6 ms·

> 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 see

by 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.

MichaelGG 10y ago
Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps being useless, perhaps seen as a drain or whatever, but not dangerous, not bad people like some junkies turn into. With proper availability, opiates are very well tolerated. Being addicted, by itself, is not a big deal. Apart from the negative pieces you see like this one, opiates are still a huge success for many people. Not just physical pain, but emotional pain, depression, and stress. Keep an eye out for pinned pupils and notice how many professionals have them. There's this stigma that addiction is inherently bad. Yet it only applies to "fun" drugs like opiates. No one, in general, goes on about the terribleness it is to be addicted to antipsychotics or insulin or antidepressants. At best, you hear how annoying it is, having to always make sure you've got your gear - but I've not seen people go on about the intrinsic badness of addictions lifesaving medications cause. What should be available is more public health awareness, and a cultural shift. People should be free to get addicted, but easily obtain services to help with it, without being labelled or criminalized. You don't need to rob people of liberty and cause suffering by requiring a paid gatekeeper to watch over everyone.
- DanBC 10y ago
  > With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose. And their pain is not being managed. > addicted to antipsychotics or insulin or antidepressants No tolerance, no seeking, no preoccupation, no continuing to take them when you know they're doing you harm -- those things are not addictive.
  - deleted 10y ago
    [deleted]
  - MichaelGG 10y ago
    What you keep saying in these threads is that opiates aren't effective. Why then do people continue to use them? Certainly if you're in pain, you're not taking a gram of morphine-equivalent per day just because. If there are effective alternatives, why are they not used? Then with pain under control, you can slowly (over a year, say) taper down.
    - DanBC 10y ago
      I'm not saying it. National organisations are saying it - Public Health England (part of government); the Faculty of Pain Medicine (part of the Royal College of Anaesthetists); NICE (The National Institute for Health and Care Excellence, a non-departmental public body) all say it. So, unusually, do the CDC: http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html If they were effective and if addiction could be safely managed you wouldn't see increasing rates of people addicted, taking dangerous amounts, and dying of overdose. http://www.theguardian.com/us-news/2016/mar/17/cdc-guidelines-against-prescribing-opioids http://www.theguardian.com/us-news/2016/mar/17/cdc-guideline... People take opiates because doctors inappropriately prescribe them (in some countries); because the word "opiate" is well known; because people reject other treatments; and because people stick to the med they know. That's why co-proxamol (and very dangerous, ineffective medication, is still being prescribed today even though there are many other better meds). They continue taking them, at massive doses, because they're addicted. And that's the problem - if they were addicted but getting pain relief we could understand the continued use of opioids as first line treatment, but most people don't get good pain control with opiates for long term pain. They end up having to mix different meds, these combinations are often dangerous. https://www.theguardian.com/science/2014/dec/09/us-patients-opiate-painkillers-prescribed-dangerous-drug-cocktails https://www.theguardian.com/science/2014/dec/09/us-patients-...
      - nommm-nommm 10y ago
        This is what I've seen firsthand from the treatment facility I've volunteered at. Long term use becomes a problem for many patients and eventually they have pain even with dangerously high doses of opiodes.
- stryk 10y ago
  "Being addicted, by itself, is not a big deal." - As someone with an en extensive amount of first-hand knowledge, I disagree very very much. It is in fact so big of a deal that it becomes your one and only deal. The worst part is, if you use opiates for a long period of time consistently - you WILL become reliant upon them. Your body will be chained to them, physically dependent, and I don't care who you are, where you come from, or how much money you have. 100% of the time, no exceptions willpower be damned. And as far as using opiates as a means to heal emotional pain and depression? That's is possibly the worst idea ever. You're flat out asking for a long, long slow death in which you probably kill yourself in the end anyway but in the meantime you disappoint anyone who has ever cared about you even slightly.
  - MichaelGG 10y ago
    Well I guess we have two different sets of people and experience then. I've seen people do rather successfully in business, all while using opiates on the side. (I've seen a few people die too, but that was pretty much caused by illegal supply and lack of regulation/QC.) The actual addiction part, without supply constraints, becomes very, very simple logistics.
    - stryk 10y ago
      Those logistics are not as simple as it may seem. 2 bags of dope/pills/caps/doses a day becomes 3, 4, 6, 8 twice a day + 9 on Sundays. Happens to everyone given a long enough usage period. There's that proverbial slippery slope there, and once you're over the hump it's checkmate. Wait until something happens to these successful folks - and it will. there's a weak link somewhere in the chain and when it breaks they will act like every other junky.
      - MichaelGG 10y ago
        And what is "acting like every other junkie" mean? Göring was a morphine user for what, 2 decades? Didn't stop him from becoming extremely powerful (misguided, but he accomplished a lot).
- capote 10y ago
  Even with heroin being illegal, I've seen people get it without a problem. They have to resort to no crime to get it other than getting it itself being a crime. But this hurts no one. What hurts people isn't getting it, it's what they do as addicts. Throw their lives away, resorting to crime to live day to day, get housing and food… They partly ruin the lives of those close to them too. Legalization would do nothing to help this, it would just hurt a little. They'd get it a bit easier, but since they didn't resort to violent crime to get it in the first place it would be meaningless. The crime and disaster they cause after getting it and becoming addicted would remain. But like you said in the other branch, we have seen different people and have had different experiences.
  - mst 10y ago
    I've seen friends destroy their relationships and careers over addiction. I've also seen a burned out house where a dealer set fire to it with the occupant inside to incentivise future debtors to pay up faster. I've seen the grey market involved in buying such things suck far harder on somebody's lifeblood than buying alcohol would an alcoholic. So ... my gut feeling is that, overall, legalisation would probably be an improvement. But I think that, if so, it would be an improvement overall, and that doing the math carefully beforehand is a really good idea. Or: I think you and MichaelGG both have valid points, and that any opinion on this subject that doesn't include both is probably going to fall short of the mark. (to be clear, I'm replying to this specific comment largely because of your last line, since I'm seeking synthesis, not antithesis, by this line of thought)

by capote 10y ago

MichaelGG 10y ago

Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps being useless, perhaps seen as a drain or whatever, but not dangerous, not bad people like some junkies turn into. With proper availability, opiates are very well tolerated. Being addicted, by itself, is not a big deal. Apart from the negative pieces you see like this one, opiates are still a huge success for many people. Not just physical pain, but emotional pain, depression, and stress. Keep an eye out for pinned pupils and notice how many professionals have them. There's this stigma that addiction is inherently bad. Yet it only applies to "fun" drugs like opiates. No one, in general, goes on about the terribleness it is to be addicted to antipsychotics or insulin or antidepressants. At best, you hear how annoying it is, having to always make sure you've got your gear - but I've not seen people go on about the intrinsic badness of addictions lifesaving medications cause. What should be available is more public health awareness, and a cultural shift. People should be free to get addicted, but easily obtain services to help with it, without being labelled or criminalized. You don't need to rob people of liberty and cause suffering by requiring a paid gatekeeper to watch over everyone.

DanBC 10y ago
> With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose. And their pain is not being managed. > addicted to antipsychotics or insulin or antidepressants No tolerance, no seeking, no preoccupation, no continuing to take them when you know they're doing you harm -- those things are not addictive.
- deleted 10y ago
  [deleted]
- MichaelGG 10y ago
  What you keep saying in these threads is that opiates aren't effective. Why then do people continue to use them? Certainly if you're in pain, you're not taking a gram of morphine-equivalent per day just because. If there are effective alternatives, why are they not used? Then with pain under control, you can slowly (over a year, say) taper down.
  - DanBC 10y ago
    I'm not saying it. National organisations are saying it - Public Health England (part of government); the Faculty of Pain Medicine (part of the Royal College of Anaesthetists); NICE (The National Institute for Health and Care Excellence, a non-departmental public body) all say it. So, unusually, do the CDC: http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html If they were effective and if addiction could be safely managed you wouldn't see increasing rates of people addicted, taking dangerous amounts, and dying of overdose. http://www.theguardian.com/us-news/2016/mar/17/cdc-guidelines-against-prescribing-opioids http://www.theguardian.com/us-news/2016/mar/17/cdc-guideline... People take opiates because doctors inappropriately prescribe them (in some countries); because the word "opiate" is well known; because people reject other treatments; and because people stick to the med they know. That's why co-proxamol (and very dangerous, ineffective medication, is still being prescribed today even though there are many other better meds). They continue taking them, at massive doses, because they're addicted. And that's the problem - if they were addicted but getting pain relief we could understand the continued use of opioids as first line treatment, but most people don't get good pain control with opiates for long term pain. They end up having to mix different meds, these combinations are often dangerous. https://www.theguardian.com/science/2014/dec/09/us-patients-opiate-painkillers-prescribed-dangerous-drug-cocktails https://www.theguardian.com/science/2014/dec/09/us-patients-...
    - nommm-nommm 10y ago
      This is what I've seen firsthand from the treatment facility I've volunteered at. Long term use becomes a problem for many patients and eventually they have pain even with dangerously high doses of opiodes.
stryk 10y ago
"Being addicted, by itself, is not a big deal." - As someone with an en extensive amount of first-hand knowledge, I disagree very very much. It is in fact so big of a deal that it becomes your one and only deal. The worst part is, if you use opiates for a long period of time consistently - you WILL become reliant upon them. Your body will be chained to them, physically dependent, and I don't care who you are, where you come from, or how much money you have. 100% of the time, no exceptions willpower be damned. And as far as using opiates as a means to heal emotional pain and depression? That's is possibly the worst idea ever. You're flat out asking for a long, long slow death in which you probably kill yourself in the end anyway but in the meantime you disappoint anyone who has ever cared about you even slightly.
- MichaelGG 10y ago
  Well I guess we have two different sets of people and experience then. I've seen people do rather successfully in business, all while using opiates on the side. (I've seen a few people die too, but that was pretty much caused by illegal supply and lack of regulation/QC.) The actual addiction part, without supply constraints, becomes very, very simple logistics.
  - stryk 10y ago
    Those logistics are not as simple as it may seem. 2 bags of dope/pills/caps/doses a day becomes 3, 4, 6, 8 twice a day + 9 on Sundays. Happens to everyone given a long enough usage period. There's that proverbial slippery slope there, and once you're over the hump it's checkmate. Wait until something happens to these successful folks - and it will. there's a weak link somewhere in the chain and when it breaks they will act like every other junky.
    - MichaelGG 10y ago
      And what is "acting like every other junkie" mean? Göring was a morphine user for what, 2 decades? Didn't stop him from becoming extremely powerful (misguided, but he accomplished a lot).
capote 10y ago
Even with heroin being illegal, I've seen people get it without a problem. They have to resort to no crime to get it other than getting it itself being a crime. But this hurts no one. What hurts people isn't getting it, it's what they do as addicts. Throw their lives away, resorting to crime to live day to day, get housing and food… They partly ruin the lives of those close to them too. Legalization would do nothing to help this, it would just hurt a little. They'd get it a bit easier, but since they didn't resort to violent crime to get it in the first place it would be meaningless. The crime and disaster they cause after getting it and becoming addicted would remain. But like you said in the other branch, we have seen different people and have had different experiences.
- mst 10y ago
  I've seen friends destroy their relationships and careers over addiction. I've also seen a burned out house where a dealer set fire to it with the occupant inside to incentivise future debtors to pay up faster. I've seen the grey market involved in buying such things suck far harder on somebody's lifeblood than buying alcohol would an alcoholic. So ... my gut feeling is that, overall, legalisation would probably be an improvement. But I think that, if so, it would be an improvement overall, and that doing the math carefully beforehand is a really good idea. Or: I think you and MichaelGG both have valid points, and that any opinion on this subject that doesn't include both is probably going to fall short of the mark. (to be clear, I'm replying to this specific comment largely because of your last line, since I'm seeking synthesis, not antithesis, by this line of thought)