Horse 3423 - The Fentanyl/Opioid Crisis Is Rational

I have been asked by someone to comment on what I think of the Fentanyl/Opioid crisis in the United States. They wish to remain anonymous.

Before we get any further, we need to ask ourselves: What is Fentanyl?

Fentanyl is a synthetic opioid drug which is used as an analgesic and an anaesthetic. It is between 30x and 50x more powerful than Heroin and about 100x more powerful than Morphine. For everyone of us out here in the cheap seats, an analgesic is a pain killer; it is for this reason that people want it.

Humans as electro-biomechanical meatbags with a squishy computer and a soul/spirit/undefinable consciousness (insert as appropriate to you belief set), like to imagine that they are rational decision making beings with rational agency. A lot of the time, they are not. A lot of the time, humans are irrational decision making beings but with rational agency which is driven by that most basic of drives: selfishness. Even when humans can acquiesce to what is good and good for them, if there is something which feels nice, then they will stump for that thing. When mapped through the drive of selfishness, so much of human decision making processes can be mapped through two sets of if/then gates.

IF: yummy, yummy, yummy THEN: DO.

IF: not yummy THEN: DO NOT WANT.

IF: not yummy THEN: AVOID AT ALL COSTS.

IF: not yummy THEN: ELIMINATE AT ALL COSTS.

Those statements of "all costs" include when the solution is actively bad or dangerous or harmful in the long run but yummy in the short run. One of the consequences of living in the here and now, and occupying a singular point in space and a singular moment in time, is that an irrational decision making beings with rational agency will make the choice to get rid of the "not yummy" at "all costs". Those costs may include death. However, as death is not now, then due to hyperbolic discounting, even the decision to do a thing which causes death, is acceptable if it means eliminating the "not yummy".

Fentanyl as an analgesic which is more powerful and effective than Heroin and Morphine, is a yummy solution to removing and eliminating the not yummy problem of pain. Humans hate pain. Pain is unpleasant. Pain is a thing which when mapped through the drive of selfishness is a thing to be eliminated at all costs. If Fentanyl as an analgesic is yummy, then DO.

So the fact that there is a Fentanyl crisis in the United States, seems perfectly rational and understandable to me. The Fentanyl crisis is a rational response to the not yummy problem of pain; which is only actually a crisis because the consequences are large and many. If a bad thing happens once, it is a tragedy; if it happens thousands of times, it is a crisis. I will even suggest that the reason that this is a national crisis is because as Fentanyl accounts for 75,000 deaths per year, it is a greater cause of death than the United States' other really big yummy thing which causes death: guns. America does not think that Gun Deaths are a national crisis because when passed through that same yummy/not yummy decision making process, shooting guns is yummy.

I understand why you would want to eliminate pain. Pain is unpleasant. I also understand pain. Pain is a thing which I live with constantly, maybe? After being hit by a car in 2022 and having a rod inserted into my leg and a plate and screws inserted into my shoulder, in doing the surgery, the surgeon although excellent and skilled, has given me a scar and a line of pain. It is like being stabbed with a pin, in a continuous line, for about four inches across my left shoulder. The best way that I can describe this is if it had a voice, it would be yelling constantly, 24-hours a day and 7-days a week, without cease, always forever. As one of those irrational decision making beings with rational agency, then I should be a perfect candidate for the use of Fentanyl to eliminate the not yummy.

But before this looks like self-praise, I have to clarify that the reason why I do not take anything for the pain, is that the unpleasantness of painkillers is in my mind, worse than the pain itself. Pain in unpleasant yes, but the nauseousness of painkillers is worse. The reason why I am able to live with pain is because after having run the two not yummys through my mind, the not yummy of pain is preferable to the not yummy of nauseousness. This is not some assertion of moral superiority but rather an acknowledgement that had any number of variables been different, then the outcome would have also have been different. 

I am nothing more than a bruised apprentice of a teacher, who is forced to go through this involuntarily; so if I have learned anything it is not through choice, nor is it because of any moral goodness that I have. Like anyone else, thanks to my selfishness, pain is a thing to be eliminated at all costs but thanks to circumstance, I am not allowed to do so.

Here's the kicker, the United States in choosing to run a private for-profit health care system, has by default let the market decide what the outcome is. The Fentanyl/Opioid crisis in the United States exists purely because the United States has decided that the existence of a universal payer/owner/operator of health care is a not yummy, and that most steps towards it are also not yummy. The decision making process as a nation is such that taxation which is seen as a not yummy, is worse, than the costs which can be hyperbolically discounted; which includes death.

The lack of a universal payer/owner/operator of health care or even any systemic steps towards it (the Affordable Care Act was a band-aid over a cancer), means that instead of going to a General Practitioner to undertake primary care, many problems for many people are allowed to become chronic because of market forces. Instead of basic maintenance, the United States health care system in many orders of magnitude, thinks that chronic problems are preferable because the "customer" will eventually be unable to avoid having to pay the costs and pay them for profit.

Of course a private for-profit health care system has a vested interest in not actually treating the underlying causes of sickness and disease, because by doing so it will eliminate the need for its core business. A private for-profit health care system no interest whatsoever in the existence of healthy people who have no need of their for-profit services.

This is why Fentanyl and other Opioid drugs exist in the numbers that they do. This is also why marijuana which is also not medicine exists in the numbers that it does. This is also why illicit drugs which are also not medicine exist in the numbers that they do. Pain medication, recreational drugs, and illicit drugs, are to a very large degree, the market solution to the problem of eliminating pain, in lieu of actual medicine and actual treatment of the sickness and disease, because people who can not afford basic health care eventually decide that they can not stand the not yummy any more.

Granted that the opportunity cost of proper health care and intervention is best measured by looking at health benefits, or years of life that aren't destroyed, or quality of life adjusted years, which could have been achieved with other programmes but that needs to be a collective decision by a nation of people who consistently report that the not yummy of taxation is worse. Fentanyl and other Opioid drugs quite frankly, are the rational choice in the face of a health care system which fundamentally doesn't care an iota about the first three words of the US Constitution.