11 ms·

Can you explain more how competition, availability, and legality will stop the more addiction-prone (low-income, chronic pain among other health problem) parts

by capote 10y ago

Can you explain more how competition, availability, and legality will stop the more addiction-prone (low-income, chronic pain among other health problem) parts of society in America from doing drugs and becoming addicted? If I read your argument correctly, it's that the pharma firms will not market it as much and not profit as much. In my mind that's not enough reasoning that people who simply have a bad situation won't reach out (to their doctor, guy next door with a prescription) and find the drug I see the experimental results in other countries that have taken steps forward on legalizing various drugs, but they also have a much better social welfare, schooling, and support system. I just don't see the connection between making a drug more available, making more versions of it, deregulating it and having less people taking it. Without your further explanation, that is.

mwsherman 10y ago
I don’t think legalization will reduce addiction (though would defer to empirical studies here). It would make the economic cost of addiction lower for the individual – one problem instead of two. More importantly, it would make doctors (and regulators) more honest participants. If a doctor wants to recommend opiates, it would largely remove their economic incentives for doing so. We don’t think of doctors having much economic incentive for prescribing acetaminophen or ibuprofen, by comparison.
- SCAQTony 10y ago
  I have to agree! The bad floats with the good and likewise. From the New York Times: "Actually, Prohibition Was a Success By Mark H. Moore; Mark H. Moore is professor of criminal justice at Harvard's Kennedy School of Government." "... Second, alcohol consumption declined dramatically during Prohibition. Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 in 1929. Admissions to state mental hospitals for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928. Arrests for public drunkennness and disorderly conduct declined 50 percent between 1916 and 1922. For the population as a whole, the best estimates are that consumption of alcohol declined by 30 percent to 50 percent. Third, violent crime did not increase dramatically during Prohibition. Homicide rates rose dramatically from 1900 to 1910 but remained roughly constant during Prohibition's 14 year rule. Organized crime may have become more visible and lurid during Prohibition, but it existed before and after. ..." http://www.nytimes.com/1989/10/16/opinion/actually-prohibition-was-a-success.html http://www.nytimes.com/1989/10/16/opinion/actually-prohibiti...
  - throwaway7767 10y ago
    > Second, alcohol consumption declined dramatically during Prohibition. Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 in 1929. Admissions to state mental hospitals for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928. From http://www.slate.com/articles/health_and_science/medical_examiner/2010/02/the_chemists_war.html http://www.slate.com/articles/health_and_science/medical_exa...: > In 1926, in New York City, 1,200 were sickened by poisonous alcohol; 400 died. The following year, deaths climbed to 700 The poisonous alcohol was a direct result of prohibition. So I think focusing on just cirrhosis deaths paints an unfair picture of the actual health effects.
- capote 10y ago
  > It would make the economic cost of addiction lower for the individual Isn't a low cost of addiction a bad thing? I'm also not just talking about legalization, but mainly the thing about deregulation/competition. I see your logic though, I hope it's not too wishful to assume that less doctors pushing drugs on patients will solve the issue. I suppose it definitely will cut it back some.
  - MichaelGG 10y ago
    No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. Less doctors "pushing" really means more doctors being very critical of patients. Which means more people in pain, scared to make too big a fuss, lest they be labeled an "addict" or "seeker". We don't accept (in theory) a legal system that condemns innocent people to suffer, why should we accept a health system that does the same?
    - DanBC 10y ago
      A number of people in this thread are saying the answer is either to prescribe opiates, or to leave people in pain. People who need opiates should be able to get them, but that's a small number of people. Giving opiates to the rest does very little to treat their pain, and leaves them with an opiate addiction. Most people with long term pain don't need better access to opiates. They need better access to pain clinics with the range of meds and physical therapies they have. (And yes, opiates if those are needed.)
    - capote 10y ago
      > No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. This seems twisted to me. Okay, so they don't do crime, but they get their stuff easier and stay addicted/get worse/die. Isn't it best to eliminate the motivation for doctors to overprescribe, but still force people to see their doctors for a fix? This way maybe the doctors can intervene and help them out.
      - 10y ago
givinguflac 10y ago
It's not just making it more available. Legalization has to bring better treatment and a shift in public perception to it being perceived as what it really is- a mental and physical health problem. If nothing else, people would be far more likely to seek help if they weren't treated as criminals for doing so. Also, truth in education makes a big difference. See Portugal for a good example.
rhizome 10y ago
Addiction can be managed, it's only a catastrophic problem for the patient in limited circumstances: the dosage is too strong or you can't get it. Where are you getting the goal of fewer people taking it, and why is the number of people taking it a concern at all? Pain management is the issue at hand.
- DanBC 10y ago
  It's often used inappropriately, which is one reason to use less of it and use other better alternative. It's a significant cause of death in suicide so that's another reason to use less of it. It accounts for a lot of accidental death, so that's yet another reason to use less of it.
  - rhizome 10y ago
    Right, that's the moralistic part. However, physiologically it remains an actual treatment path. How are opiates a significant cause of suicide? How do they compare to the antidepressants I see advertised on TV that mention an increased likelihood of suicidal thoughts? There are actual people with actual suffering involved here, remember that. Don't let your misconceptions of junkies determine public heath policy.
    - DanBC 10y ago
      How is it moralistic? We know in the UK that self poisoning is the second most common method of suicide after hanging, strangling and suffocation. (and that's likely to change with the next release of numbers - self poisoning is likely to overtake hanging strangling and suffocation). the list of meds used in self poisoning is something like 1) Opiates 2) Anti-psychotics 3) Tri-cyclics 4) Paracetamol 5) Paracetamol and opiate combination > However, physiologically it remains an actual treatment path But that's the point, it doesn't. > are actual people with actual suffering involved here, remember that That's entirely the point! Opiates are not effective for most of those people. Opiates work in the short term, but the patient develops tolerance and needs to take more. Opiates are not suitable for long term use. A patient can very quickly build up to dangerous harmful levels of opiate use, and they're not getting pain relief. Calling a medication dangerous and ineffective, and pointing out safer more effective alternatives, is not moralising, unlike your "remember there are people suffering" comment.
sev 10y ago
Controlled legalization of other currently illegal drugs may or may not have benefits that can't be proven yet due to research of these drugs being illegal. There is empirical evidence that certain psychedelic drugs may reduce or eradicate opiate addiction. Even if these drugs were also addictive, it may be that the harm they cause is orders of magnitude less than opiates or similar. Replacing one problem with a lesser one is indeed a better outcome than what we have now. None of this will be known, though, until certain deregulation and controlled legalization occurs.
hackuser 10y ago
> addiction-prone (low-income Are low-income people more likely to become addicted? I'd like to see some statistics. A few thoughts: * There are many more low-income people than wealthy people, so low-income addicts may be greater in sheer numbers but not in rate. * I expect that addition tends to reduce income, so people who started wealthier may become low-income * Prescription opiods are by reputation the wealthy person's heroin. Given the high cost of presecription drugs, and that low-income people sometimes can't even afford drugs necessary for their health, I wonder if Oxycontin is widely abused in low-income groups.
- SilasX 10y ago
  At the some time, income is inversely correlated with impulsiveness, which is correlated with being addiction prone. (The old one/two marshmallow experiment.)
  - hackuser 10y ago
    > income is inversely correlated with impulsiveness, which is correlated with being addiction prone I'm sure many people think this, but do we know if it's actually true? Is there any research or data? For example, as a completely speculative alternative hypothesis, people with more money could be more impulsive because they can afford it.
  - fucking_tragedy 10y ago
    The Marshmallow experiment fails to take into account the findings of previous experiments that the author of the original experiment conducted. Mainly, that a child's belief about whether or not the stated outcome would happen influenced how long they would wait before acting 'impulsively'. http://www.rochester.edu/news/show.php?id=4622 http://www.rochester.edu/news/show.php?id=4622
- capote 10y ago
  There is no correlation. People of all incomes become addicted to all sorts of things. And it was perhaps wrong of me to phrase myself that way. I suppose the motivation for that parenthetical was just subconscious--as I've seen some people who happened to be lower income have their lives ruined by their pain meds, whereas in the higher income circles I've seen, they're more addicted to strictly recreational drugs.
empath75 10y ago
Addicts are going to get fucked up on whatever they can find. If they can't find opiates or whatever, they're going to get fucked up on cough syrup, or booze or huffing paint or whatever. In general, though, addicts don't necessarily go straight to the hard stuff or inevitably to the hard stuff, if other options are available. Prohibition actually encourages people to go to the hardest purest forms, though. When you're moving around contraband, you want the most expensive high you can get in the smallest volume. It's easier to move around heroin or crack than something like codeine or coca wine, so that's what's going to be available on the street.
- vzcx 10y ago
  > Addicts are going to get fucked up on whatever they can find. If they can't find opiates or whatever, they're going to get fucked up on cough syrup, or booze or huffing paint or whatever. While this is reminiscent of something Matt Dillon's "shameless dopefiend" character from Drugstore Cowboy said, I'm not sure if this is true. There is another thread of addiction research that establishes the notion of "addiction as self-medication," in which users seek the drugs that work to alleviate their symptoms, be they physical or psychological. Anecdotally, I've experimented with a lot of substances, and opioids are the only class of compounds that I have sampled that work for me. In addition, while it's certainly true that, if you attach two acetyl groups to morphine you end up with something 2-3 times more potent by weight, I wonder if people's conception of the "hardness" of drugs is somewhat artificial.

by capote 10y ago

mwsherman 10y ago

I don’t think legalization will reduce addiction (though would defer to empirical studies here). It would make the economic cost of addiction lower for the individual – one problem instead of two. More importantly, it would make doctors (and regulators) more honest participants. If a doctor wants to recommend opiates, it would largely remove their economic incentives for doing so. We don’t think of doctors having much economic incentive for prescribing acetaminophen or ibuprofen, by comparison.

SCAQTony 10y ago
I have to agree! The bad floats with the good and likewise. From the New York Times: "Actually, Prohibition Was a Success By Mark H. Moore; Mark H. Moore is professor of criminal justice at Harvard's Kennedy School of Government." "... Second, alcohol consumption declined dramatically during Prohibition. Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 in 1929. Admissions to state mental hospitals for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928. Arrests for public drunkennness and disorderly conduct declined 50 percent between 1916 and 1922. For the population as a whole, the best estimates are that consumption of alcohol declined by 30 percent to 50 percent. Third, violent crime did not increase dramatically during Prohibition. Homicide rates rose dramatically from 1900 to 1910 but remained roughly constant during Prohibition's 14 year rule. Organized crime may have become more visible and lurid during Prohibition, but it existed before and after. ..." http://www.nytimes.com/1989/10/16/opinion/actually-prohibition-was-a-success.html http://www.nytimes.com/1989/10/16/opinion/actually-prohibiti...
- throwaway7767 10y ago
  > Second, alcohol consumption declined dramatically during Prohibition. Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 in 1929. Admissions to state mental hospitals for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928. From http://www.slate.com/articles/health_and_science/medical_examiner/2010/02/the_chemists_war.html http://www.slate.com/articles/health_and_science/medical_exa...: > In 1926, in New York City, 1,200 were sickened by poisonous alcohol; 400 died. The following year, deaths climbed to 700 The poisonous alcohol was a direct result of prohibition. So I think focusing on just cirrhosis deaths paints an unfair picture of the actual health effects.
capote 10y ago
> It would make the economic cost of addiction lower for the individual Isn't a low cost of addiction a bad thing? I'm also not just talking about legalization, but mainly the thing about deregulation/competition. I see your logic though, I hope it's not too wishful to assume that less doctors pushing drugs on patients will solve the issue. I suppose it definitely will cut it back some.
- MichaelGG 10y ago
  No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. Less doctors "pushing" really means more doctors being very critical of patients. Which means more people in pain, scared to make too big a fuss, lest they be labeled an "addict" or "seeker". We don't accept (in theory) a legal system that condemns innocent people to suffer, why should we accept a health system that does the same?
  - DanBC 10y ago
    A number of people in this thread are saying the answer is either to prescribe opiates, or to leave people in pain. People who need opiates should be able to get them, but that's a small number of people. Giving opiates to the rest does very little to treat their pain, and leaves them with an opiate addiction. Most people with long term pain don't need better access to opiates. They need better access to pain clinics with the range of meds and physical therapies they have. (And yes, opiates if those are needed.)
  - capote 10y ago
    > No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. This seems twisted to me. Okay, so they don't do crime, but they get their stuff easier and stay addicted/get worse/die. Isn't it best to eliminate the motivation for doctors to overprescribe, but still force people to see their doctors for a fix? This way maybe the doctors can intervene and help them out.
    - 10y ago

givinguflac 10y ago

It's not just making it more available. Legalization has to bring better treatment and a shift in public perception to it being perceived as what it really is- a mental and physical health problem. If nothing else, people would be far more likely to seek help if they weren't treated as criminals for doing so. Also, truth in education makes a big difference. See Portugal for a good example.

rhizome 10y ago

Addiction can be managed, it's only a catastrophic problem for the patient in limited circumstances: the dosage is too strong or you can't get it. Where are you getting the goal of fewer people taking it, and why is the number of people taking it a concern at all? Pain management is the issue at hand.

DanBC 10y ago
It's often used inappropriately, which is one reason to use less of it and use other better alternative. It's a significant cause of death in suicide so that's another reason to use less of it. It accounts for a lot of accidental death, so that's yet another reason to use less of it.
- rhizome 10y ago
  Right, that's the moralistic part. However, physiologically it remains an actual treatment path. How are opiates a significant cause of suicide? How do they compare to the antidepressants I see advertised on TV that mention an increased likelihood of suicidal thoughts? There are actual people with actual suffering involved here, remember that. Don't let your misconceptions of junkies determine public heath policy.
  - DanBC 10y ago
    How is it moralistic? We know in the UK that self poisoning is the second most common method of suicide after hanging, strangling and suffocation. (and that's likely to change with the next release of numbers - self poisoning is likely to overtake hanging strangling and suffocation). the list of meds used in self poisoning is something like 1) Opiates 2) Anti-psychotics 3) Tri-cyclics 4) Paracetamol 5) Paracetamol and opiate combination > However, physiologically it remains an actual treatment path But that's the point, it doesn't. > are actual people with actual suffering involved here, remember that That's entirely the point! Opiates are not effective for most of those people. Opiates work in the short term, but the patient develops tolerance and needs to take more. Opiates are not suitable for long term use. A patient can very quickly build up to dangerous harmful levels of opiate use, and they're not getting pain relief. Calling a medication dangerous and ineffective, and pointing out safer more effective alternatives, is not moralising, unlike your "remember there are people suffering" comment.

sev 10y ago

Controlled legalization of other currently illegal drugs may or may not have benefits that can't be proven yet due to research of these drugs being illegal. There is empirical evidence that certain psychedelic drugs may reduce or eradicate opiate addiction. Even if these drugs were also addictive, it may be that the harm they cause is orders of magnitude less than opiates or similar. Replacing one problem with a lesser one is indeed a better outcome than what we have now. None of this will be known, though, until certain deregulation and controlled legalization occurs.

hackuser 10y ago

> addiction-prone (low-income Are low-income people more likely to become addicted? I'd like to see some statistics. A few thoughts: * There are many more low-income people than wealthy people, so low-income addicts may be greater in sheer numbers but not in rate. * I expect that addition tends to reduce income, so people who started wealthier may become low-income * Prescription opiods are by reputation the wealthy person's heroin. Given the high cost of presecription drugs, and that low-income people sometimes can't even afford drugs necessary for their health, I wonder if Oxycontin is widely abused in low-income groups.

SilasX 10y ago
At the some time, income is inversely correlated with impulsiveness, which is correlated with being addiction prone. (The old one/two marshmallow experiment.)
- hackuser 10y ago
  > income is inversely correlated with impulsiveness, which is correlated with being addiction prone I'm sure many people think this, but do we know if it's actually true? Is there any research or data? For example, as a completely speculative alternative hypothesis, people with more money could be more impulsive because they can afford it.
- fucking_tragedy 10y ago
  The Marshmallow experiment fails to take into account the findings of previous experiments that the author of the original experiment conducted. Mainly, that a child's belief about whether or not the stated outcome would happen influenced how long they would wait before acting 'impulsively'. http://www.rochester.edu/news/show.php?id=4622 http://www.rochester.edu/news/show.php?id=4622
capote 10y ago
There is no correlation. People of all incomes become addicted to all sorts of things. And it was perhaps wrong of me to phrase myself that way. I suppose the motivation for that parenthetical was just subconscious--as I've seen some people who happened to be lower income have their lives ruined by their pain meds, whereas in the higher income circles I've seen, they're more addicted to strictly recreational drugs.

empath75 10y ago

Addicts are going to get fucked up on whatever they can find. If they can't find opiates or whatever, they're going to get fucked up on cough syrup, or booze or huffing paint or whatever. In general, though, addicts don't necessarily go straight to the hard stuff or inevitably to the hard stuff, if other options are available. Prohibition actually encourages people to go to the hardest purest forms, though. When you're moving around contraband, you want the most expensive high you can get in the smallest volume. It's easier to move around heroin or crack than something like codeine or coca wine, so that's what's going to be available on the street.

vzcx 10y ago
> Addicts are going to get fucked up on whatever they can find. If they can't find opiates or whatever, they're going to get fucked up on cough syrup, or booze or huffing paint or whatever. While this is reminiscent of something Matt Dillon's "shameless dopefiend" character from Drugstore Cowboy said, I'm not sure if this is true. There is another thread of addiction research that establishes the notion of "addiction as self-medication," in which users seek the drugs that work to alleviate their symptoms, be they physical or psychological. Anecdotally, I've experimented with a lot of substances, and opioids are the only class of compounds that I have sampled that work for me. In addition, while it's certainly true that, if you attach two acetyl groups to morphine you end up with something 2-3 times more potent by weight, I wonder if people's conception of the "hardness" of drugs is somewhat artificial.