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I am not convinced that that it will reduce overdose or trafficking. It depends on the drug's economics and pharmacodynamics, ease of production, addictiveness,

by jayajay 10y ago

I am not convinced that that it will reduce overdose or trafficking. It depends on the drug's economics and pharmacodynamics, ease of production, addictiveness, LD50, etc. What's better? More people using high-grade heroin in a controlled, safe environment, or less people using low quality heroin in an uncontrolled, dangerous environment? If the LD50 is very easy to arrive at in everyday usage, then I don't see this helping out very much. You could sell heroin in doses << LD50 for a high regulated price, but then you will end up with black markets which sell much larger doses at lower prices (if the substance is easy to produce in various quality levels). If the price to get "safe" heroin is not artificially increased, then it would be way too easy to accidentally have too much, especially if herion is highly addictive, which, it supposedly is. People would just end up riding their doses up to dangerous levels, in which case they would now have a dependency on heroin. Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin?

paulmd 10y ago
> Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin? For an answer, you can just look at alcohol, which is typically assessed as having roughly similar social harm to heroin (although it varies by source). Were things better during prohibition, or today?
- jayajay 10y ago
  I can't accept that heroin and alcohol are equal in that sense. I would be very skeptical about any sources claiming this equality. Ease of production, pharmacodynamics, etc. Edit: Ideally, humans wouldn't be consuming poison? But, what is poison? It's a lot more complicated than "alcohol is bad" or "heroin is bad". Maybe you are right, letting down the flood gates will surely kill people who don't have control, and we'll be OK asymptotically. Making alcohol legal certainly killed people who wouldn't have died, and saved people who would have died. At some point, this is just a variation of the trolley problem. If heroin was made CVS-able without prescription, I would not guarantee that I wouldn't try it, and that scares me because I know how dangerous it is.
  - paulmd 10y ago
    Honest question, do you have an alcohol problem or addictive personality that is driving this fear? If not, what keeps you from drinking yourself to sleep on the sidewalk every night? When it comes down to it, not all drugs are equal. Heroin isn't "alcohol but worse". People who drink tend to get pretty nasty sometimes, and that's a social harm that someone who's nodding doesn't perpetrate. And in terms of physical harm, heroin is actually pretty low compared to alcohol. Lots of people destroy their livers with alcohol and die early, while there's an awful lot of rockstars who do piles of heroin and cocaine and live to their 70s and beyond (we need to start worrying about the kind of world we're going to leave for Keith Richards). The harm comes from getting bathtub stuff of uncertain potency and purity, and from the things people need to do to afford their fix. If it's clean and affordable you tend to do fairly well on both the 'personal' and 'social' harm aspects. Obviously that's not how DARE told you to feel, but the fact is that the current state of things is not the only one that is ever possible. You don't know what social use would look like in a society with legalized heroin usage. If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away. Some people will still choose to do it, but we free up a whole bunch of police money that can be redirected to free treatment resources to help people quit when they realize they aren't going to find happiness in drugs.
    - jayajay 10y ago
      If this were several years ago and I was still a college freshman, I bet I would have tried heroin if it was available for 5 bucks a pop next to the Benadryl at CVS. Things much more innocent than heroin get in the way of a freshman, so yeah, I would be concerned if heroin was on the shelf for anyone who is 18 right now.
      - chillacy 10y ago
        I would've too, but I'm fairly confident it would have been a one-time-only thing. I had a roommate, smart lawyer kid, who talked casually about doing cocaine one day, which surprised me since back then I drew a line between "hard drugs" like cocaine, H, meth, and "soft drugs" like marijuana, LSD, and the like. And this guy seemed (and still is) like such a smart, successful person. He told me that drugs don't change who you are... if you're a cautious person who has self control, that doesn't change.
- edblarney 10y ago
  "alcohol, which is typically assessed as having roughly similar social harm to heroin" This is absurd. There is no place on earth where it is 'typical' to consider alcohol to be more dangerous than heroin. The ridiculous 'research' on alcohol v. heroin make comparisons as to 'how many accidents are caused by each' etc. in society, which is obviously not a fair comparison considering once is widely used, the other very infrequently. Opioids are extremely addictive, and destructive in almost all cases of use.
  - echlebek 10y ago
    > destructive in almost all cases of use. Demonstrably false. The vast majority of opioid users are recovering from surgery, taking Tylenol 3, etc. You're basically just talking out of your butt here.
zkms 10y ago
Opioid use is not inherently dangerous (indeed, long-term pharmaceutical-grade opioid use is remarkably safe does not cause organ damage, unlike alcohol). There are several actual circumstances where opioid use gets dangerous to life and they are: 1) Dosage/concentration uncertainty 2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues) 3) Poly-drug use -- such as combining opioids with benzos to exploit synergistic effects When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl. The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use. There are definitely real harms involved with / caused by opioid use today -- but most of those are caused by (or greatly worsened by) opioid prohibition.
- jayajay 10y ago
  Good points, but what about addiction and neurotransmitter equilibrium? If something is addictive enough, and highly available, do you think that it would become an unnecessary brain dependency?
  - zkms 10y ago
    I feel like someone functions better with their regular, stable dose of pharmaceutical-grade opioids in them -- I don't have any medical or moral issue with that at all. It's honestly...a lot like the hair dryer anecdote in http://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ http://slatestarcodex.com/2014/11/21/the-categories-were-mad.... As for the LD50 issue -- yes, opioid-naive (non-tolerant) users will have a low LD50 but they also won't need much a dose to get the effects. As people get opioid tolerant, the dose that will kill them also increases in step. It's not a case of "user needs higher and higher dose but needs to not cross a fixed LD50 threshold". Because opioids mostly just affect opioid receptors (unlike stuff like alcohol, which is hepatotoxic), tolerance means the LD50 increases in step with the effective dose. The popular picture of the heroin addict who has to use higher and higher doses to get the desired "high" is a creation of prohibition -- there's no inherent need to do anything of the sort if one has proper medical access to the right dose of prescription opioids. Moderate and safe opioid use is difficult under prohibition if only because it's hard to moderate oneself without precise and pure measured doses. There's plenty of people who engage in moderate long-term opioid use, between pain patients or "high functioning" heroin users. Those people tend not be the face of opioid use precisely because they have access to the drugs in ways that are stable, safe, not life-ruiningly expensive, and doesn't place them in regular contact with criminal organizations. They aren't exposed to the worst harms of prohibition and that's why they're able to keep using (without anyone knowing that they use) and have a stable career/family. To be clear, none of this is to say that opioids are harmless or that should be handed out like candy -- they're serious drugs and should be used responsibly by people who are aware of the risks/contraindications.
theptip 10y ago
The LD-50 of heroin is high relative to the recreational dose; it's widely regarded to be a relatively safe drug, when administered pure. Many governments have programs that administer heroin prescriptions to addicts, e.g. Switzerland [1]. Wikipedia gives the overdose level at 75-600mg[2], and Erowid reports the recreational dose at 5mg[3] (both for "opiate-naive" individuals, i.e. no tolerance). >10x is a high safety margin; alcohol is of the order of 10x for reference. The piece you're missing here is that the primary risk of accidental overdose is greatly increased with illicit heroin where the purity is unknown, and can fluctuate wildly as it always cut to some extent, but seldom predictably so. In the case of heroin, most of the harm from usage is directly caused by prohibition. [1]: https://www.ncbi.nlm.nih.gov/pubmed/11705488 https://www.ncbi.nlm.nih.gov/pubmed/11705488 [2]: https://en.wikipedia.org/wiki/Heroin#Overdose https://en.wikipedia.org/wiki/Heroin#Overdose [3]: https://www.erowid.org/chemicals/heroin/heroin_dose1.shtml https://www.erowid.org/chemicals/heroin/heroin_dose1.shtml
- jayajay 10y ago
  Impure drugs is certainly a big problem, and is the most compelling reason for legalization and healthcare instead of incarceration and war. Only a single order of magnitude is not enough of a safety margin, depending on the substance, and how easy it is to administer the substance. Is alcohol's LD50/dose ratio an apt comparison? Does alcohol require a higher administration energy than heroin? It seems like it would be easier to "accidentally" consume half a gram of heroin in a small amount of time, as opposed to "accidentally" consuming 100 beers (or 2 handles). Drug users experiment across this mere 10x range effortlessly, according to your source: > As usage increases, however, the doses get much higher Apparently, they get to 100x. Crazy!: > The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg This seems to support my view. I can't help but imagine a dystopian future (past?) where they start selling a soda called "HeroHera" which has trace amounts of heroin in it. Anyways, it seems pretty dangerous for brains to depend on the naive-LD50 of heroin. Forgetting to consume it after one has an established a dependency must surely be an issue. How do we know that a potential widespread dependency on heroin and a requirement for widespread heroin sanctuaries won't actually cost more than the war on drugs?

by jayajay 10y ago

paulmd 10y ago

> Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin? For an answer, you can just look at alcohol, which is typically assessed as having roughly similar social harm to heroin (although it varies by source). Were things better during prohibition, or today?

jayajay 10y ago
I can't accept that heroin and alcohol are equal in that sense. I would be very skeptical about any sources claiming this equality. Ease of production, pharmacodynamics, etc. Edit: Ideally, humans wouldn't be consuming poison? But, what is poison? It's a lot more complicated than "alcohol is bad" or "heroin is bad". Maybe you are right, letting down the flood gates will surely kill people who don't have control, and we'll be OK asymptotically. Making alcohol legal certainly killed people who wouldn't have died, and saved people who would have died. At some point, this is just a variation of the trolley problem. If heroin was made CVS-able without prescription, I would not guarantee that I wouldn't try it, and that scares me because I know how dangerous it is.
- paulmd 10y ago
  Honest question, do you have an alcohol problem or addictive personality that is driving this fear? If not, what keeps you from drinking yourself to sleep on the sidewalk every night? When it comes down to it, not all drugs are equal. Heroin isn't "alcohol but worse". People who drink tend to get pretty nasty sometimes, and that's a social harm that someone who's nodding doesn't perpetrate. And in terms of physical harm, heroin is actually pretty low compared to alcohol. Lots of people destroy their livers with alcohol and die early, while there's an awful lot of rockstars who do piles of heroin and cocaine and live to their 70s and beyond (we need to start worrying about the kind of world we're going to leave for Keith Richards). The harm comes from getting bathtub stuff of uncertain potency and purity, and from the things people need to do to afford their fix. If it's clean and affordable you tend to do fairly well on both the 'personal' and 'social' harm aspects. Obviously that's not how DARE told you to feel, but the fact is that the current state of things is not the only one that is ever possible. You don't know what social use would look like in a society with legalized heroin usage. If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away. Some people will still choose to do it, but we free up a whole bunch of police money that can be redirected to free treatment resources to help people quit when they realize they aren't going to find happiness in drugs.
  - jayajay 10y ago
    If this were several years ago and I was still a college freshman, I bet I would have tried heroin if it was available for 5 bucks a pop next to the Benadryl at CVS. Things much more innocent than heroin get in the way of a freshman, so yeah, I would be concerned if heroin was on the shelf for anyone who is 18 right now.
    - chillacy 10y ago
      I would've too, but I'm fairly confident it would have been a one-time-only thing. I had a roommate, smart lawyer kid, who talked casually about doing cocaine one day, which surprised me since back then I drew a line between "hard drugs" like cocaine, H, meth, and "soft drugs" like marijuana, LSD, and the like. And this guy seemed (and still is) like such a smart, successful person. He told me that drugs don't change who you are... if you're a cautious person who has self control, that doesn't change.
edblarney 10y ago
"alcohol, which is typically assessed as having roughly similar social harm to heroin" This is absurd. There is no place on earth where it is 'typical' to consider alcohol to be more dangerous than heroin. The ridiculous 'research' on alcohol v. heroin make comparisons as to 'how many accidents are caused by each' etc. in society, which is obviously not a fair comparison considering once is widely used, the other very infrequently. Opioids are extremely addictive, and destructive in almost all cases of use.
- echlebek 10y ago
  > destructive in almost all cases of use. Demonstrably false. The vast majority of opioid users are recovering from surgery, taking Tylenol 3, etc. You're basically just talking out of your butt here.

zkms 10y ago

Opioid use is not inherently dangerous (indeed, long-term pharmaceutical-grade opioid use is remarkably safe does not cause organ damage, unlike alcohol). There are several actual circumstances where opioid use gets dangerous to life and they are: 1) Dosage/concentration uncertainty 2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues) 3) Poly-drug use -- such as combining opioids with benzos to exploit synergistic effects When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl. The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use. There are definitely real harms involved with / caused by opioid use today -- but most of those are caused by (or greatly worsened by) opioid prohibition.

jayajay 10y ago
Good points, but what about addiction and neurotransmitter equilibrium? If something is addictive enough, and highly available, do you think that it would become an unnecessary brain dependency?
- zkms 10y ago
  I feel like someone functions better with their regular, stable dose of pharmaceutical-grade opioids in them -- I don't have any medical or moral issue with that at all. It's honestly...a lot like the hair dryer anecdote in http://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ http://slatestarcodex.com/2014/11/21/the-categories-were-mad.... As for the LD50 issue -- yes, opioid-naive (non-tolerant) users will have a low LD50 but they also won't need much a dose to get the effects. As people get opioid tolerant, the dose that will kill them also increases in step. It's not a case of "user needs higher and higher dose but needs to not cross a fixed LD50 threshold". Because opioids mostly just affect opioid receptors (unlike stuff like alcohol, which is hepatotoxic), tolerance means the LD50 increases in step with the effective dose. The popular picture of the heroin addict who has to use higher and higher doses to get the desired "high" is a creation of prohibition -- there's no inherent need to do anything of the sort if one has proper medical access to the right dose of prescription opioids. Moderate and safe opioid use is difficult under prohibition if only because it's hard to moderate oneself without precise and pure measured doses. There's plenty of people who engage in moderate long-term opioid use, between pain patients or "high functioning" heroin users. Those people tend not be the face of opioid use precisely because they have access to the drugs in ways that are stable, safe, not life-ruiningly expensive, and doesn't place them in regular contact with criminal organizations. They aren't exposed to the worst harms of prohibition and that's why they're able to keep using (without anyone knowing that they use) and have a stable career/family. To be clear, none of this is to say that opioids are harmless or that should be handed out like candy -- they're serious drugs and should be used responsibly by people who are aware of the risks/contraindications.

theptip 10y ago

The LD-50 of heroin is high relative to the recreational dose; it's widely regarded to be a relatively safe drug, when administered pure. Many governments have programs that administer heroin prescriptions to addicts, e.g. Switzerland [1]. Wikipedia gives the overdose level at 75-600mg[2], and Erowid reports the recreational dose at 5mg[3] (both for "opiate-naive" individuals, i.e. no tolerance). >10x is a high safety margin; alcohol is of the order of 10x for reference. The piece you're missing here is that the primary risk of accidental overdose is greatly increased with illicit heroin where the purity is unknown, and can fluctuate wildly as it always cut to some extent, but seldom predictably so. In the case of heroin, most of the harm from usage is directly caused by prohibition. [1]: https://www.ncbi.nlm.nih.gov/pubmed/11705488 https://www.ncbi.nlm.nih.gov/pubmed/11705488 [2]: https://en.wikipedia.org/wiki/Heroin#Overdose https://en.wikipedia.org/wiki/Heroin#Overdose [3]: https://www.erowid.org/chemicals/heroin/heroin_dose1.shtml https://www.erowid.org/chemicals/heroin/heroin_dose1.shtml

jayajay 10y ago
Impure drugs is certainly a big problem, and is the most compelling reason for legalization and healthcare instead of incarceration and war. Only a single order of magnitude is not enough of a safety margin, depending on the substance, and how easy it is to administer the substance. Is alcohol's LD50/dose ratio an apt comparison? Does alcohol require a higher administration energy than heroin? It seems like it would be easier to "accidentally" consume half a gram of heroin in a small amount of time, as opposed to "accidentally" consuming 100 beers (or 2 handles). Drug users experiment across this mere 10x range effortlessly, according to your source: > As usage increases, however, the doses get much higher Apparently, they get to 100x. Crazy!: > The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg This seems to support my view. I can't help but imagine a dystopian future (past?) where they start selling a soda called "HeroHera" which has trace amounts of heroin in it. Anyways, it seems pretty dangerous for brains to depend on the naive-LD50 of heroin. Forgetting to consume it after one has an established a dependency must surely be an issue. How do we know that a potential widespread dependency on heroin and a requirement for widespread heroin sanctuaries won't actually cost more than the war on drugs?