4 ms·

Opioid use is not inherently dangerous (indeed, long-term pharmaceutical-grade opioid use is remarkably safe does not cause organ damage, unlike alcohol). There

by 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.
  - jayajay 10y ago
    These are all good points, in agreement with the general consensus here. I think most people here can agree that uncertain (i.e. impure, unpredictable) doses of pretty much anything is far worse than having predictable doses. You also mention the LD50 is a function of tolerance, which, of course makes sense. My main concern is the backlash of suddenly stopping opioid consumption after one has reached a significantly higher (compared to the naive values) personal LD50 and dosage.
edblarney 10y ago
"Opioid use is not inherently dangerous" Yes, it is. It's extremely addictive, and is very well known to destroy lives.
- xorxornop 10y ago
  They most certainly can - but the majority of the harms actually result from our treatment of the issue, not the issue itself. I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so. If the first step of a plan says something like "1) First, change fundamental human nature", the plan really needs a rethink.
  - edblarney 10y ago
    "but the majority of the harms actually result from our treatment of the issue, not the issue itself." Total nonsense. Please tell me what 'harms' come from heroin treatments? The primary 'treatment' for heroin addiction is to simply 'not do heroin'. Stop doing it. Ultimately, that's the only way out. " I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so." No - again false. Law of Supply and Demand: if we make it hard enough to get, and raise the barrier of supply, and also try to push back demand by teaching kids not to use it - then it becomes rare. Enabling users lowers the 'difficulty of access', like lowering the cost curve - and creates more usage. Anyhow who is caught in public, high on heroin, can be asked to go to a dry out clinic where they won't have access to it. They have to go through withdrawal.
    - jayajay 10y ago
      > "the treatment for heroin addiction is to simply not do heroin... ...they have to go through withdrawal." This is true for people who do not consume heroin a priori. For the others, suddenly stopping heroin use can be life threatening. Most people need assistance to wane off of things like that. Also, I think you are right that enabling will increase usage, but you must also consider the black markets which are enabled in response to disabling the regulated markets. It seems like a majority viewpoint on this thread is that it's better for more people to be using real opioids safely than to have a smaller, effectively invisible/black-market population using "opioids" very, very dangerously.

by zkms 10y ago

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.
- jayajay 10y ago
  These are all good points, in agreement with the general consensus here. I think most people here can agree that uncertain (i.e. impure, unpredictable) doses of pretty much anything is far worse than having predictable doses. You also mention the LD50 is a function of tolerance, which, of course makes sense. My main concern is the backlash of suddenly stopping opioid consumption after one has reached a significantly higher (compared to the naive values) personal LD50 and dosage.

edblarney 10y ago

"Opioid use is not inherently dangerous" Yes, it is. It's extremely addictive, and is very well known to destroy lives.

xorxornop 10y ago
They most certainly can - but the majority of the harms actually result from our treatment of the issue, not the issue itself. I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so. If the first step of a plan says something like "1) First, change fundamental human nature", the plan really needs a rethink.
- edblarney 10y ago
  "but the majority of the harms actually result from our treatment of the issue, not the issue itself." Total nonsense. Please tell me what 'harms' come from heroin treatments? The primary 'treatment' for heroin addiction is to simply 'not do heroin'. Stop doing it. Ultimately, that's the only way out. " I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so." No - again false. Law of Supply and Demand: if we make it hard enough to get, and raise the barrier of supply, and also try to push back demand by teaching kids not to use it - then it becomes rare. Enabling users lowers the 'difficulty of access', like lowering the cost curve - and creates more usage. Anyhow who is caught in public, high on heroin, can be asked to go to a dry out clinic where they won't have access to it. They have to go through withdrawal.
  - jayajay 10y ago
    > "the treatment for heroin addiction is to simply not do heroin... ...they have to go through withdrawal." This is true for people who do not consume heroin a priori. For the others, suddenly stopping heroin use can be life threatening. Most people need assistance to wane off of things like that. Also, I think you are right that enabling will increase usage, but you must also consider the black markets which are enabled in response to disabling the regulated markets. It seems like a majority viewpoint on this thread is that it's better for more people to be using real opioids safely than to have a smaller, effectively invisible/black-market population using "opioids" very, very dangerously.