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> Isn't the counterargument to this to point out the Oxycontin abuse epidemic? I don't see the origins of addiction relevant to arguments about containing curr

by _jal 10y ago

> Isn't the counterargument to this to point out the Oxycontin abuse epidemic? I don't see the origins of addiction relevant to arguments about containing current addiction when it moves to the illegal market. But I agree that supply-side targeting when talking about legal industry makes a lot of sense. Being legal, they also have lobbyists, which reduces the impact, same as other legal drug suppliers. > If violence is coming from addicts and not from suppliers Others have mentioned this, but opiate abusers don't get violent when high. Some small percentage sometimes get violent when they run out of money to score. Experiments elsewhere suggest that it is a lot cheaper (in money and in human costs) to contain, (in some way) legalize and (if they want it) help them get clean then clean up after them.

tptacek 10y ago
I'm not sure I was arguing that opiate addicts are violent when they're high. I'm not making a moral argument about legalization or even (as is being repeatedly suggested on this thread) subsidization of opiates. I'm saying that if the cause of the epidemic is prescription opioids, and the ultimate problem is "too many people are non-functional opioid addicts", then deregulation won't fix the problem.
- narag 10y ago
  I'm not sure "epidemic" is a good word here. When compared with infectious diseases, we see that cause (the microbe) and effect (from fever to death) are clearly related. Here we have deaths caused by a prescription. Why were opioids prescribed to start with? And if abused, why?
  - tptacek 10y ago
    I'm just using the article's term, and thinking in terms of what the problem is, and what the likely solutions are.
- microtherion 10y ago
  > too many people are non-functional opioid addicts Experience here in Switzerland would suggest that if the state takes dirty needles, expensive supply, and highly variable purity out of the equation, opioid addicts can lead a life that is, while far from ideal, considerably more functional than before. My impression is that drugs like Heroin, taken in correct dosage, do not inherently cause massive health damage. It's not clear how deregulation would work with drugs like meth, which DOES seem to inherently cause health damage.
  - digler999 10y ago
    > Heroin, taken in correct dosage by what ROA ? You smoke it, and you're good until your dependence increases. Then you must smoke it to feel normal. But if you slam it, you'll get high again. Do that a while and your dependence increases just as before, now you have to slam it just to feel normal. But if you just got someone to give you their dose, then you could slam 2 doses and get high again...and now you're in overdose territory
    - microtherion 10y ago
      By "correct dosage", I meant that there exists a dosage for each patient that neither induces withdrawal symptoms nor causes acute health risks.
  - DanBC 10y ago
    > It's not clear how deregulation would work with drugs like meth, which DOES seem to inherently cause health damage. Pure clean meth causes harm. Dirty street meth obtained using the methods addicts use would be more harmful to the addict and to society.
    - stagbeetle 10y ago
      There is prescription meth called Desoxyn.
- jessaustin 10y ago
  If we believe that some addicts can be helped to deal more productively with their addiction (personally I think that's true), and we observe that prohibition tactics don't help addicts get that help (see TFA and basically every other serious examination of this), then ending prohibition will certainly help some addicts. One might argue that more people would start using without prohibition, but that would be pretty lame in the context of the Pill Doctor Pipeline described here.
  - tptacek 10y ago
    I understand that it's difficult to avoid litigation of decriminalization (or, apparently, subsidization) in discussions about illegal drugs. I'm generally receptive to decriminalization. But I'm not making a point about decriminalization. In the same way that it's counterproductive to spend a lot of time talking about prohibition in mass incarceration discussions (significant reduction in incarceration --- which is absolutely necessary --- will require us to adjust sentencing and policies surrounding violent crime among offenders who have never been convicted of drug offenses), spending a lot of time talking about free heroin isn't going to help us if the problem underlying the opiate crisis isn't heroin prohibition, but instead overprescription and negligent formulation of opiate painkillers.
    - kevinmchugh 10y ago
      Are prescription opiate users as likely to overdose as heroin users? My understanding is that they are not. If you're buying oxycontin at CVS, you're getting oxycontin in the dosage prescribed. At least once a year in Chicago we see a news story about dozens of people hospitalized after using what they bought as heroin but which was not. Making heroin available to those who want or need to use it may reduce deaths or even hospitalizations without changing the number of opiate users.
      - rev_null 10y ago
        You are assuming that the people prescribed oxycontin are following the label. If they go through a months supply in a week, then suddenly heroin is the next best option.
- vidarh 10y ago
  > "too many people are non-functional opioid addicts" Part of the issue with things like heroin is that unlike many weaker drugs the highs are brief. Heroin addicts are as a result very often highly functioning if they don't have to worry about where to get their next high and can get highly consistent doses. I worked with one years ago, and we only realised when a series of large busts drove prices through the roof and he started spending his time looking really nervous and on the phone until suddenly disappearing for two days once prices normalised and he "made up" for the stress by staying high most of those two days before checking himself into a hospital (which was when we finally found out). He was married and had kids, and neither his family or his co-workers had noticed a thing through years of addiction prior to that, despite having to struggle with an illegal supply. There are lots of problems with heroin, but many of the worst ones are a direct result of addicts inability to meet their needs in a quick and "safe" way.

by _jal 10y ago

tptacek 10y ago

I'm not sure I was arguing that opiate addicts are violent when they're high. I'm not making a moral argument about legalization or even (as is being repeatedly suggested on this thread) subsidization of opiates. I'm saying that if the cause of the epidemic is prescription opioids, and the ultimate problem is "too many people are non-functional opioid addicts", then deregulation won't fix the problem.

narag 10y ago
I'm not sure "epidemic" is a good word here. When compared with infectious diseases, we see that cause (the microbe) and effect (from fever to death) are clearly related. Here we have deaths caused by a prescription. Why were opioids prescribed to start with? And if abused, why?
- tptacek 10y ago
  I'm just using the article's term, and thinking in terms of what the problem is, and what the likely solutions are.
microtherion 10y ago
> too many people are non-functional opioid addicts Experience here in Switzerland would suggest that if the state takes dirty needles, expensive supply, and highly variable purity out of the equation, opioid addicts can lead a life that is, while far from ideal, considerably more functional than before. My impression is that drugs like Heroin, taken in correct dosage, do not inherently cause massive health damage. It's not clear how deregulation would work with drugs like meth, which DOES seem to inherently cause health damage.
- digler999 10y ago
  > Heroin, taken in correct dosage by what ROA ? You smoke it, and you're good until your dependence increases. Then you must smoke it to feel normal. But if you slam it, you'll get high again. Do that a while and your dependence increases just as before, now you have to slam it just to feel normal. But if you just got someone to give you their dose, then you could slam 2 doses and get high again...and now you're in overdose territory
  - microtherion 10y ago
    By "correct dosage", I meant that there exists a dosage for each patient that neither induces withdrawal symptoms nor causes acute health risks.
- DanBC 10y ago
  > It's not clear how deregulation would work with drugs like meth, which DOES seem to inherently cause health damage. Pure clean meth causes harm. Dirty street meth obtained using the methods addicts use would be more harmful to the addict and to society.
  - stagbeetle 10y ago
    There is prescription meth called Desoxyn.
jessaustin 10y ago
If we believe that some addicts can be helped to deal more productively with their addiction (personally I think that's true), and we observe that prohibition tactics don't help addicts get that help (see TFA and basically every other serious examination of this), then ending prohibition will certainly help some addicts. One might argue that more people would start using without prohibition, but that would be pretty lame in the context of the Pill Doctor Pipeline described here.
- tptacek 10y ago
  I understand that it's difficult to avoid litigation of decriminalization (or, apparently, subsidization) in discussions about illegal drugs. I'm generally receptive to decriminalization. But I'm not making a point about decriminalization. In the same way that it's counterproductive to spend a lot of time talking about prohibition in mass incarceration discussions (significant reduction in incarceration --- which is absolutely necessary --- will require us to adjust sentencing and policies surrounding violent crime among offenders who have never been convicted of drug offenses), spending a lot of time talking about free heroin isn't going to help us if the problem underlying the opiate crisis isn't heroin prohibition, but instead overprescription and negligent formulation of opiate painkillers.
  - kevinmchugh 10y ago
    Are prescription opiate users as likely to overdose as heroin users? My understanding is that they are not. If you're buying oxycontin at CVS, you're getting oxycontin in the dosage prescribed. At least once a year in Chicago we see a news story about dozens of people hospitalized after using what they bought as heroin but which was not. Making heroin available to those who want or need to use it may reduce deaths or even hospitalizations without changing the number of opiate users.
    - rev_null 10y ago
      You are assuming that the people prescribed oxycontin are following the label. If they go through a months supply in a week, then suddenly heroin is the next best option.
vidarh 10y ago
> "too many people are non-functional opioid addicts" Part of the issue with things like heroin is that unlike many weaker drugs the highs are brief. Heroin addicts are as a result very often highly functioning if they don't have to worry about where to get their next high and can get highly consistent doses. I worked with one years ago, and we only realised when a series of large busts drove prices through the roof and he started spending his time looking really nervous and on the phone until suddenly disappearing for two days once prices normalised and he "made up" for the stress by staying high most of those two days before checking himself into a hospital (which was when we finally found out). He was married and had kids, and neither his family or his co-workers had noticed a thing through years of addiction prior to that, despite having to struggle with an illegal supply. There are lots of problems with heroin, but many of the worst ones are a direct result of addicts inability to meet their needs in a quick and "safe" way.