for labor, management wouldn’t spend so much time and money trying to suppress them.

        The IAM knew full well that unionizing in SC was a long shot, given how profoundly hostile the state and its government has been to trade unionism over the years.

      2. Moneta

        In this case, I don’t care about comparisons. I care about absolutes. And less than 20$ per hour is absolutely a hard way to support a family or enjoy many perks

        1. Stelios Theoharidis

          I think it is an expression of our optimism when someone says $12 to $20 an hour, that everyone immediately quotes $20 an hour. No one is going to get the $20 off the bat. It is more likely that starting salaries are $12 and $20 being supervisory salaries that they may receive after 10 years of employment.

      3. Penny

        A college professor in the US who is working full time (either tenured on on a tenure track) has an annual income ranging from $40,000 to $120,000 for a 9 month year for relatively junior members of academic staff to twice (at both ends) that for established members of staff. A big range. It also assumes summer wages are separate. Not everyone works the summer term. Assuming the standard schedule of 1 month vacation plus 8 months of work, we have 40 hours per week (8 x 4.3weeks per month x 40 hours per week) = 1376 hours of work or about $30 per hour for newly minted Phd’s and $60 for tenured in subjects like social work; at the high end, new hires earn $90 per hour and once tenured, twice that or $180. In actual fact, the work rhythm is entirely different and these hourly estimates are a bit misleading because there is little uniformity across disciplines and types of institutions of higher learning. However, it does illustrate the weakness of such a comparison . More relevant is the fact that in 1970, steel workers earned (on average) more than those starting out in a university career. Moreover, when adjusted for inflation, steel workers earned, in today’s money, closer to $80/ hour; much more than they do today.

        1. Felix_47

          As a union construction laborer in 1963…….I made 4.25 per hour and they had to fund the union pension system and provide health care on top. This was in the New York area which obviously was the top of the pay pyramid. Now the same work pays 9 or 10 per hour to an undocumented immigrant. The health benefits are now provided to the laborer’s family by Medicaid and schooling and food stamps. I would guess the cost to the Federal government of a non union undocumented laborer now is greater than what the employers are paying. If you add up the benefits and health coverage to their partners and children it has to be more than 10 per hour. In those days the unions were strong. No one would ever cross a picket line. When construction went down everything stopped. When the teamsters struck…..nothing moved. In those days if someone broke a picket line they were putting their life at risk. Everyone knew the pay and benefits had been bought with blood. Overall though the taxpayer was getting a good deal. Laborers could raise a family, buy a car, and live a decent life without government support. Many of the guys I worked with were native blacks. Our undocumented immigrants can’t do that. Overall though the quality of construction is a lot better now……..because labor is so cheap……and there is less drinking beer on the job on a boiling hot Friday with the empty cans cemented into the masonry……probably a roach attraction..

    2. PJ

      $20/hour in Scottsdale PA is almost certainly reasonable pay, especially for a non-college graduate.

      That’s roughly what I make in Pittsburgh, and I have a relatively low $250/month student loan payment coming out of my take home every month.

      $12, probably not so much, but still livable if you don’t have a family.

      1. JP

        I left the Pgh. region for NW Indiana, where compensation is approximately 40℅ higher and living expenses lower (example: fuel, $.50 per-gal. cheaper) than PA.

        My starting wage of approximately $25 per hour (top at $39) is a very far cry from what is considered “competitive,” $12-20, for an industrial technician for the position in Scottsdale cited by the author.

        I’d love to move back because the Pittsburgh region can be quite beautiful with great opportunities for recreation, but I have a kid to support and hopefully a retirement to plan for.

        If you consider that each $1 an hour is $2k a year, well, see where the math takes you

        1. Ultrapope

          Completely agree, $20/hour in Scottdale is good pay, even more so considering its for a non-college grad. I also live and work in PGH, earning about 15/hr as a research assistant with only 170/mo student loan repayment. I would also like to reiterate what JP said: compensation is low in this region of PA in comparison to other regions in the country and living expenses over the past 8 years have climbed rapidly.

          In regards to Westmoreland County in general, there are two other factors in addition to opioids that affect the area: extreme weather and ancient infrastructure. Westmoreland Country gets alot of tornadoes, hail, and flooding ( Unsurprisingly, it has been getting worse over the years, especially with flooding. Local News reports on road floodings, bridge damage, fires, etc. on a near daily basis. These roads, bridges and houses always look to be >50 years old and the ‘repairs’ made on them wouldnt be considered adequate for even temporary fixes.

          One interesting side note: most individuals in westmoreland county are registered Democrats. However, the county’s voting record in presidential elections swung from consistently Democrat to consistently Republican in 2000.

      2. Watermelonpunch

        I’m betting the jobs he can’t fill are the 12/hr jobs in rough working conditions. They pay CNC machinists that some places here in ne Pennsylvania and then wonder why trained CNC machinists go work in landscaping. This is what I’ve heard for years from skilled laborers. The work environment can be worth a pay cut but often qualified people can do better in both pay and work environment.

        Could very well be that you’d have to be on drugs to want that job at that pay!

  2. Moneta

    Discrimination and underemployment go hand in hand as that’s how groups protect their turf. Then just convince everyone they deserve their lot in life and voilà, iron clad.

  3. timotheus

    Knowing this makes it hard to file into one of the Sackler galleries. Then again, the welcoming wall at the Met lists Altria (Philip Morris) as a major donor, and the main NY Public Library trumpets Mr Schwartzman’s largesse, so I guess there’s a long tradition of burnishing one’s image as an art patron after amassing a fortune on the dead bodies of workers.

    1. Colonel Smithers

      The galleries often have private evenings / viewings arranged by firms and / or their lobbyists. Politicians (and regulators) are invited. I have attended such evenings at the Royal Academy.

    2. Colonel Smithers

      Was Steven Schwartzman’s donation to the library as much as what he spent on his birthday? Does Patti Labelle serenade visitors?

  4. BeliTsari

    HMMmm… Papaver bracteatum, Iran, Thebaine, Purdue Pharma, pill-mills, EZ Credit, PayCheck Loans…

    seems impossible for the small investor to cash in on my people’s decades-old nightmare? Just like Heroin?

  5. Colonel Smithers

    Thank you, Yves.

    The situation is similar in the UK, even in “True Blue” (as in Tory) and seemingly well to do Buckinghamshire.

  6. Colonel Smithers

    I forgot to add that the Sacklers, like so many magnates before them, have sought to “put mascara”, to use a Brazilian friend’s phrase, on their fortune by funding, amongst other things, art galleries, including in London.

    I am staying near the Honore de Balzac statue on Avenue Friedland in Paris. He analysed such matters well.

  7. John

    Do I have this correct? Pushing heroin in small quantities is a felony. Pushing oxycontin in huge quantities is just good business. Heroin and oxycontin are both addictive. Selling the first sends you to prison. Selling the second sends you to your gallery opening.

    1. Colonel Smithers

      Thank you, John.

      In the 19th century, the opium dealers set up banks and bought estates in Scotland and titles / peerages. Their descendants, after Queen Mum’s marriage into the Saxe-Coburgs, became related to these German immigrants.

      I imagine that it will be the same for the descendants of ex USSR oligarchs, Mobutu, dos Santos, Bongo, Obiang and Escobar.

    2. Marc b.

      See below re: paradoxical problem of pain management schemes, which were part of the Sackler PR vice. Physicians were given ratings by a body funded by the Sacklers, ratings being based on how aggressively the doctors treated pain. This was the genesis of the whole pain management meme in the 90s.

      “Led by CU-Boulder Assistant Research Professor Peter Grace and Distinguished Professor Linda Watkins, the study showed that just a few days of morphine treatment caused chronic pain that went on for several months by exacerbating the release of pain signals from specific immune cells in the spinal cord. The results suggest that the recent escalation of opioid prescriptions in humans may be a contributor to chronic pain, said Grace.”

      1. susan the other

        Very interesting Marc. There must be something so beneficial about pain signals that they get “stored” for later use. Specific immune cells in the spinal cord? Specific to nerve pain, physical injury. So opioids just mask them… Must wonder about emotional pain also being stored.

        1. Dave

          In 2006 I herniated 3 discs in my back with 2 tears and have permanent nerve damage(at work). After 2 years of doctors visits and fighting my employer in court I won a settlement. During this time I was on percocet. Every 4 hours the pain would hit and I would take a pill. After settling the case the doctor said your time with me is done and gave me one last scrip. I cut the pills in half and they finally ran out. The pain was coming every 4 hours as I was on my last pills and I thought boy I am screwed.

          A week after the pills ran out the pain stopped. I realized then that I was addicted, my body triggered a pain response to get the reward of a percocet.

          To this day I have mostly good days, every once in a while the back will go out and I treat with motrin, heat packs and rest.

          I am one of the lucky ones.

        2. marc b.

          susan, there have also been studies involving the use of beta blockers (e.g propranolol) to ‘erase’ painful memories, including the potential treatment of PTSD for vets. setting aside the cultural implications of erasing an important part of the historical record, studies have shown that the loss of the memory of a traumatic event can actually impede recovery. so in both cases the medication intended to suppress pain in reality prolongs the pain.

      2. Wade Riddick

        Morphine activates NFKB and can accelerate certain viral infections like hepatitis.

        The microglia inhibitor, minocycline, has had some success in animal models limiting tolerance and addiction [PMID 25276817]. A DRD2 antagonist might also help [PMID 28004735]. Blocking TLR4 (e.g., naltrexone or GLP-1) or the beta-arrestin/GSK-3beta complex (e.g., lithium), might also reset this circuit.

  8. russell1200

    $12 to $20 so call it $24,000 to $40,000 annual.

    People would want them in Central North Carolina. The pay isn’t great, but the cost of living would help a lot. The problem is that there is just too many people trying to fill these jobs. And drugs would be a big issue but a good number of people, particularly folks who have been to college, are fairly good at scamming drug tests. Only hair samples are hard to spoof.

    1. funemployed

      Wonder which drugs they test for. In order of person I’d least like to be operating the machine next to me: 1) opiod addict going through withdrawal or high, 2) person who drinks a 12 pack every night, 3) person with serious insomnia, 4) person who just had fight with spouse, 5) person who forgot to eat breakfast, 6) person who spaces out periodically for whatever reason, 7) person who smokes a joint after work to relax.

      Some of the healthiest, most competent people I’ve ever met smoke near daily, yet here in the midwest, apparently smoking pot recreationally in your own time disqualifies you from the vital task of stocking shelves and helping customers at Kroger (our regionally dominant grocery chain) (both tasks, IMO, that weed would make more pleasant and effective with minimal customer risk).

      1. Art Eclectic

        Exactly. The drug test is the problem and going to continue to be a problem as more and more states legalize. Instead of testing for drugs, they’d do better to test people at the actual skills they’re to be performing. Someone who can’t do the job won’t be able to do it clean or not.

        1. polecat

          Ok .. lets start a pilot program on skills testing …… starting with CONgress !

          … and while we’re at it test all members to see what drugs they AREN’T on ….

      2. roxan

        Which drugs? That’s easy–go to your drug store and read the package of the strip tests for drugs. I had to perform those tests now and then and that’s all I did–stick a cheap test strip in the bottle out-of-sight of the patient. That’s what employers usually use. Grass stays in your system several weeks; benzos maybe a week or more depending on which one; actual opiates, not even 24 hrs.

        Most people are caught for ‘opioids’ (no such drug class exists actually it’s made-up) of various sorts which may have a longer half-life. Classed in there are now muscle anti-spastic drugs and even some anti-emetics, which means actual sick people can’t get them.

        BYW urine is just water and…there is no difference between animal urine and human. I substituted cat urine a few times, since I don’t have dogs but collecting it was not easy.

        Just more proof the evil and oppressive Drug War needs to end! Why should anyone be subjected to piss tests and background checks for minimum wage jobs that require zero skills?

        1. roxan

          As an addendum–I can tell you from personal experience, even home typing jobs require drug tests! Also, people seem to forget there was plenty of drug use long before anyone came up with the idea of drug testing employees and I don’t recall hearing of A. a lot of unemployment B. disasters due to stoned employees.

      3. mirjonray

        My dad was amazed when his management training courses in the 1970’s taught him that he was not allowed to mention alcohol, drug use, etc. to any of his employees. Instead of telling someone “I’m writing you up because this is the second time this week you showed up drunk”, he would instead have to say something like “I’m writing you up because this is the second time this week you showed up late for work. Also, your co-workers have to put in extra time because you aren’t meeting your production targets.” That advice seems pretty quaint now.

        As a result, alcohol and drug use was pretty much ignored unless it affected work.performance. Knowing this I was surprised when drug testing as a condition for employment started taking hold in the 1980’s.

    2. nipsip

      One of the problems of hourly wage employees (in rural areas), I will use Fred Myer as an example. Lots of part time jobs, all under 30 hours a week, good pay, however, slots remain open because of drug testing.
      There are 78MM Americans who work in hourly wage jobs with little or no job protection, retirement, or employer-sponsored health care insurance. Failing a drug test or having a criminal record assures the applicant they need to keep on looking.

  9. Pogonip

    I can see why our moral and intellectual betters are so desperate to keep a perpetual war going. They want these men safely out of the country before the men wake up and realize who their real enemy is.

    I guess this also explains their hatred of Vladimir Putin, a class traitor who persists in doing his job, looking out for the welfare of Mother Russia, even the Russian equivalent of Deplorables.

  10. animalogic

    What an ugly situation.
    Pity the poor, the less than beautiful in the US, they are a rag upon which the rich, the respectable may wipe their arse with.
    Firstly, drug testing: in the MANY jobs, is a nasty invasion of privacy: if a person turns up on time, does their job properly, it’s no one’s business what is in their blood — especially what was there years ago.
    Of course this emphasis on “drugs !”(tm) is a great way of keeping a boot on the throats of the lower orders — also a great way of demonstrating Christian vengeance.
    And after all — fuck them ! Open borders, floods of desperate immigrants — we DON’T NEED THEM !
    This is why we have a veritable penal culture in the US: the inevitability of prison means there is NO escape from the SIN of being poor, ill educated & desperate.
    And the most beautiful symmetry ? WE — the “good”, the respectable can make BILLIONS from exploiting their innate weaknesses !
    Truly, we of corporate America — we do god’s work . Like the good Shepard we care for our flock.
    (At this point, this commentator leans over…& spews on his own shoes….)

    1. Art Eclectic

      Drug testing and education requirements have take the place of religious discrimination, gender discrimination, and marital status discrimination.

      Every decent paying job today REQUIRES a college diploma as a way of screening out those who didn’t come from middle class families.

      “Colored by regional grammar” is indeed another screening mechanism. Class is crucially important since middle class people want to work with other middle class people. That goes for a kid from Compton CA as much as for kid from West Virginia. Speech is a giveaway to class. Dress and mannerisms are a giveaway to class. Someone who wants to climb the ladder from a non-class-approved background needs to conquer both of those things.

  11. nathan riley

    The origin of the heroin epidemic (and it’s only an epidemic because American hostility to drug use elevates the number of users dying of accidental overdoses) isn’t solely Purdue’s fault. Sensible clear headed adults made the decision to use its painkillers to get high. Drug use occurs among friends, and we can be certain that most users either moderated their use or stop using it. So we don’t know why this use escalated, but we should at least credit these people with some sense that the drug satisfied a need. We can be certain that cutting off the supply of Oxy made by Purdue hurt the lives of users and we know that opioid overdose deaths have increased as the supply of pharmaceutical quality opioids with uniform doses was curtailed. Facing similar problems about 20 years ago, Swiss voters authorized the government to give heroin addicts their drug of choice. About a 1000 users are on this program, and the majority enjoy stable lives maintaining relationships and employment. Other heroins user have access to methadone and Buprenorphine which control the highs associated with heroin. Meanwhile sensible innovations that are used all over the world like safe-injection facilities where users buy their drugs on the streets and then inject them with a nurse or physician assistant present are forbidden. This drug problem like all other stems from The American Disease: Prohibition.

    1. Clive

      Have you any relevant experience or expertise in the area of addiction treatment?

      Most people are exposed to potentially addictive agents at some point in their lives. But only a subset of those exposed go on to become addicted. Genetic, cultural and economic factors have strong evidence to support direct causal links.

      Purdue manufactures a product whose active ingredient is a known narcotic. It markets that product in communities with economic factors that are addict-o-genic. The formulation of the product makes it more susceptible to abuse. Under no circumstances should they be let off the hook.

      1. Harry

        I often wonder what Perdue’ s marketing files must look like. For some reason I can imagine a lot of towns called Springfield, population 5k, which consume 300k doses per year.

        Nothing to see here folk. Move along now….

      2. Art Eclectic

        There is an amazing TED talk on exactly that subject. Johann Hari makes the exact point that if the substance were a problem, everyone who’s ever had surgery or even taken a drink would have become an addict.

        The problem is really despair and not being able to bear to be present in your own life. Solve the despair and the addiction will take care of itself in most cases.

      3. Julie

        It doesn’t appear to me like the poster is letting Purdue “off the hook” rather he is making the important point that the drug war (prohibition) and its accompanying dictum that drugs are horrible and make slaves of people by hijacking their brains is making the problem of addiction worse. Purdue didn’t create the dislocation that people feel when they have no money, no job, no hope and are viewed as sick criminals when they try to get some relief.

        1. Clive

          … isn’t solely Purdue’s fault…

          is letting them off the hook. If you supply and market an addictive substance you absolutely as a minimum have to take reasonable steps to ensure it is not being abused. If you are presented with irrefutable evidence is is being abused, but do nothing or make token gestures then you are culpable. That’s before we get to the reformulation to increase the potential for inducing chemical dependency in those susceptible. This is a “if we don’t, someone else will” logical fallacy.

  12. Clive

    From what I saw when I used to volunteer at a treatment centre, getting off prescription drugs is just as hard — harder even — than getting off street drugs.

    And treating addicts using conventional interventions (psychotherapy, physician-managed tapering, alternatives like methadone) is incredibly costly. That is if the resources are there to staff the treatment programmes. Which there aren’t. Residential programmes especially — often vital to removing the addict from the environment which is addict-o-genic — have stratospheric costs.

    Depressingly — but realistically — most addicts go on to die of their addictions. What eventually led me to stop volunteer work in this field was the realisation that, once addicted, the recovery rate was very low. And, despite the best efforts of funding bodies to determine what I always termed a “consumerist” approach to their supposedly-scientific allocating money to the problem (that somehow they could identify what cash, directed where, would result in the highest recovery rates per £ (or $) “invested”) it was simply impossible to tell for any given addict who would recover and who wouldn’t.

    So, in my opinion, the damage is already done and largely irrevocable. Merely limiting the supply of the most damaging prescription opioids will not resolve the problem of the currently established addiction base. Those who are addicted will need treatment, that treatment is expensive and not especially effective. As so well observed — and we never, ever see real, unvarnished coverage of this subject, as Yves pointed out when critiquing the Bloomberg piece, there’s a lot of window-dressing even in the rare instances where the subject is reported — all we can do now is pick up the (very expensive) pieces. And that assumes our societies will start to tackle the problem of opioid abuse now, which we certainly aren’t doing. So things will get a lot, lot worse before they get better. If, indeed, they ever do.

    1. Jim Haygood

      ‘Merely limiting the supply of the most damaging prescription opioids will not resolve the problem.’

      You could go even farther and assert that limiting the supply of prescription opioids has exacerbated the problem. This is what has happened in the US, as central prescription monitoring cut back the supply from doctor-shopping resellers, and raised the street price of Oxycontin.

      This made the price of black market heroin far cheaper than prescription opioids. But as with any black market product, the potency is unknown and untested, and users are dying like flies from overdoses.

      In the mindless prohibition mentality of the US, relatively harmless painkillers with low abuse potential, such as cannabis, are lumped together in the same Schedule I category as heroin. This grotesque misclassification of cannabis, based solely on the Nixon/Agnew obsession with suppressing the counterculture of 1970, was reviewed again just last year. Once again, the Obama administration punted.

      It’s a blazing signpost of US political and cultural decay that after nearly a half century of failed prohibition based on prison sentences rather than addiction treatment, no plans exist to even hold hearings on alternate approaches which have been successful elsewhere. Annual drug overdose deaths of 47,000 — about the same total as US combat deaths in Vietnam — provoke a shrug of the shoulders among elected representatives … or perhaps a bill to ‘toughen’ the most draconian penal regime on the planet.

      When nearly half of kids have a parent with a criminal record, “failed policy” doesn’t even begin to describe the magnitude of the error.

      1. Clive

        I agree. The kindest — and possibly most effective, certainly no less effective than any other treatment approach and vastly superior to the laissez-faire “solutions” being served up right now — would be to give free prescription opioids to diagnosed addicts along with NA group literature and a schedule of local meetings. Reasonable quality, secure, safe and free accommodation would be a cherry on the top. I suspect the reduced offending would make it cost neutral. And I’d get Purdue to pay for a good chunk of it anyhow.

        1. Aumua

          NA works. It saved my life and I’ve been clean for 6 years. And it’s free! However, it only works if the addict is ready to apply it in their lives, and not everyone is. But if you’re struggling then know that there is hope, and help freely given by those who know better than anyone else what addicts go through.

          This made the price of black market heroin far cheaper than prescription opioids.

          Cheaper, yeah. That’s the way it seems.. until you start to count the hidden costs. It ain’t cheaper, by a long shot.

          1. Clive

            I wonder if you’d go along with me in adding, if anyone has stumbled onto this post (maybe by accident) and is reading these comments who is struggling with opioid dependency then, if they’re a) broke b) desperate and c) sick of being sick of being sick then NA is always worth a try. Like you rightly say, not a cure, not a guarantee and not necessarily for everyone. But I’d rather mention it than have someone in the agony of addiction click away from here in despair that their problems are hopeless.

    2. kareninca

      “What eventually led me to stop volunteer work in this field was the realisation that, once addicted, the recovery rate was very low.”

      I have a relative by marriage – an engineer – who is an addict due to having been treated for terrible back pain that required many surgeries. He is still employed, has committed no crimes, but it has destroyed his marriage (and I don’t blame his wife for divorcing him; she endured it for many years because of their kids). The thing is, he has been in many well-regarded, well-run treatment programs but he can’t quit, despite being desperately motivated to stop. I hope he can continue to work. He is a really fine person; the sort of guy who does all of the most dreary tasks at the family picnic without your noticing that someone has done them. I’m afraid that his experience makes me wonder how often rehab programs succeed.

      I’m afraid we’ll need a “cure” out of a bottle, courtesy of Pharma. No doubt this was their plan.

        1. kareninca

          That is very interesting. I’m afraid that he would never use it in a million years; he is a guilt-ridden rule-bound Catholic, and from what I am seeing Ibogaine is illegal in the U.S. (and at this point he has no money to go to another country; every penny is going to support his kids). Part of the reason he got addicted was that he believed doctors (rather than being utterly cynical)(the other part was the desperate pain he was in). But I will mention it to his mother-in-law just in case; thank you.

        2. different clue

          If Ibogaine is a C1 felony drug in America, the seeker after Ibogaine would have to go to some country, if any, where Ibogaine is legal.

          Unless there is an Ibogaine Underground in Amierica. If Ibogaine works, I should think the authorities would prevent any such underground from existing and reducing their addiction-based revenue streams.

      1. aab

        I don’t know where to put this, so since I entered the thread here, I’m putting it here. It’s sort of a placeholder. I read the original piece this morning, basically haven’t been here all day.

        I personally know someone who died because of the opioid epidemic. She had been previously addicted to other substances, including alcohol. My parents, to whom I am not biologically related, were both alcoholics who sobered up. My mother went to AA after a short stay at a residential treatment center. My father piggybacked on her sobriety. Neither ever drank again until their deaths many decades later, although my mother’s addictive nature got her hooked on Prozac unknowingly for a year or so, but that’s much easier to get off than opiates or alcohol. (It was the same basic issue you see with other prescription medications, where the doctors kept upping the dosage for the nice middle-aged lady and once her addiction was triggered, she started engaging in manipulative drug-seeking behavior without realizing what she was sliding into, because nobody was watching out for addiction issues, because it was Prozac. I was left to figure it out long distance, which wasn’t actually that hard, because if you’ve been raised by alcoholics, alarm bells go off pretty quick.)

        That’s a very long way to offer up a certain amount of lived experience street cred.

        I only read from Clive’s first person observations of volunteering at a treatment center to here. That is all I am responding to. I believe it to be a mistake to draw broad conclusions about addiction from volunteering at a treatment center, for many reasons. First, who gets into a treatment center is a small subset of who is addicted. Alcohol addiction has issues that narcotic addiction does not. Some substances will hook absolutely anybody almost immediately. Others need be abused extensively by someone with a pre-existing mental condition to create a physical addition; that creates not just a different pathway into addiction, but a different pathway back to freedom from addiction.

        We are only now starting to understand alcoholism and addiction. Because the AA/12 Steps system is so entrenched now, in our policing, justice, and health care systems, it’s going to be difficult to take the developing understanding of how to better help more people and put it into practice broadly.

        It’s important to understand that the assumptions of the last 80 years are incorrect, which means that many addicts who might be helped by appropriate treatment have not been helped. The 12 Steps approach helps a small minority of addicts. It helped my mother. I’m aware that there are people for whom it works, and I am grateful that my mother sobered up while I was still living at home. But the assumption has been for quite a while that this is the ONLY approach that works, and if it doesn’t work for you, YOU are unsalvageable. Yet my own family disproves this. My father didn’t do any of the things you’re supposed to do, and his sobriety was, if anything, stronger than my mom’s. He didn’t even break when he was dying of terminal cancer, with her already gone, and nothing to lose. He wouldn’t even take the opiates he was being given to help him with the death process. And he was a very, very serious alcoholic before he stopped.

        This is not directly relevant to the article, or the issue of the opioid epidemic, which has somewhat different addiction and recovery parameters than other types of addiction. And I’m not dying to talk about this in detail here, because I feel like I’m already far too biographically revelatory for an economics blog. But reading multiple people saying it’s impossible to recover and most people will die or be addicted for life is upsetting, because there is a growing body of evidence that that’s simply incorrect. If someone reading this has found AA/NA unhelpful, please don’t despair. There ARE other ways to recover. If the 12 Steps approach helps you, that’s wonderful. But you’re not irredeemable if it doesn’t.

        It is true that to help all the people who have become hooked on Oxy, fentanyl, heroin, etc. due to the drug pushing pharmaceutical companies will cost real money, which our government is unlikely to be willing to allocate. That’s no more or less true than all the soldiers whose lives have been broken by PTSD and other mental as well as physical wounds from participating in war. We now have ways to treat PTSD much more effectively. Our vets suffer not because they can’t be cured, but because our government views them as disposable.

        All those people addicted now could potentially recover. Having said that, even if the government did what was necessary to offer people the full range of treatment options, we still probably wouldn’t get a 100% success rate. The new approaches probably aren’t worked out enough yet to be as effective as they will be later, and all these treatments involve the patient doing a lot of hard work that some people simply can’t or won’t do. But the majority could absolutely recover. I realize that is not what recovery rates are now. But that’s because we don’t fund either enough treatment access or the full range of treatment options.

        I don’t want to see the government let off the hook. There are a lot of people who became physically addicted but do not have an underlying mental wound; that’s totally treatable. But if they are living in a community that has been ripped apart by austerity and offshoring, that makes recovery a much bigger challenge. Because even if you didn’t have a pre-existing addictive mindset, once you’re hooked on something, you have habits and other triggers in addition to the physical feedback loop that need to be reset. That takes time, stability, the social and economic opportunities to build different habits, etc. If you don’t have a job, or your family is economically vulnerable, that makes recovery harder. If the social fabric of the community has been shredded, that makes establishing positive habits and relationships harder. And so on.

        And then we get to something Yves mentioned in the post: that once a non-wealthy person is ensnared by the justice system because of their addiction, it’s almost impossible to get their life back. Again, those added obstacles and stressors which could easily be dealt with if our country cared about its citizens beyond how to exploit them, make a robust recovery much harder.

        But recovery is possible, and not just for the few, but for the many. And every single addict still alive deserves to recover. They are as worthwhile as any other person. My mother literally saved people, both before and after her alcoholism. The person I know who died of an opiate overdose worked in social services, and was apparently amazing at it.

        If the deaths continue, it isn’t because it’s hopeless now to help them. It’s because our ruling class does not care, and we haven’t tamed or toppled it. So it’s on all of us, just like the murder of our black citizens for sport by law enforcement officers, just like all the children growing up in poverty, never knowing what it is not to be hungry. All the deaths from lack of health care access. All of this human suffering is the result of conscious choices being made by immoral people. None of it is necessary. All of it is avoidable and correctable. If we work together.

    3. Moneta

      Most of the population still believes in free will. It makes people believe that most of what happens to them is their doing (good results) or fault (bad results).

      If you kick a ball a certain way, the wind will need to be very strong to make it deviate from its trajectory. Same thing with the brain… there needs to be some strong variables to change the facilitated loops. And very often these are irreversible. You can create new loops but these will cross the old loops getting the thought traffic right back into the old circuit.

    1. flora

      Thanks for the link. I read an earlier NC link from the Seattle Times about Providence Health’s Swedish Cherry Hill Hospital. The Seattle Times is doing good reporting.

  13. Painter's Drunk

    The distribution of opioids is state policy. Both state and federal authorities do not pursue the crime of wide spread illicit distribution of opioids.
    This means that the wide spread availability of licence plate readers, the wide spread use of paid informants, the common use of cell phone interception technologies, the ability of federal agencies to capture Internet communication service has been unable to stop one major shipment of opioids (prescription or illicit). And there are tons of this stuff floating around.
    In addition, note that federal agents complain that opioid cases are being “Slow Walked”, that it is widely reported that an agreement was reached with a least one of the cartels to not prosecute.
    Addiction is state policy.
    This creates a class of folks who are unable to vote in many states, folks despair of employment, and in the very end destroys the community and offshores jobs.

    1. clarky90

      Oxy-Contin is a Zyklon B for the 21st Century. The “technology” of mass-murder is usually mundane, everyday objects/activities, re-imagined; a pesticide, a machete, a pit, truck exhaust re-routed into a confined space, withdrawal of food (famine), extreme cold with inadequate clothing (Siberia), extreme heat with no drinking water (Herero and Namaqua genocide) ….

      “Zyklon B was the trade name of a cyanide-based pesticide invented in Germany in the early 1920s…….. Walter Heerdt (de) and Bruno Tesch developed a method of packaging hydrogen cyanide in sealed canisters along with a cautionary eye irritant and adsorbent stabilizers….Uses included delousing clothing and disinfesting ships, warehouses, and trains.”

      The Nazis re-purposed Zyklon B to murder millions of European deplorables.

      “Prior to World War II Degesch derived most of its Zyklon B profits from overseas sales, particularly in the United States, where it was produced under license by Roessler & Hasslacher prior to 1931 and by American Cyanamid from 1931 to 1943…….By 1943, sales of Zyklon B accounted for 65 per cent of Degesch’s sales revenue and 70 per cent of its gross profits.”

      1. blert

        Typical Wiki errors:

        1) Zyklon or Zyklon A was the odorized toxin. It was so stinky that it repelled.

        2) The SS demanded that the odorant be removed for their specific use. It’s THIS formula that became labeled Zyklon B… and the original being tacitly re-named Zyklon A. Naturally, the existence of this was top secret.

  14. JimTan

    Well said Yves. Hopefully stories like this will increase awareness about the correlations between joblessness or underemployment, depression, and opioid abuse in the U.S. Last month a well know comedian performed a fairly mean spirited monologue that dismissively mocked opioid abusers as ‘pillbillies’:

    While I understand that part of his ridicule was motivated by a contentious presidential election, it was disappointing to see someone rest blame on a defenseless group while failing to reflect on why this demographic has been steadily growing.

  15. Dr. Bob Mc

    My take on Yves piece is quite different. I witnessed an “experiment” of sort in Vietnam in 1970 while I was an internist at the 12th Evac Hosp in Cu Chi. In Feb, Mar and April I found morale in the hospitalized GI’s of the 25th Div and 1st Air Cav (malaria, hepatitis B, wounds) to be surprisingly good and those GI’s wanted to get back to their units. The Cambodian invasion for the US started in May and ended June 30th and was ordered by Nixon. The change in morale was dramatic. GI’s coming back with malaria reported units sent into Cambodia at half strength, poor resupply of food, water and ammo, all for mostly a few rice caches which certainly did not make up for dead and wounded comrades. One West Point grad battalion commander told me he was refused artillery and air support when his unit came under serious attack at the end of June. The change in morale was accompanied by a huge increase in heroin use, such that by September I had 50 GI’s hospitalized either for heroin overdose or withdrawal. The incidence of officer fragging increased. Drug rings trying to get heroin into the West Coast came into being. The source of the cheap heroin was either the NVA or VC and helped finance their activities. My conclusion was that you put people (young draftees) in a situation they can not escape (war) and then destroy their trust (Nixon’s orders and officers wanting to get their career combat ticket punched in Vietnam) and any sense of justice, you have created a heroin epidemic.

    I think a similar sense of loss of trust and a sense of justice has occurred for decades in coal country and small town USA. Through the Bush, Clinton, Bush, Obama administrations there has been a loss of trust and any sense of justice in these areas as GOP and Dems alike catered to big money, big business and Wall Street. The events of 2008 confirmed any doubts with Wall Street being bailed out and the middle digit extended to Main Street.

    As to Big Pharma including Purdue, they should have been reined in long ago. Attendance to a few AA/ NA meetings would have told the story and what needed to be done. The neoliberal globalization policies have emptied out jobs and manufacturing in the US and Oxycontin and heroin are their replacements.

    1. barrisj

      I think a similar sense of loss of trust and a sense of justice has occurred for decades in coal country and small town USA. Through the Bush, Clinton, Bush, Obama administrations there has been a loss of trust and any sense of justice in these areas as GOP and Dems alike catered to big money, big business and Wall Street. The events of 2008 confirmed any doubts with Wall Street being bailed out and the middle digit extended to Main Street.

      Not only loss of trust and sense of justice, but also a cruel lack of empathy from more well-off citizens of this country. Many of my erstwhile “librul” friends hold the persons described in the Bloomberg article in utter contempt…”Have you ever talked to ‘those people’, they’re effing stoopid!” “Trump supporters – the dumbest dickheads on the planet”, and more, in that vein. Class and credentialism weigh heavily in blue states, and in the collective minds of not only the Democratic elite, but the beyond-cynical Republicans as well. Exploiting the fears and depressed prospects of the unprivileged for electoral gain has been red-state Repub policy for decades, and it continues with the “Trump revolution”, and simply to hand out political theatre as in the “rally” in Florida this weekend is doing bugger-all to address issues raised in the Bloomberg piece.
      I have mentioned this book before, and in light of the above, I heartily recommend as an excellent reference for historical perspective Nancy Isenberg’s White Trash. The 400-Year Untold History of Class in America.

    2. susan the other

      Yes, Bob – and let us not forget recently being disgusted to the bone by that arrogant Federal Reserve member who condemned useless old boomers and “drug addicts” for the malaise in our economy – blaming them. As if drugs came first, then unemployment on such a vast scale that it collapsed the labor market. End the Fed. Now. That comment makes me so sick I can’t eat enough to puke enough to feel better.

  16. washunate

    I wholeheartedly agree we could (and should) do more about helping treat drug abuse and prevent the conditions that exacerbate it.

    However, I would really push back against the overarching framing of an opioid epidemic. It’s not drugs per se that is the epidemic in question. Criminalization (primarily of poverty and black communities) is the epidemic.

    1. Jim Haygood

      The Fair Sentencing Act of 2010 reduces the disparity between the amount of crack cocaine and powder cocaine needed to trigger certain federal criminal penalties from a 100:1 weight ratio to an 18:1 weight ratio.

      They don’t even try to hide it: the War on Drugs is designed to round up n-words en masse and put them in cages. And it’s working like nobody’s business.

      Which makes you wonder, what was the point of the empty suit Obama and the Congressional Black Caucus?

  17. LD

    This is the link to the study about drug testing. They contacted 870 companies, only 200 of which had drug testing. Then they recorded opinions about the percentage of employees who refuse/don’t show/fail. More than 10% of respondents weren’t sure, the rest cited ranges (0-10%, etc.). It’s a PR hack piece.

    If MLP needs someone to run the machine, just look to the next paragraph and hire the guy from Buffalo.

  18. mk

    Thank you for linking Purdue Pharma to these stories. They should be investigated and prosecuted, hell tar and feather them and run them out of the country.

    1. frank rizzo

      I’m ok with investigating and prosecuting those connected with the Purdue Pharma Epidemic.

      I’m also ok with tarring and feathering them.

      However, I don’t think we should run them off so they can peddle their poison and destroy the citizens of another country.

    1. Bullwinkle

      Very true. Age discrimination is alive an well in many fields not just in IT. I don’t know how you can keep any age related information off of your resume. Dates of graduation and length of positions held are usually required. From there the hiring officials just do the math.

      1. KurtisMayfield

        Simple solutions:

        #1. I don’t put the dates on my degrees anymore. No one has ever asked to see them.
        #2. I put my last three positions, or related experiences.
        #3. I give them three references that are from the three positions listed.

        Never seemed to bother anyone. Plus I add a publication history if relevant to the position.

        1. Bullwinkle

          Very good but I still find that public sector (govt) applications are date oriented. I have done your #2 solution and was once called out on it during an interview as if I were hiding something. It was very awkward to say the least.

        2. Moneta

          Sorry to burst your bubble but after working on rfps, I can assert that there are huge unmistakable CV differences between those of millenials, gen-x and boomers. One look and you know.

          Yours is a case of being at the right place at the right time with the right package.

  19. Paid Minion

    The problem with “druggies” and alcoholics, is that a high percentage of them end up being pains in the azz. Given a choice, no manager/supervisor I know has the time or desire to screw with them. You have enough problems in this “do more with less” economy. Unless they are “exceptional” at their job. Which most of them aren’t.

    Call us lousy conformists, but the benefits of drug use just aren’t worth running the risk of screwing yourself out of a job.

    Observation of my kids friends shows a high correlation of early drug use, when the parents are using. It’s their “normal”.They drag some of their “friends” into the circle, because the parents are “cooler” and “more fun”, and don’t nag them.

    Which is what a lot of people are discovering. There are jobs out there for drug alcohol users……….and they all pay $8-12/hour.

    The real answer is to improve the job market for everyone, so that employers have no choice but to hire whoever they can get. We’ll see that alongside the “Hell freezes over” headline.

  20. Mack Ratthe

    As a long term user, thirty five years, of all kinds of opioids from ultram to oxycontin to maximum strength actiq fentanyl lollipop lozenges, i can say with absolute confidence and authority that the laws regulating the distribution and use of opioids are infinitely more harmful than any opioid could ever be. Dont blame the chronic pain sufferer whose society places him in the literally excruciating position of having to either forge prescriptions or suffer unendurable pain. Dont blame the drug manufacturers either for quite properly recommending dose escalation when tolerance is acquired. The truth is that there is no ‘maximum’ opioid dosage. There is only acquired tolerance matched with the answer to the question: how is the patient doing? Tolerance is a natural and inevitable process. And ‘targeting’ accident prone regions merely helps people whod otherwise suffer unendyrable pain get relief. Nor should you blame the drug user for’failing” drug’tests’. Instead eliminate the unconstitutional invasion of privacy which in 99% of cases is unnecessary in the first place. The truth is until we get the govt entirely out of the pain game(and realize the entire specialty practice of’pain management’ is a legal invention. Any nineteenth century dr who felt unqualified to rx an opiate would be considered unqualified to practice at all. ) no one will get either the proper pain medicine in the proper dosage and no one will be able to properly manage their meds. Right now… No one is getting enough. And any bill passed will inevitably by its very nature as legislation only serve to make the problem worse.

    1. UserFriendly

      I agree. Almost all of my friends in highschool did oxy every once in awhile and I only know one that went on to get addicted to heroin. He OD’ed about a year ago because it’s cheaper to cut fentanyl than heroin, but when you buy it off the street you have no idea how strong it is. When I broke my elbow a few years ago I had the worst time in the hospital because I have a naturally high tolerance to everything and they just would not up my dose no matter how much I complained. After the surgery it was insane how many hoops I had to jump through just to get vicodin. I understand Opiates are addictive but when you are not helping people with their pain out of fear then we have gone too far.

  21. Mack Ratthe

    While mentioning in passing that half of all children in the US have at least one parent with a record you also ought to have noted that will soon make at -least- half of all persons agreeing to perform criminal background checks rank hypocrites.

  22. geoff

    Here is an excellent and relevant article from Counterpunch:

    The article describes cooperation between prescription drug distributors and regulatory authorities (primarily DEA) as to the size of the markets they’ll be allowed to “serve”(i.e. how many pills they can sell there). This is regulatory capture on a deadly level, and answers my main question of, how is this allowed to happen? The answer is that the same “revolving door” we see in financial regulation is also found here in the regulation of controlled substances, where DEA employees move on to highly compensated jobs in the pharma industry or as lobbyists after their government “service”.

    1. Gman

      ‘Approximately 80 percent of the global opioid supply is consumed in the United States’

      The population of the US can’t be in that much more pain relative to the rest of the world, so nothing screams legalised exploitation of other people’s misery for profit as a matter of policy than this tragic piece. Opioids just happen to be the state sanctioned mass sedation drug of choice for the potentially restive, superfluous unwashed masses they don’t know what to do with it seems.

      Still, if there are next to no jobs in the rust belt, and next no chance of there being any, it makes sense for big pharma to exploit its biggest natural resource ‘misery’ for vast ‘taxable’ profits, and has the added bonus of providing employers with a ready made excuse for not employing them anyway for the few precious jobs that are available.

      A virtuous circle…..for some.

  23. Altandmain

    I think that legalization is the only real option at this point.

    The demand for drugs is going to be strong so long as unemployment is strong and neoliberal economics exists to wage class warfare on the rest of society. Legalization will reduce the price and force purity standards. Money is a huge issue, especially to those at the margins of survival.

    It is fueling drug gang wars in South and Central America, while having no effect on reducing consumption. There is a huge element of race and class to who gets persecuted. Upper middle class and wealthy drug addicts will get off. People who are less well=off go to jail. There is an element of class warfare that is very strong in this and it exposes the appalling injustices of American society.

    The other thing that needs to happen is that a lot of the stigma needs to go. Those affected cannot find jobs that pay well and often do not seek help for fear of stigma. Finally, giving treatment will be a long, hard road with no assurance of success.

    Ultimately though, unless the root cause is addressed, there’s no cure possible. We need a society that shares the economic benefits with everyone, not just a few people.

  24. Scott

    “I need a drink.” is part of the American way of dealing with living to work. “Alcohol is the mother of all drugs.”
    Point of fact is that drug use is an American Folkway.
    The Drug War has been the most serious war waged against national neighborhoods & international adversaries.
    In Fact the Doctors do not lead the system and are led by a pathological system. Doctors know that marijuana is of all of the prevalent drugs the least harmful.
    The piss testing industry has a gold mine since even minor usage of marijuana can be found.
    Since the nearly harmless adult vice of marijuana use is such a part of hypocritical oppression baked into the system now, logically for many it becomes a ‘Why Not’ impetus to use the entirely different class of drugs.

    1. jrs

      Yea marijuana sometimes works for pain and is an alternative for all those who have gotten addicted to prescription meds for real pain. But for those who use opiates FOR the psychoactive effects, not all are similar pleased with marijuana, opiates can be uniquely pleasurable, depending in biochemistry.

  25. Sluggeaux

    Thank you Yves, for sharing Bloomberg’s paternalistic attempt at drumming-up a little sympathy for the Deplorables, and your clear-eyed link to the crony-capitalists of Big Pharma — and the generally gross incompetence of the medical profession.

    My successful labor activism on behalf of prosecutors and public defenders landed me in Drug Courts and on Workers Compensation cases during my later years, and I can confirm many comments above about addiction, especially Clive’s. Not everyone who tries drugs becomes an addict (myself included), but there are many complex psycho-social problems which predispose some of us to addiction. I think this is why some have developed the view that addiction is some sort of moral failure, and addicts are seen as deplorables. However, I’ve worked blue collar jobs with addicts, and they don’t always make the best employees. I also have grave concerns about the effects of drug use, especially cannabis, on the brain development of Transition-Aged Youth between the ages of 17 and 24.

    And don’t get me started on the medical profession, who in my experience are mostly egotistical quacks enriching themselves with loose scrip-pads and golden scalpels. Been playing whack-a-mole with them for years…

    1. H. Alexander Ivey

      I also have grave concerns about the effects of drug use, especially cannabis, on the brain development of Transition-Aged Youth between the ages of 17 and 24.

      Thank you, I’ve been wondering where to put my 2 cents in. If one is wondering about drugs and their impact on our youth, lets compare cannabis with alcohol. Has anyone heard of a hop head, reefer madness crazed stoner dying of liver disease? dying from taking too much cannabis (drink a quart of scotch straight down and you’ll be dead before the bottle hits the ground – ethynol is still a poison)? becaming enraged and beating up their spouse or a stranger sharing a toke? driving a car too fast and killing others / being killed? And if you have, bring along some numbers. The fact clearly is that alcohol is really the drug to keep your eye on, not cannabis.

      1. Sluggeaux

        You are comparing apples to oranges.

        Just because alcohol kills — and it often does — doesn’t make cannabis a benign alternative. Scientific and peer-reviewed studies tell us that brain development occurring between the ages of 17 and 24 is dependent on experience, and we know that chronic cannabis use inhibits that experientally-based brain development — which can never be recovered.

        Just because alcohol is bad for kids and young adults, doesn’t mean that cannabis isn’t as well. They both can be bad — but in different ways at different developmental stages. We don’t legally tolerate under-aged drinking either. They are developmentally inappropriate.

        Sex is good, but Milo Yiannopoulis is wrong that it’s good between 13-year old boys and grown men. Alcohol and cannabis can be good — but not developmentally appropriate for kids.

  26. Wade Riddick

    Rent-seekers jack up costs by tightening supply and reducing production costs, often to the case of selling a fraudulent, crippled product. (Think about the quality of bundled mortgages in 2007.). In this case, costs are cut on workman’s comp for workplace injuries and the V.A. for combat injuries. Rather than treat the underlying problem causing the pain, they throw opiates and other poor choices at it (NSAIDs – inhibit Tregs, causing autoimmunity; Gabapentin, Lyrica – immense criminal fines) to mask the symptoms. This problems get worse while the treatment causes its own damage. In the case of opiates, throw in fraud from the sales team. Addiction produces repeat business and higher sales commissions. It’s part of the cost-cutting attack on workman’s comp and veteran’s health. In the name of “efficiency,” middle managers are pocketing part of their budget. Patient gets sicker and returns for more “treatment,” spending money more dollars. It’s counterfeiting. Don’t mistake profit with real value, especially in medicine.

    1. Felix_47

      And don’t forget Wade that one thing looked at with disability rating which means real income to many families is the amount of pills taken. Obviously the higher the disability rating with the VA the higher the disability payment which is given no matter how short the military service is. We see many young men and women sucked it up for basic and AIT who then start to complain of their pre-existing condition at their first duty station. They get medically discharged and a VA disability pension. The conflation of future income with medical treatment seen in worker’s comp and the military (24 hour worker’s comp) is a huge driver of inappropriate treatment demanded by the injured workers or the servicepeople or their families. Every soldier and barracks lawyer as well as many workers comp seekers know that an instrumented spine fusion is the route to a big payment and a lifetime sinecure. And if they have kids free tuition in many states. They don’t understand the rest of the consequences. What it says is that their self respect has been driven so low that they see no other way out. And it is a vicious circle because any employer with a brain will not hire people that are not absolutely necessary in the US so the economy gets worse. They hire only to service local needs such as warehousing and distributing but not manufacturing.

  27. Paid Minion

    “Moral failure”? How about “judgement failure”?

    We all have that “Do I?” moment.

    In my case, it was a choice between spending my limited funds on drugs/alcohol, or cars. I chose cars. The investment seemed better.

    Later, it was either no drugs/drinking, or drugs/drink and run the risks of the draconian punishments leveled against “safety-sensitive” employees, as delivered by the FAA and my employers.

    (As a “on-call” tech, drinking/drugs are pretty much a no-no 24/7/365).

    It has been a pretty easy decision for me. Other guys chose to continue, and many of them got snagged by drug/alcohol tests over the years. Let’s just say that none of their lives were improved.

    Yeah, I’m coerced into not using drugs/alcohol. BFD. I’ve got too much invested, and have too much to lose to risk it.

    My brother OTOH, likes marijuana and booze too much to quit. He quit a good job, because they had “no right” to drug test him. Now, he’s almost 60, and is treated for depression, because he can’t find work that pays over $15/hour…… dealing with all of the financial issues that come with working for $15/hour. So, who has the most “personal liberty”?

    1. witters

      Not the one with principles (“He quit a good job, because they had “no right” to drug test him.”)

  28. Olivier

    @Yves Bravo! I would add, though, that if you are old or handicapped you don’t need an appalachian accent to face fierce discrimination.

    @Colonel Smithers Avenue de Friedland, eh? Such an address calls for a great fortune and thus, pace Balzac, for a great crime. What is yours? Only half-kidding.

  29. Jazz Paw

    The Bloomberg article highlights the complicated nature of the unemployment problem. There is the rural version of the inner city unemployable problem, whether it is due to drugs, criminal record, poor education, or bad habits. There is the changing nature of work skills. There is the aging worker problem.

    We are engaging in a national discussion about “bringing back jobs” but missing from this discussion is that even if those jobs come back, they may not go back to the areas that have the unemployment problems. At some point, the ability to rehab the unemployed and reintroduce them to the workforce is going to be required to make progress. It doesn’t sound like protectionism is going to make someone pass their drug test.

    The states,that appear to have the biggest problems are also the ones that have traditionally had poor social systems. Perhsps it is time for them to examine if their ideological opposition to some form of social intervention is counterproductive.

  30. H. Alexander Ivey

    My last two cents:

    It looks to me like this ‘war on drugs’ and the opioid epidemic is the natural (and expected) outcome of identify politics. Instead of attacking the problems based on need, our fearless leaders attack the problems based on moral right-ness. But ‘need’ is too close to a have vs have not PoV, ‘moral right-ness’ keeps eyes off of our leader’s wallets.

  31. Patricia D

    It is truly a shame what has happened all over this country since the recession. People have lost just about everything about themselves and there are really no answers. Personally, the hourly rates for anything today is disgraceful and does not allow any one of us who lost a job to “pick up the pieces” no matter what the age today. Age discrimination/age bias live and live largely unfortunately too as well. Whatever this new administration does in the future, I feel there are large numbers of folks out there that would just love to work and feel good again about something in a day other than have a day “wherein we wait for the next shoe to drop”.

  32. GERMO

    This was a great post and my only contribution is to point out one thing that is too often overlooked in this conversation: workplace injury, repetitive stress injuries, and especially the sort of injuries that simply build up over time for older workers who have to be on their feet 40 hours a week if not more. Disability claims are realistic only for those who have been injured in specified ways, like heavy machinery, back injuries from heavy weight — the courts tend to assume no one is really injured by cumulative effects or actions taking place over time.

    Still the chronic pain suffered by so much of the working class is more or less like being ground into hamburger. The prescriptions have a ready market but not in unemployed people — it is people who can’t work because work caused so much pain. The solution, of course, is not to be working people so miserably hard and to provide pensions early enough in life that they can take it easy and leave the backbreaking stuff to youngsters who can still handle it.

  33. Zane Zodrow

    In the smallish midwestern city I live in, gas stations and grocery stores are starting people at $11 – $14 per hour, many with some benefits. $12-$20 usually means you start at $12 and work your way up to $20. You get what you pay for. Change $12-$20 to $16-$22, or $20-$25, and tons of applicants would pass a drug test.

    Marijuana can show up in a urine test several weeks after last use. If someone gets high only every Friday and Saturday night, how does that affect job performance Monday through Friday? Imagine a zero tolerance alcohol policy, if alcohol showed up in testing several weeks after last use. 40% of the workforce would be ‘unemployable’. Every job in existence over the past 50 years has been performed many times by people who were high, drunk, hung over, whacked out on cold medicine or prescription drugs, or otherwise impaired by some substance to some degree.

    How are the working conditions at the $12-$20 manufacturing job the guy is having trouble finding workers for? Hot? Noisy? Really monotonous? Physically demanding? Supervisor always nagging? 60+ hour work weeks? Many production jobs don’t even bother to treat the workers like animals these days, they treat them like meat.

    There is no ‘worker shortage’ problem. There are low pay, poor working condition, and poor treatment of worker problems.

    1. Felix_47


      Like cutting meat……only illegals will do it……..Americans won’t……..but when meatcutters were unionized it was a job in great demand and many families were raised…….and with a non union strategy IBP solved the problem and wiped an occupation off the map just like many other occupations that now only illegals will do…….for dirt wages…….

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