9 ms·

I supported legalizing all drugs, then the opioid epidemic happened

46 points by abhi3 10y ago

seibelj 10y ago
I don't see how forcing addicts to purchase heroin on the street is safer than getting it prescribed by a doctor. People wouldn't overdose if they knew exactly how strong the drugs they injected were, they OD when the drug is unexpectedly powerful, especially when laced with fentanyl. I don't think you should be able to purchase heroin at 7/11, but certainly there is something better than total prohibition. If you want to keep killing people, force addicts to buy opiates on the street.
- TerminalJunkie 10y ago
  If you were able to get drugs from a pharmacy or dispensary or a regulated service, there would't (hopefully) be a black market to supply the drugs which creates untold violence. I have a completely untested theory that the number of deaths would be less with a well regulated legalization of drugs than with an unregulated black market where gangs and organized crime supply the demand for illicit substances.
  - bluedino 10y ago
    >> If you were able to get drugs from a pharmacy or dispensary or a regulated service, there would't (hopefully) be a black market Medical marijuana is legal where I live, you can buy it at a regulated service, however there are plenty of people who still buy it on the street or produce more than they are legally able to and sell the excess.
    - toolz 10y ago
      Yeah, then the black market goes from some cartel pipeline to someone in your neighborhood. There's a huge difference in regards to funding violence.
      - nannal 10y ago
        Except Joe who grows weed in his cupboard isn't really capable of producing heroin let alone the extraordinarily dangerous opium derivatives that pharmaceutical are pushing on doctors.
        nyolfen 10y ago
        welcome to our grim cyberpunk (near-)future: https://www.wired.com/2015/08/dont-try-home-scientists-brew-opiates-yeast/ https://www.wired.com/2015/08/dont-try-home-scientists-brew-...
        nnfy 10y ago
        If Joe can grow weed in his cupboard, he absolutely can grow poppies and produce opium. The process is not complex.
        narrowrail 10y ago
        The required acreage to yield opium in significant quantities is way beyond a closet (or even a basement). Not to mention that heroin is ~1% of total opium weight.
        nnfy 10y ago
        If we're talking about Joe's personal use, a single poppy plant produces multiple doses, according to this[1] reference and some anecdotal drug forum dose suggestions, on the order of tens of mg. 1.https://erowid.org/archive/rhodium/chemistry/opium.html https://erowid.org/archive/rhodium/chemistry/opium.html
        narrowrail 10y ago
        >produces multiple doses Could you tell me what number "multiple" is and what a "dose" looks like? Are we talking about raw plant material that is opium, or refined heroin/morphine/codeine? The conflation of the word drugs and plant material seems like the most absurd gorilla in the room. Off to do some coffee...
  - arprocter 10y ago
    Portugal decriminalized in 2001 and guess what happened[0] [0]https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/?utm_term=.a2a535945f50 https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-h...
  - qbrass 10y ago
    There's already a black market for prescription drugs. Because there's still a barrier to access, providing a way around it still provides profit.
    - NotSammyHagar 10y ago
      There's a black market because most people can't just get a prescription from a doctor, they have to lie or get someone else's drugs, there isn't enough legal availability to rule it out.
- zzalpha 10y ago
  Absolutely. There's one sure way to control an epidemic like this: education. That means educating the populace on just how addictive and dangerous these drugs are, educating law enforcement to treat addicts as people who are sick instead of simply stigmatizing criminality, and educating the medical community so that these drugs aren't handed out so casually, and in cases where they are appropriate, that patients are closely monitored for signs of addiction. And the latter would benefit greatly from the US restricting drug company advertising and lobbying (this crisis was helped along significantly because of Purdue's marketing of Oxy in the 90s) so that medical decisions are made based on science and not marketing... but we know what the odds are of that happening.
  - ipnon 10y ago
    I think most people know heroin is dangerous. They start taking it because they don't have an incentive not to. A lot of people in places hit worst by the opioid epidemic don't have much of a reason to get up in the morning, whether that be for lack of job opportunities, a weak social network, or some more general malaise. If there life is already disappointing, there's no reason to not take heroin. The worst that can happen is that there life becomes bad, but it already is.
    - zzalpha 10y ago
      Many many people don't start with heroin, nor do they turn to drugs for the reasons you cite. They start with back pain due to a workplace injury, for which a doctor immediately prescribes them a powerful opiod (and perhaps a companion drug to deal with the resultant constipation). Because it's "medicine", these people don't fully understand the risk of addiction nor do they recognize the signs of addiction and tolerance as they develop. Meanwhile, the doctor shirks their duty by not remaining in constant contact with the patient to manage any dependency should it occur. These individuals eventually become addicted because the drugs lose efficacy over time (and in the case of Oxy, don't actually work for as long a period of time in the body as claimed, forcing people to up their own dosage). And thus the spiral of addiction begins. Because of the lack of public awareness and the shame and stigma of addiction, people don't seek out help. Instead they try to manage the problem themselves. Ultimately, once addicted they turn to street drugs because they're a) cheaper, and b) more readily available.
- lightedman 10y ago
  " People wouldn't overdose if they knew exactly how strong the drugs they injected were" Opiates are highly unpredictable. The exact same 'homogenized' batch can kill you at any time. One dose you can slam half a syringe, next dose a day or two later, you can do 1/4 that amount and die.
  - nnfy 10y ago
    Right, that's why people are dropping dead left and right from prescription opioids, hospital injections of morphine, opioid patches... No drug has this kind of unpredictable physiological profile, you're spreading nonsense. I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that.
    - darpa_escapee 10y ago
      People do drop dead from prescription opioids. Hospital injections of morphine are done under close supervision by trained staff. Fentanyl patches do kill. > I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that. That is an inherently unpredictable situation. We cannot predict or measure the subjective and changing tolerance a patient has to opioids.
      - nnfy 10y ago
        The comment implied that repeated doses to a given person are wildly unpredictable. This is false. Further, you absolutely can approximate how long tolerance lasts, but my point was that you can predict that your tolerance is reduced after abstinence, as opposed to the original comment which suggested that all dosing was unpredictable.
        darpa_escapee 10y ago
        > The comment implied that repeated doses to a given person are wildly unpredictable. This is false. I didn't imply that repeated doses are unpredictable. Regular repeated dosages can be predictable as long as the patient remains stable with regards to infection/health and other drugs they ingest. Initial dosages, dosage increases and returning to a previously safe repeated-dose after cessation are not at all predictable. This is why I mentioned titration in a previous comment: subjective response to drugs and subjective tolerance cannot be accurately predicted or measured. This is also why drugs like Subutex are titrated when beginning suboxone treatment: a doctor cannot accurately measure tolerance to determine how much of the drug is needed to keep a person out of withdrawals. > you absolutely can approximate how long tolerance lasts Naloxone or naltrexone induced withdrawal rapidly diminishes tolerance faster than it would naturally. This suggests that there's a function that can accurately output a safe and effective dose of opioids based on the variables of previous dosage and time since cessation. I'm arguing that there is a missing variable that's unable to be measured accurately: each person's subjective tolerance. That subjective tolerance depends on a multitude of factors that cannot be determined clinically.
- cowmoo728 10y ago
  The other common cause of OD is relapse. 30 day drug programs are not very good at getting people to quit, but they are good at lowering tolerance enough to make their previous doses life-threatening. This is another reason medical supervision of addicts saves lives.
- darpa_escapee 10y ago
  > People wouldn't overdose if they knew exactly how strong the drugs they injected were This is not how tolerance works. The same dose can have vastly different effects depending on how long it was since your last dose, other drugs in your system and your body's natural tolerance that might be diminished by exhaustion or infection. The dose someone uses to feel baseline today might have them completely dysfunctional in a few days or kill them after a couple of weeks.
  - nnfy 10y ago
    Everything you said outside of tolerance is exceedingly rare. If you're not taking one of a handful of herbal supplements, you are extremely unlikely to have a measurably different response to the same dosage of opioid. And the effects will not be vastly different. Just varied in intensity.
    - darpa_escapee 10y ago
      > If you're not taking one of a handful of herbal supplements, you are extremely unlikely to have a measurably different response to the same dosage of opioid. If you've taken any common CNS depressant, such as alcohol, benzodiazepines, psychiatric drugs, drugs that are metabolized by the same pathways as opioids, even blood pressure medication or sedatives including antihistamines, you are going to potentiate the CNS depression from opioids. > And the effects will not be vastly different. Just varied in intensity. The scale of intensity of effects from a dose of an opioid varies from: enough to get a patient out of withdrawals to completely stopping breathing. Titration of dose is the only way to more accurately determine a safe and effective dosing schedule for opioids.
      - nnfy 10y ago
        I concede that I neglected drug interactions; however when you said vastly different effects, I interpreted it as meaning unique effects based on dosage, similar to something like DXM, as opposed to two ends of a relatively linear scale of analgesia->sedation->death. Which is untrue.
- jmngomes 10y ago
  Agreed, and this has been tried in Switzerland with positive results; to quote just one: "The cost-benefit analysis showed a considerable reduction in costs for medical care and law enforcement; the benefits per day and patient amount to the double of the daily treatment costs in HAT (Frey et al 2000)." in https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht1-e.htm https://sencanada.ca/content/sen/committee/371/ille/presenta...
- gjmacd 10y ago
  Agree. Control it, regulate it, distribute it. We do this with alcohol. It doesn't prevent people from getting addicted, but it certainly prevents people from having to resort to crimes to get the product because it's illegal.
  - actsasbuffoon 10y ago
    The article isn't about committing crimes in order to get drugs, it's about people dying because pharma companies got greedy. Additionally, alcohol kills more people than opiates every year, so I'm not sure that's a good sign for the effects of legalization.
- EnFinlay 10y ago
  Article: > and legal painkillers are still linked to most opioid overdose deaths. Your comment: > People wouldn't overdose if they knew exactly how strong the drugs they injected were Is your comment a knee jerk reaction to an anti-legalization headline because it doesn't appear to be related to the actual content or points raised in the article.
- dontreact 10y ago
  The problem is that it has been proven that it is easy for large pharmaceutical companies to deceptively represent these drugs. Oxycontin has been marketed as being effective at managing pain for 12 or sometimes even 24 hours, but this is not the case in many users and this is a big factor in why the drug is so addictive. http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ What about the Portugese model described in the article (legal for consumption, illegal to commercialize), with some of the funds spent on controlling drug related violence instead being turned towards treatment centers where addicts can get something like Methadone?
  - actsasbuffoon 10y ago
    I strongly agree. I'm as anti-drug as it gets, but locking up non-violent drug users with rapists and murderers doesn't make sense. If our goal is to help drug addicts get clean, prison is a terrible strategy. There's a kind of despair spiral that kicks in for some addicts. Life isn't going well, so they turn to drugs to ease the pain. Then they get arrested, sent to prison, and get labelled as a felon. Now they can't get a job or have a stable living arrangement and they turn back to drugs to get through the despair. For these people, we need to break the cycle if we're ever going to help them get clean. Making their lives worse will only further entrap them.
- jimbokun 10y ago
  But the opioid epidemic did not stem from addicts purchasing heroin on the street, but from doctors prescribing them, backed by government efforts to encourage their use, and industry lobbying and advertising. That's a lot more powerful formula for starting a drug epidemic, than people buying heroin illegally off the street. At least there's no confusion about "experts" and "science" and "doctors" promoting something as safe and effective.
  - snarf21 10y ago
    Right this is the problem. We need to ban all opioid prescriptions. 80% of heroin addicts got addicted because of the opioid prescriptions obtained legally. According to the documentary on HBO, drug companies made $5B on opioids in 2014 but the economic costs were $55B. If people have chronic pain, we need to be more progressive and allow medical marijuana everywhere. (There are also quite a few studies that show that chronic pain is not helped with opioids anyway.) If people are in the hospital or end-of-life/hospice, then give them morphine or whatever they need but we need zero prescribable opioids.
    - thesmallestcat 10y ago
      For painkilling, MMJ may as well be aspirin when compared to powerful opiates. Over-prescription of powerful opiates is the issue. Banning all opiate prescriptions would be cruel, forcing people to the black market at best.
    - bdavisx 10y ago
      Yeah, banning opioids isn't the solution, unless you think people should needlessly suffer. I've had a hernia surgery and my wife had throat surgery, and I don't think that marijuana would have been the answer for the first several days after either surgery.
      - DanBC 10y ago
        >> If people have chronic pain Chronic pain refers to long term pain. Your hernia surgery is short term pain. No-one credible is suggesting preventing using opioids for short term (such as post operative) pain (although it does seem that Drs in the US prescribe too much for this type of pain).
brilliantcode 10y ago
I used to be very pro-legalization of all drugs in my early 20s but I've shifted completely after seeing so many Fetanyl overdose cases in Vancouver as well as now we are seeing Elephant tranquilizers make its way. Some drugs are just too damn harmful to even be consumed by it's end users. The thing about opiod is that it completely warps the human mind. Outside of managing extreme pain, it really should be banned. For those who are addicted, they should not be viewed from a legal platform but medical care that actively tries to rehabilitate them. Agreed. I can't believe some people still view drug use as criminal behavior. These are people who otherwise are out of coping resources and variety of other factor. It should be handled with medical assistance, not locking them up and creating life long criminals/addicts in the process. I think Portugal is a great demonstration of what I've illustrated - helping addicts while going after the supply and providing a publicly accessible harm reduction platform and alternative to hard drugs. Vancouver has safe injection sites but it's hard to go after the dealers as they are highly decentralized and blends right in or often protected by layers of addicts who sell to support their own high.
- AQuantized 10y ago
  You can be pro-legalization without being "pro-drug." In the sense that criminalizing drugs doesn't necessarily reduce usage.
  - armenarmen 10y ago
    It's funny how often people conflate these. I can be pro freedom of religion but an atheist. Support of the freedom to do anything != an endorsement
  - dontreact 10y ago
    Just want to point out that the article is actually in favor of decriminalizing drugs.
- reefoctopus 10y ago
  Prohibition is the cause of the fetanyl epidemic. As enforcement increases so does potency because smaller portions are easier to smuggle. Fentanyl is ~50x stronger than heroin which means 50x the payoff for smuggling the same quantity, but it's also much easier to misjudge the dosage. https://en.wikipedia.org/wiki/Iron_law_of_prohibition https://en.wikipedia.org/wiki/Iron_law_of_prohibition Yes, opioids are terrible for the human mind and spirit, but the unintended consequences of prohibition make them that much worse.
junto 10y ago
I recently visited my gran, who told me she has prescriptions for Co-codamol and Tramadol. She had no idea how addictive they were and was popping them down like candy. The doctor had given her no warning as to how addictive they are. I told her to speak to her GP and that she should consider disposing the tablets at her local pharmacy. A recent study showed that on average it takes 10 days for a patient to become dependent and addicted to opiates like these and weaning people off them is a horrible experience for the patient.
3pt14159 10y ago
I've come to believe that the unabomber, though horribly misguided in terms of tactics and conclusion, was right about one thing: Maybe one day things will be different, but for now, humans are not designed to live in the manner that they do. We were meant to climb and run. Maybe even to work the soil and to create wine. But evolution isn't fast enough to keep up with the rate of change of technology. We're in cars and looking at computers. We're comparing ourselves to the best people on the planet. We're pulling out the fibre from our food and loading it up with sugar and trans fats. I've come to view drugs and alcohol as symptoms. We've probably co-evolved with alcohol, since it's correlated both to genetics and with intelligence. Maybe it's the method that evolution allows people to be honest enough for social cooperation, while being dishonest enough to cheat on a spouse occasionally. But when it comes to drugs like opioids, I tend to think it's people filling a void from a lack of self worth. Overweight, stressed financially due to easy credit, depressed, usually sick in some way. Banning opioids isn't going to help any more than banning cocaine has helped. So how to get out of it? Make use more similar to how we used to live and take away or tax the things that we haven't adapted to yet. Opioids should be taxed, highly regulated, and we should start working on mental health and education, but we also need redesigned cities with more reliance on self-propulsion (bikes, skiing, walking, running). We need redesigned food laws that focus on consequences not on arbitrary labelling requirements. We should outright ban foods for children that we're sure destroy their lives, like soft drinks or fruit juice. (Yes, fruit juice. Without fibre it's just empty sugar. Kids get enough Vit C in a single apple. One in four children in the US has pre-diabetes and one in four seniors have full blown diabetes, we need to start treating refined sugar as a poison.) I'm sure a certain part of the epidemic is people not knowing that these were hyper-addictive and then getting addicted, but I don't really think it's the primary cause. Also, we should start using safer drugs that we've evolved around for pain management and therapy. Magic mushrooms, cannabis, etc.
- bluedino 10y ago
  >> We're in cars and looking at computers. We had opium problems since morphine/heroin have been around. Plenty of people were using in the late 1800's and it wasn't banned until the early part of last century.
coretx 10y ago
People revert to opiods because of better alternatives either being too expensive or not available. The designer dope industry can supply alternatives for all kinds of populair drugs. Including MDMA, amphetamines, opiods, khat, cocain and more. These alternatives can be created at a dirt cheap pricepoint and often come with significantly reduced health impacts; by design. The actual production and R&D of these synthetic substances however is illegal, and so are the precursors and the precursors of the precursors, increasing the price up to the point they can no longer compete with primitive and more unhealthy alternatives such as for example heroin. No matter how you spin it, the "War on Drugs" costs much more money & lives than drugs at large. Let's respect citizens thus the right to self determination - Legalize & Regulate all the things!
pcmaffey 10y ago
Tldr; Don't give big pharma another product. They're an irresponsible, poorly regulated system, directly to blame for the opiod epidemic.
lisper 10y ago
> Faced with an excessively harsh criminal justice system and a legal industry that carelessly causes drug epidemics, I have come down somewhere in the middle of these two extremes. But the middle is where we are now. Opioids are highly regulated. It is illegal to possess them without a doctor's prescription. The regulatory regime is so strict that some doctors are afraid to prescribe them at all [1]. And yet, here we are. The free-market answer is to allow civil suits against drug manufacturers for damages caused by overdoses. That's not a perfect solution either, but it's a hell of a lot better than what we have now. At least it doesn't produce perverse incentives the way all other proposed solutions do. [1] http://www.health.com/health/condition-article/0,,20189399,00.html http://www.health.com/health/condition-article/0,,20189399,0...
- sehugg 10y ago
  The free-market answer is to allow civil suits against drug manufacturers for damages caused by overdoses. We'll see how that goes -- Cherokee Nation sues drug firms, retailers for flooding communities with opioids: https://www.washingtonpost.com/investigations/cherokee-nation-sues-drug-firms-retailers-for-flooding-communities-with-opioids/2017/04/20/03d04a74-2519-11e7-b503-9d616bd5a305_story.html?tid=ss_tw&utm_term=.c3911f5ba16b https://www.washingtonpost.com/investigations/cherokee-natio...
such_a_casual 10y ago
Only children think that making X against the rules makes X go away. Regulation and first world health care (ie free health care) are some steps you can take to address the problem. Making addicts criminals shows irresponsibly poor leadership.
- armenarmen 10y ago
  I agree entirely with your first point. Sadly though, the free healthcare bit works against a sensible legalization path. The pearl clutching puritans have a legitimate gripe with drug use if they, the taxpayers, are forced to fund the fallout of drug abuse. Turning a personal, though be it poor, decision to use hard drugs from a personal issue into a public one.
deleted 10y ago
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bonniemuffin 10y ago
Rat park is highly illuminating in this conversation, and suggests that drug addiction is just a symptom. When people (or animals) are forced into a life of social and cultural isolation, drugs become the most appealing thing they have available. If we could find a way to give people a social/cultural support system that's more appealing than drugs, we might be able to reduce addiction without prohibition. http://www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park http://www.brucekalexander.com/articles-speeches/rat-park/14...
- loeg 10y ago
  Rat Park doesn't replicate. Don't read too much into it.
gremlinsinc 10y ago
I think drugs should be legal --or not prosecutable to the 'addict' they are the victim imho -- dealers/sellers that's a whole 'nother story. The issue at large is one where drugees are going through mental health crisis and the last place they need to be is jail/prison -- they need help, mentally. It's proven though that legalizing Marijuana has shown a decrease in opioid use in the states where it's legal, so there's that.
gjmacd 10y ago
I'm still very pro-legalization because most of the epidemic is born out of legal prescription drugs, then people move to stronger illegal drugs. So here you have a legal means and illegal means working in simpatico to fuel an epidemic. Stopping one isn't going to stop the other... it's not about the legalities, it's about humans. Some humans are wired for addiction more than others. Once they get on a substance, regardless of how, it's going to only to set these "pre conditioned" folks towards their addiction. Treating the drug as the issue is only going to continue the process and make it harder for acceptance of this disease. Recovery and prevention is what people need to learn. Trying to make something illegal isn't going to stop people -- we've seen this with alcohol (arguably just as big of a problem). It's interesting how as a society we treat opioid addiction differently BECAUSE drugs like Heroin are deemed illegal -- the stigma around "illegal" detracts from the root cause of the issue and therefore stunts any idea of a solid course towards acceptance and then hopefully treatment or a cure. I can only feel that if we treated all drugs as legal and the addiction as a health crisis, we might have made better strides. Lastly, we did the "War on Drugs", it didn't work -- let's look at that data and realize that it's not a problem of substance and access, it's a problem of human nature. Spending money on supporting the illegal nature of something like this only continues to perpetuate the problem.
- dontreact 10y ago
  The article is in favor of making consumption legal (as in Portugal). However, the Portugese model (which has had some success) also depends on not making drugs like fentanyl and heroin commercializable. This is really what the article means by "making drugs illegal". Which is somewhat deceptive, but I do think that is the argument actually made in the article. Given the massive misrepresentation of Oxycontin as a drug effective at treating pain for 12-24 hours with a single pill which has caused so much addiction: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ Do you not see some issues with giving these companies which have already successfully deceived the public another set of dangerous products like Fentanyl and Heroin?
anentropic 10y ago
Isn't this a failure of the USA health care system rather than a failure of legalization...?
Danihan 10y ago
Philosophically and ethically you can't tell anyone what they are allowed to put in their body. It's their body. They can do what they want with it. It seems so basic to me, but people can't seem to get it through their thick skulls. Stop trying to legislate other people's bodies. Take steroids, for instance. Who should be allowed to decide what levels of hormones I have in my body? The answer is me, and me alone. It's my body, for fuck's sake! Same applies to all drugs.
- noonespecial 10y ago
  Just to float the "thick skull" perspective here. Some people believe health care should be treated as a right. We find ourselves wedged into a situation where the damage to an individual caused by the actions of that individual become a cost that must be borne by others. Not that I agree fully with either perspective. Its a difficult problem. "My body and mine alone" is a great perspective until you break it and need help beyond your own means to fix it. Edit: Ahh- Thankyou. At this point I can safely say that this is a reliably unpopular opinion. I'm not sure why though. Would someone do me the courtesy of resolving the question for me after you hit that down button: Why is it my body to unconditionally do with as I please but someone else's responsibility to fix it no matter what? I can't resolve the dissonance here but the notion seems repugnant to all sides of the debate. I'm a big proponent of basic universal healthcare but this seems a big drawback of this approach. I really would like to hear what people think I'm missing.
  - Danihan 10y ago
    It's not someone else's responsibility to fix a person's health issues no matter what.. that sort of thinking, in my opinion, is at the root of an incredible amount of government overreach. Along the same lines, if someone weighs 500 pounds and yet eats 6000 calories day, it's the same issue. How much should society intervene on people who are absurdly self-destructive? How much freedom should people have to damage themselves so much that society has to pay to rescue them from themselves. There are lots of places you could draw that line.
- pault 10y ago
whiddershins 10y ago
I don't think we have enough evidence to conclude the legality of the opioids is the reason for the number of overdoses. I think it is better explained by: 1) the nature of these drugs, they are definitely more addictive and possibly more dangerous than nearly every common street drug. Many street drugs are either not addictive at all, or have very low addiction rates. These opioids are likely more addictive than heroin. 2) that these drugs are first prescribed by doctors, which clouds people's judgment about how dangerous they are, making it more likely people may become addicted 3) then in the coup de grace, they are illegal to purchase recreationally, which forces addicts to the black market where it is much more difficult to get consistent dosages, which greatly increases the rate of overdose. The article lacks intellectual rigor.
armenarmen 10y ago
Ok. So I've had more than a handful of friends and family OD on opiates. They were in accidents, got hooked on prescribed painkillers. Then they were for a while able to buy pills from "pain clinics" relatively cheap, safe, and pure opiates. THEN the pill mills got shut down. This didn't magically stop them from being dope fiends. It made them have to go for street versions. Heroin. Which is less safe and less pure. Then they started dying. You gotta explain to me how not having access to consistent doses that aren't cut with poison and are bought from legitimate businesses is somehow better than the alternative. The drug war is bullshit and it turns addicts into corpses.
justaaron 10y ago
ummm, this is why we need to end the war on drugs, hello!? 1) cut out the cartels 2) inform the public A) Opioids are for dying people in pain, or losers... B) "Drugs" are not a monolithic equal evil. Opioids actually do suck the life out of well-meaning people, see letter A The author here seems to follow the "bills of rights only exist until something really extreme like terrorism negates them" school of thought... panic before thought... Heroin costs pennies a dose to produce, and should be available for free injection in a walk-in clinic 1) whereas something like 100% of all overdoses are related to the fact that no one actually knows the street heroins potency and the difference between the effective-dose and the deadly-dose is inside of 1 magnitude of 10... something like double perhaps? hello 2) whereas one saves a lot of car stereos, eliminates many petty crimes like muggings, and basically all the crap that an unemployed non-independently-wealthy junkie does to maintain their habit... no brainer...
abcdefghijklm 10y ago
Funny that I've been reading HN for years and never posted until an article about drugs, but that's how it goes sometimes. I was just talking about this with my wife last night during an NPR story about opiod addiction and wondered if there was quantitative evidence about the cost/benefit ratio of opiods, as opposed to anecdotal stories, valuable as they might be. I found this article from a year ago: https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/ https://blogs.scientificamerican.com/mind-guest-blog/opioid-... Some key points, all direct quotes from the article: 1. Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs. This type of drug use, not medical treatment with opioids, is by far the greatest risk factor for opioid addiction 2. In general, new addictions are uncommon among people who take opioids for pain in general. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care 3. The vast majority of people who are prescribed opioids use them responsibly—recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors. 4. If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment. Two thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes. 5. The reality, however, is that as long as there is distress and despair, some people are going to seek chemical ways to feel better. So in summary: I am NOT saying that you don't know someone who developed an opioid addiction without prior risk factors. I am saying that it seems in aggregate, this is a new phase of a common societal issue: lots of people are unhappy, for any number of reasons, and seek the most available fix. That used to be other drugs, then we cracked down on those drugs. Now it's opioids, and we're likely about to crack down on those. But something will be next, because we haven't solved the real problem.
mikhailt 10y ago
Maybe I've skimmed this too fast but I saw nothing in the article that looks at the source of people doing the drugs in the first place. I had friends that did drugs merely because they were in bad situations and there was no public support they could reach out before resorting to doing illegal things to avoid feeling hopeless. There are people that got roped into doing these specific drugs because of the hell they went through with injuries/diseases and the painkillers gave them a bit of sanity. Do we have public programs that assign mentors and counselors to these people for a year or longer? Regulations, criminalization, legalization will never ever deter drug use in this country as long as we continue to have lackluster support systems for these folks. We need to stop looking at the drugs and start looking at the people and stop treating them as subhumans.
- dontreact 10y ago
  The article doesn't argue in favor of making drug consumption illegal. Given the success that large pharmaceutical companies have had in deceptively marketing Oxycontin: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ Why should the government allow them to commercialize and sell even more dangerous drugs that are not needed clinically?
  - mikhailt 10y ago
    I think you're missing my point. I'm not talking about legalization or no legalization at all. The article is fully clear on pros and cons for them, the article just doesn't go further to explain why there is "demand" in the first place. And if the government regulates these companies, it will not stop these folks from getting it elsewhere. That's the point I'm trying to make, as long as there is demand, there will always be supply. This is pretty much a fact since the beginning of civilization. The best thing we can do is reduce the demand. These companies do not want to produce drugs that do not make them any profits, that's why so many life-saving drugs for very small market share are very expensive and barely marketed. If these companies have a cure for cancer, they're not going to make a big deal out of it because they'd be out of business. They'll look for drug treatments that ensure a lifetime use of drugs that sustain their business models.
dontreact 10y ago
I think the title is a _little_ clickbaity because the author does seem to support the Portugese model of decriminalizing all drugs. The arguments seem to be mostly against making it legal for large pharmaceutical companies to sell heroin, but some of the discussion here seems to be around the legality of consumption and decriminalizing drugs.
wand3r 10y ago
It's important to realize opiods are likely the best proof laws don't work. These are largely made and controlled by American companies. The whole supply chain. It's not like cocaine that is largely imported by diverse entities. These are made in America and "tightly" controlled yet they are available enough to be an epidemic. Drugs should be legal in my opinion.
loeg 10y ago
You know that the opioid epidemic has blossomed under the war-on-drugs / prohibition model, right? We're already trying prohibition, it isn't working anyway.
NotSammyHagar 10y ago
This is a great article that causes me to challenge some of my own assumptions. I have also been generally supportive of decriminilization of drugs because of the damage done with our prohibition. But the problems with opiods show me that if heroin was easily available it really could lead to too much use. So I think the problem that first needs to be addressed is that drug legalization needs to go through a non-legisltive process. If we have true techocrats (doctors & scientists) deciding what drug policies were, it would be much harder for drug companies like beer producers to force laws that they like. But we do live in that world of lobbying, so what's the thing to do to help control opiod use with more drug decriminalization? I do not know.
Neliquat 10y ago
I supported skydiving, then my buddy died base jumping. This article is a logical disaster for myrad reasons.
bdavisx 10y ago
All this talk about prescription OD's; how many people die from too much acetaminophen in the pills they are taking to try to get high from the opioids? I don't know the numbers, but they shouldn't count as an OD, it isn't the same thing.

46 points by abhi3 10y ago

I don't see how forcing addicts to purchase heroin on the street is safer than getting it prescribed by a doctor. People wouldn't overdose if they knew exactly how strong the drugs they injected were, they OD when the drug is unexpectedly powerful, especially when laced with fentanyl. I don't think you should be able to purchase heroin at 7/11, but certainly there is something better than total prohibition. If you want to keep killing people, force addicts to buy opiates on the street.

TerminalJunkie 10y ago
If you were able to get drugs from a pharmacy or dispensary or a regulated service, there would't (hopefully) be a black market to supply the drugs which creates untold violence. I have a completely untested theory that the number of deaths would be less with a well regulated legalization of drugs than with an unregulated black market where gangs and organized crime supply the demand for illicit substances.
- bluedino 10y ago
  >> If you were able to get drugs from a pharmacy or dispensary or a regulated service, there would't (hopefully) be a black market Medical marijuana is legal where I live, you can buy it at a regulated service, however there are plenty of people who still buy it on the street or produce more than they are legally able to and sell the excess.
  - toolz 10y ago
    Yeah, then the black market goes from some cartel pipeline to someone in your neighborhood. There's a huge difference in regards to funding violence.
    - nannal 10y ago
      Except Joe who grows weed in his cupboard isn't really capable of producing heroin let alone the extraordinarily dangerous opium derivatives that pharmaceutical are pushing on doctors.
      - nyolfen 10y ago
        welcome to our grim cyberpunk (near-)future: https://www.wired.com/2015/08/dont-try-home-scientists-brew-opiates-yeast/ https://www.wired.com/2015/08/dont-try-home-scientists-brew-...
      - nnfy 10y ago
        If Joe can grow weed in his cupboard, he absolutely can grow poppies and produce opium. The process is not complex.
        narrowrail 10y ago
        The required acreage to yield opium in significant quantities is way beyond a closet (or even a basement). Not to mention that heroin is ~1% of total opium weight.
        nnfy 10y ago
        If we're talking about Joe's personal use, a single poppy plant produces multiple doses, according to this[1] reference and some anecdotal drug forum dose suggestions, on the order of tens of mg. 1.https://erowid.org/archive/rhodium/chemistry/opium.html https://erowid.org/archive/rhodium/chemistry/opium.html
        narrowrail 10y ago
        >produces multiple doses Could you tell me what number "multiple" is and what a "dose" looks like? Are we talking about raw plant material that is opium, or refined heroin/morphine/codeine? The conflation of the word drugs and plant material seems like the most absurd gorilla in the room. Off to do some coffee...
- arprocter 10y ago
  Portugal decriminalized in 2001 and guess what happened[0] [0]https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/?utm_term=.a2a535945f50 https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-h...
- qbrass 10y ago
  There's already a black market for prescription drugs. Because there's still a barrier to access, providing a way around it still provides profit.
  - NotSammyHagar 10y ago
    There's a black market because most people can't just get a prescription from a doctor, they have to lie or get someone else's drugs, there isn't enough legal availability to rule it out.
zzalpha 10y ago
Absolutely. There's one sure way to control an epidemic like this: education. That means educating the populace on just how addictive and dangerous these drugs are, educating law enforcement to treat addicts as people who are sick instead of simply stigmatizing criminality, and educating the medical community so that these drugs aren't handed out so casually, and in cases where they are appropriate, that patients are closely monitored for signs of addiction. And the latter would benefit greatly from the US restricting drug company advertising and lobbying (this crisis was helped along significantly because of Purdue's marketing of Oxy in the 90s) so that medical decisions are made based on science and not marketing... but we know what the odds are of that happening.
- ipnon 10y ago
  I think most people know heroin is dangerous. They start taking it because they don't have an incentive not to. A lot of people in places hit worst by the opioid epidemic don't have much of a reason to get up in the morning, whether that be for lack of job opportunities, a weak social network, or some more general malaise. If there life is already disappointing, there's no reason to not take heroin. The worst that can happen is that there life becomes bad, but it already is.
  - zzalpha 10y ago
    Many many people don't start with heroin, nor do they turn to drugs for the reasons you cite. They start with back pain due to a workplace injury, for which a doctor immediately prescribes them a powerful opiod (and perhaps a companion drug to deal with the resultant constipation). Because it's "medicine", these people don't fully understand the risk of addiction nor do they recognize the signs of addiction and tolerance as they develop. Meanwhile, the doctor shirks their duty by not remaining in constant contact with the patient to manage any dependency should it occur. These individuals eventually become addicted because the drugs lose efficacy over time (and in the case of Oxy, don't actually work for as long a period of time in the body as claimed, forcing people to up their own dosage). And thus the spiral of addiction begins. Because of the lack of public awareness and the shame and stigma of addiction, people don't seek out help. Instead they try to manage the problem themselves. Ultimately, once addicted they turn to street drugs because they're a) cheaper, and b) more readily available.
lightedman 10y ago
" People wouldn't overdose if they knew exactly how strong the drugs they injected were" Opiates are highly unpredictable. The exact same 'homogenized' batch can kill you at any time. One dose you can slam half a syringe, next dose a day or two later, you can do 1/4 that amount and die.
- nnfy 10y ago
  Right, that's why people are dropping dead left and right from prescription opioids, hospital injections of morphine, opioid patches... No drug has this kind of unpredictable physiological profile, you're spreading nonsense. I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that.
  - darpa_escapee 10y ago
    People do drop dead from prescription opioids. Hospital injections of morphine are done under close supervision by trained staff. Fentanyl patches do kill. > I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that. That is an inherently unpredictable situation. We cannot predict or measure the subjective and changing tolerance a patient has to opioids.
    - nnfy 10y ago
      The comment implied that repeated doses to a given person are wildly unpredictable. This is false. Further, you absolutely can approximate how long tolerance lasts, but my point was that you can predict that your tolerance is reduced after abstinence, as opposed to the original comment which suggested that all dosing was unpredictable.
      - darpa_escapee 10y ago
        > The comment implied that repeated doses to a given person are wildly unpredictable. This is false. I didn't imply that repeated doses are unpredictable. Regular repeated dosages can be predictable as long as the patient remains stable with regards to infection/health and other drugs they ingest. Initial dosages, dosage increases and returning to a previously safe repeated-dose after cessation are not at all predictable. This is why I mentioned titration in a previous comment: subjective response to drugs and subjective tolerance cannot be accurately predicted or measured. This is also why drugs like Subutex are titrated when beginning suboxone treatment: a doctor cannot accurately measure tolerance to determine how much of the drug is needed to keep a person out of withdrawals. > you absolutely can approximate how long tolerance lasts Naloxone or naltrexone induced withdrawal rapidly diminishes tolerance faster than it would naturally. This suggests that there's a function that can accurately output a safe and effective dose of opioids based on the variables of previous dosage and time since cessation. I'm arguing that there is a missing variable that's unable to be measured accurately: each person's subjective tolerance. That subjective tolerance depends on a multitude of factors that cannot be determined clinically.
cowmoo728 10y ago
The other common cause of OD is relapse. 30 day drug programs are not very good at getting people to quit, but they are good at lowering tolerance enough to make their previous doses life-threatening. This is another reason medical supervision of addicts saves lives.
darpa_escapee 10y ago
> People wouldn't overdose if they knew exactly how strong the drugs they injected were This is not how tolerance works. The same dose can have vastly different effects depending on how long it was since your last dose, other drugs in your system and your body's natural tolerance that might be diminished by exhaustion or infection. The dose someone uses to feel baseline today might have them completely dysfunctional in a few days or kill them after a couple of weeks.
- nnfy 10y ago
  Everything you said outside of tolerance is exceedingly rare. If you're not taking one of a handful of herbal supplements, you are extremely unlikely to have a measurably different response to the same dosage of opioid. And the effects will not be vastly different. Just varied in intensity.
  - darpa_escapee 10y ago
    > If you're not taking one of a handful of herbal supplements, you are extremely unlikely to have a measurably different response to the same dosage of opioid. If you've taken any common CNS depressant, such as alcohol, benzodiazepines, psychiatric drugs, drugs that are metabolized by the same pathways as opioids, even blood pressure medication or sedatives including antihistamines, you are going to potentiate the CNS depression from opioids. > And the effects will not be vastly different. Just varied in intensity. The scale of intensity of effects from a dose of an opioid varies from: enough to get a patient out of withdrawals to completely stopping breathing. Titration of dose is the only way to more accurately determine a safe and effective dosing schedule for opioids.
    - nnfy 10y ago
      I concede that I neglected drug interactions; however when you said vastly different effects, I interpreted it as meaning unique effects based on dosage, similar to something like DXM, as opposed to two ends of a relatively linear scale of analgesia->sedation->death. Which is untrue.
jmngomes 10y ago
Agreed, and this has been tried in Switzerland with positive results; to quote just one: "The cost-benefit analysis showed a considerable reduction in costs for medical care and law enforcement; the benefits per day and patient amount to the double of the daily treatment costs in HAT (Frey et al 2000)." in https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht1-e.htm https://sencanada.ca/content/sen/committee/371/ille/presenta...
gjmacd 10y ago
Agree. Control it, regulate it, distribute it. We do this with alcohol. It doesn't prevent people from getting addicted, but it certainly prevents people from having to resort to crimes to get the product because it's illegal.
- actsasbuffoon 10y ago
  The article isn't about committing crimes in order to get drugs, it's about people dying because pharma companies got greedy. Additionally, alcohol kills more people than opiates every year, so I'm not sure that's a good sign for the effects of legalization.
EnFinlay 10y ago
Article: > and legal painkillers are still linked to most opioid overdose deaths. Your comment: > People wouldn't overdose if they knew exactly how strong the drugs they injected were Is your comment a knee jerk reaction to an anti-legalization headline because it doesn't appear to be related to the actual content or points raised in the article.
dontreact 10y ago
The problem is that it has been proven that it is easy for large pharmaceutical companies to deceptively represent these drugs. Oxycontin has been marketed as being effective at managing pain for 12 or sometimes even 24 hours, but this is not the case in many users and this is a big factor in why the drug is so addictive. http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ What about the Portugese model described in the article (legal for consumption, illegal to commercialize), with some of the funds spent on controlling drug related violence instead being turned towards treatment centers where addicts can get something like Methadone?
- actsasbuffoon 10y ago
  I strongly agree. I'm as anti-drug as it gets, but locking up non-violent drug users with rapists and murderers doesn't make sense. If our goal is to help drug addicts get clean, prison is a terrible strategy. There's a kind of despair spiral that kicks in for some addicts. Life isn't going well, so they turn to drugs to ease the pain. Then they get arrested, sent to prison, and get labelled as a felon. Now they can't get a job or have a stable living arrangement and they turn back to drugs to get through the despair. For these people, we need to break the cycle if we're ever going to help them get clean. Making their lives worse will only further entrap them.
jimbokun 10y ago
But the opioid epidemic did not stem from addicts purchasing heroin on the street, but from doctors prescribing them, backed by government efforts to encourage their use, and industry lobbying and advertising. That's a lot more powerful formula for starting a drug epidemic, than people buying heroin illegally off the street. At least there's no confusion about "experts" and "science" and "doctors" promoting something as safe and effective.
- snarf21 10y ago
  Right this is the problem. We need to ban all opioid prescriptions. 80% of heroin addicts got addicted because of the opioid prescriptions obtained legally. According to the documentary on HBO, drug companies made $5B on opioids in 2014 but the economic costs were $55B. If people have chronic pain, we need to be more progressive and allow medical marijuana everywhere. (There are also quite a few studies that show that chronic pain is not helped with opioids anyway.) If people are in the hospital or end-of-life/hospice, then give them morphine or whatever they need but we need zero prescribable opioids.
  - thesmallestcat 10y ago
    For painkilling, MMJ may as well be aspirin when compared to powerful opiates. Over-prescription of powerful opiates is the issue. Banning all opiate prescriptions would be cruel, forcing people to the black market at best.
  - bdavisx 10y ago
    Yeah, banning opioids isn't the solution, unless you think people should needlessly suffer. I've had a hernia surgery and my wife had throat surgery, and I don't think that marijuana would have been the answer for the first several days after either surgery.
    - DanBC 10y ago
      >> If people have chronic pain Chronic pain refers to long term pain. Your hernia surgery is short term pain. No-one credible is suggesting preventing using opioids for short term (such as post operative) pain (although it does seem that Drs in the US prescribe too much for this type of pain).

brilliantcode 10y ago

I used to be very pro-legalization of all drugs in my early 20s but I've shifted completely after seeing so many Fetanyl overdose cases in Vancouver as well as now we are seeing Elephant tranquilizers make its way. Some drugs are just too damn harmful to even be consumed by it's end users. The thing about opiod is that it completely warps the human mind. Outside of managing extreme pain, it really should be banned. For those who are addicted, they should not be viewed from a legal platform but medical care that actively tries to rehabilitate them. Agreed. I can't believe some people still view drug use as criminal behavior. These are people who otherwise are out of coping resources and variety of other factor. It should be handled with medical assistance, not locking them up and creating life long criminals/addicts in the process. I think Portugal is a great demonstration of what I've illustrated - helping addicts while going after the supply and providing a publicly accessible harm reduction platform and alternative to hard drugs. Vancouver has safe injection sites but it's hard to go after the dealers as they are highly decentralized and blends right in or often protected by layers of addicts who sell to support their own high.

AQuantized 10y ago
You can be pro-legalization without being "pro-drug." In the sense that criminalizing drugs doesn't necessarily reduce usage.
- armenarmen 10y ago
  It's funny how often people conflate these. I can be pro freedom of religion but an atheist. Support of the freedom to do anything != an endorsement
- dontreact 10y ago
  Just want to point out that the article is actually in favor of decriminalizing drugs.
reefoctopus 10y ago
Prohibition is the cause of the fetanyl epidemic. As enforcement increases so does potency because smaller portions are easier to smuggle. Fentanyl is ~50x stronger than heroin which means 50x the payoff for smuggling the same quantity, but it's also much easier to misjudge the dosage. https://en.wikipedia.org/wiki/Iron_law_of_prohibition https://en.wikipedia.org/wiki/Iron_law_of_prohibition Yes, opioids are terrible for the human mind and spirit, but the unintended consequences of prohibition make them that much worse.

junto 10y ago

I recently visited my gran, who told me she has prescriptions for Co-codamol and Tramadol. She had no idea how addictive they were and was popping them down like candy. The doctor had given her no warning as to how addictive they are. I told her to speak to her GP and that she should consider disposing the tablets at her local pharmacy. A recent study showed that on average it takes 10 days for a patient to become dependent and addicted to opiates like these and weaning people off them is a horrible experience for the patient.

3pt14159 10y ago

I've come to believe that the unabomber, though horribly misguided in terms of tactics and conclusion, was right about one thing: Maybe one day things will be different, but for now, humans are not designed to live in the manner that they do. We were meant to climb and run. Maybe even to work the soil and to create wine. But evolution isn't fast enough to keep up with the rate of change of technology. We're in cars and looking at computers. We're comparing ourselves to the best people on the planet. We're pulling out the fibre from our food and loading it up with sugar and trans fats. I've come to view drugs and alcohol as symptoms. We've probably co-evolved with alcohol, since it's correlated both to genetics and with intelligence. Maybe it's the method that evolution allows people to be honest enough for social cooperation, while being dishonest enough to cheat on a spouse occasionally. But when it comes to drugs like opioids, I tend to think it's people filling a void from a lack of self worth. Overweight, stressed financially due to easy credit, depressed, usually sick in some way. Banning opioids isn't going to help any more than banning cocaine has helped. So how to get out of it? Make use more similar to how we used to live and take away or tax the things that we haven't adapted to yet. Opioids should be taxed, highly regulated, and we should start working on mental health and education, but we also need redesigned cities with more reliance on self-propulsion (bikes, skiing, walking, running). We need redesigned food laws that focus on consequences not on arbitrary labelling requirements. We should outright ban foods for children that we're sure destroy their lives, like soft drinks or fruit juice. (Yes, fruit juice. Without fibre it's just empty sugar. Kids get enough Vit C in a single apple. One in four children in the US has pre-diabetes and one in four seniors have full blown diabetes, we need to start treating refined sugar as a poison.) I'm sure a certain part of the epidemic is people not knowing that these were hyper-addictive and then getting addicted, but I don't really think it's the primary cause. Also, we should start using safer drugs that we've evolved around for pain management and therapy. Magic mushrooms, cannabis, etc.

bluedino 10y ago
>> We're in cars and looking at computers. We had opium problems since morphine/heroin have been around. Plenty of people were using in the late 1800's and it wasn't banned until the early part of last century.

coretx 10y ago

People revert to opiods because of better alternatives either being too expensive or not available. The designer dope industry can supply alternatives for all kinds of populair drugs. Including MDMA, amphetamines, opiods, khat, cocain and more. These alternatives can be created at a dirt cheap pricepoint and often come with significantly reduced health impacts; by design. The actual production and R&D of these synthetic substances however is illegal, and so are the precursors and the precursors of the precursors, increasing the price up to the point they can no longer compete with primitive and more unhealthy alternatives such as for example heroin. No matter how you spin it, the "War on Drugs" costs much more money & lives than drugs at large. Let's respect citizens thus the right to self determination - Legalize & Regulate all the things!

pcmaffey 10y ago

Tldr; Don't give big pharma another product. They're an irresponsible, poorly regulated system, directly to blame for the opiod epidemic.

lisper 10y ago

> Faced with an excessively harsh criminal justice system and a legal industry that carelessly causes drug epidemics, I have come down somewhere in the middle of these two extremes. But the middle is where we are now. Opioids are highly regulated. It is illegal to possess them without a doctor's prescription. The regulatory regime is so strict that some doctors are afraid to prescribe them at all [1]. And yet, here we are. The free-market answer is to allow civil suits against drug manufacturers for damages caused by overdoses. That's not a perfect solution either, but it's a hell of a lot better than what we have now. At least it doesn't produce perverse incentives the way all other proposed solutions do. [1] http://www.health.com/health/condition-article/0,,20189399,00.html http://www.health.com/health/condition-article/0,,20189399,0...

sehugg 10y ago
The free-market answer is to allow civil suits against drug manufacturers for damages caused by overdoses. We'll see how that goes -- Cherokee Nation sues drug firms, retailers for flooding communities with opioids: https://www.washingtonpost.com/investigations/cherokee-nation-sues-drug-firms-retailers-for-flooding-communities-with-opioids/2017/04/20/03d04a74-2519-11e7-b503-9d616bd5a305_story.html?tid=ss_tw&utm_term=.c3911f5ba16b https://www.washingtonpost.com/investigations/cherokee-natio...

such_a_casual 10y ago

Only children think that making X against the rules makes X go away. Regulation and first world health care (ie free health care) are some steps you can take to address the problem. Making addicts criminals shows irresponsibly poor leadership.

armenarmen 10y ago
I agree entirely with your first point. Sadly though, the free healthcare bit works against a sensible legalization path. The pearl clutching puritans have a legitimate gripe with drug use if they, the taxpayers, are forced to fund the fallout of drug abuse. Turning a personal, though be it poor, decision to use hard drugs from a personal issue into a public one.

deleted 10y ago

[deleted]

bonniemuffin 10y ago

Rat park is highly illuminating in this conversation, and suggests that drug addiction is just a symptom. When people (or animals) are forced into a life of social and cultural isolation, drugs become the most appealing thing they have available. If we could find a way to give people a social/cultural support system that's more appealing than drugs, we might be able to reduce addiction without prohibition. http://www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park http://www.brucekalexander.com/articles-speeches/rat-park/14...

loeg 10y ago
Rat Park doesn't replicate. Don't read too much into it.

gremlinsinc 10y ago

I think drugs should be legal --or not prosecutable to the 'addict' they are the victim imho -- dealers/sellers that's a whole 'nother story. The issue at large is one where drugees are going through mental health crisis and the last place they need to be is jail/prison -- they need help, mentally. It's proven though that legalizing Marijuana has shown a decrease in opioid use in the states where it's legal, so there's that.

gjmacd 10y ago

I'm still very pro-legalization because most of the epidemic is born out of legal prescription drugs, then people move to stronger illegal drugs. So here you have a legal means and illegal means working in simpatico to fuel an epidemic. Stopping one isn't going to stop the other... it's not about the legalities, it's about humans. Some humans are wired for addiction more than others. Once they get on a substance, regardless of how, it's going to only to set these "pre conditioned" folks towards their addiction. Treating the drug as the issue is only going to continue the process and make it harder for acceptance of this disease. Recovery and prevention is what people need to learn. Trying to make something illegal isn't going to stop people -- we've seen this with alcohol (arguably just as big of a problem). It's interesting how as a society we treat opioid addiction differently BECAUSE drugs like Heroin are deemed illegal -- the stigma around "illegal" detracts from the root cause of the issue and therefore stunts any idea of a solid course towards acceptance and then hopefully treatment or a cure. I can only feel that if we treated all drugs as legal and the addiction as a health crisis, we might have made better strides. Lastly, we did the "War on Drugs", it didn't work -- let's look at that data and realize that it's not a problem of substance and access, it's a problem of human nature. Spending money on supporting the illegal nature of something like this only continues to perpetuate the problem.

dontreact 10y ago
The article is in favor of making consumption legal (as in Portugal). However, the Portugese model (which has had some success) also depends on not making drugs like fentanyl and heroin commercializable. This is really what the article means by "making drugs illegal". Which is somewhat deceptive, but I do think that is the argument actually made in the article. Given the massive misrepresentation of Oxycontin as a drug effective at treating pain for 12-24 hours with a single pill which has caused so much addiction: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ Do you not see some issues with giving these companies which have already successfully deceived the public another set of dangerous products like Fentanyl and Heroin?

anentropic 10y ago

Isn't this a failure of the USA health care system rather than a failure of legalization...?

Danihan 10y ago

Philosophically and ethically you can't tell anyone what they are allowed to put in their body. It's their body. They can do what they want with it. It seems so basic to me, but people can't seem to get it through their thick skulls. Stop trying to legislate other people's bodies. Take steroids, for instance. Who should be allowed to decide what levels of hormones I have in my body? The answer is me, and me alone. It's my body, for fuck's sake! Same applies to all drugs.

noonespecial 10y ago
Just to float the "thick skull" perspective here. Some people believe health care should be treated as a right. We find ourselves wedged into a situation where the damage to an individual caused by the actions of that individual become a cost that must be borne by others. Not that I agree fully with either perspective. Its a difficult problem. "My body and mine alone" is a great perspective until you break it and need help beyond your own means to fix it. Edit: Ahh- Thankyou. At this point I can safely say that this is a reliably unpopular opinion. I'm not sure why though. Would someone do me the courtesy of resolving the question for me after you hit that down button: Why is it my body to unconditionally do with as I please but someone else's responsibility to fix it no matter what? I can't resolve the dissonance here but the notion seems repugnant to all sides of the debate. I'm a big proponent of basic universal healthcare but this seems a big drawback of this approach. I really would like to hear what people think I'm missing.
- Danihan 10y ago
  It's not someone else's responsibility to fix a person's health issues no matter what.. that sort of thinking, in my opinion, is at the root of an incredible amount of government overreach. Along the same lines, if someone weighs 500 pounds and yet eats 6000 calories day, it's the same issue. How much should society intervene on people who are absurdly self-destructive? How much freedom should people have to damage themselves so much that society has to pay to rescue them from themselves. There are lots of places you could draw that line.
pault 10y ago

whiddershins 10y ago

I don't think we have enough evidence to conclude the legality of the opioids is the reason for the number of overdoses. I think it is better explained by: 1) the nature of these drugs, they are definitely more addictive and possibly more dangerous than nearly every common street drug. Many street drugs are either not addictive at all, or have very low addiction rates. These opioids are likely more addictive than heroin. 2) that these drugs are first prescribed by doctors, which clouds people's judgment about how dangerous they are, making it more likely people may become addicted 3) then in the coup de grace, they are illegal to purchase recreationally, which forces addicts to the black market where it is much more difficult to get consistent dosages, which greatly increases the rate of overdose. The article lacks intellectual rigor.

armenarmen 10y ago

Ok. So I've had more than a handful of friends and family OD on opiates. They were in accidents, got hooked on prescribed painkillers. Then they were for a while able to buy pills from "pain clinics" relatively cheap, safe, and pure opiates. THEN the pill mills got shut down. This didn't magically stop them from being dope fiends. It made them have to go for street versions. Heroin. Which is less safe and less pure. Then they started dying. You gotta explain to me how not having access to consistent doses that aren't cut with poison and are bought from legitimate businesses is somehow better than the alternative. The drug war is bullshit and it turns addicts into corpses.

justaaron 10y ago

ummm, this is why we need to end the war on drugs, hello!? 1) cut out the cartels 2) inform the public A) Opioids are for dying people in pain, or losers... B) "Drugs" are not a monolithic equal evil. Opioids actually do suck the life out of well-meaning people, see letter A The author here seems to follow the "bills of rights only exist until something really extreme like terrorism negates them" school of thought... panic before thought... Heroin costs pennies a dose to produce, and should be available for free injection in a walk-in clinic 1) whereas something like 100% of all overdoses are related to the fact that no one actually knows the street heroins potency and the difference between the effective-dose and the deadly-dose is inside of 1 magnitude of 10... something like double perhaps? hello 2) whereas one saves a lot of car stereos, eliminates many petty crimes like muggings, and basically all the crap that an unemployed non-independently-wealthy junkie does to maintain their habit... no brainer...

abcdefghijklm 10y ago

Funny that I've been reading HN for years and never posted until an article about drugs, but that's how it goes sometimes. I was just talking about this with my wife last night during an NPR story about opiod addiction and wondered if there was quantitative evidence about the cost/benefit ratio of opiods, as opposed to anecdotal stories, valuable as they might be. I found this article from a year ago: https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/ https://blogs.scientificamerican.com/mind-guest-blog/opioid-... Some key points, all direct quotes from the article: 1. Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs. This type of drug use, not medical treatment with opioids, is by far the greatest risk factor for opioid addiction 2. In general, new addictions are uncommon among people who take opioids for pain in general. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care 3. The vast majority of people who are prescribed opioids use them responsibly—recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors. 4. If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment. Two thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes. 5. The reality, however, is that as long as there is distress and despair, some people are going to seek chemical ways to feel better. So in summary: I am NOT saying that you don't know someone who developed an opioid addiction without prior risk factors. I am saying that it seems in aggregate, this is a new phase of a common societal issue: lots of people are unhappy, for any number of reasons, and seek the most available fix. That used to be other drugs, then we cracked down on those drugs. Now it's opioids, and we're likely about to crack down on those. But something will be next, because we haven't solved the real problem.

mikhailt 10y ago

Maybe I've skimmed this too fast but I saw nothing in the article that looks at the source of people doing the drugs in the first place. I had friends that did drugs merely because they were in bad situations and there was no public support they could reach out before resorting to doing illegal things to avoid feeling hopeless. There are people that got roped into doing these specific drugs because of the hell they went through with injuries/diseases and the painkillers gave them a bit of sanity. Do we have public programs that assign mentors and counselors to these people for a year or longer? Regulations, criminalization, legalization will never ever deter drug use in this country as long as we continue to have lackluster support systems for these folks. We need to stop looking at the drugs and start looking at the people and stop treating them as subhumans.

dontreact 10y ago
The article doesn't argue in favor of making drug consumption illegal. Given the success that large pharmaceutical companies have had in deceptively marketing Oxycontin: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ Why should the government allow them to commercialize and sell even more dangerous drugs that are not needed clinically?
- mikhailt 10y ago
  I think you're missing my point. I'm not talking about legalization or no legalization at all. The article is fully clear on pros and cons for them, the article just doesn't go further to explain why there is "demand" in the first place. And if the government regulates these companies, it will not stop these folks from getting it elsewhere. That's the point I'm trying to make, as long as there is demand, there will always be supply. This is pretty much a fact since the beginning of civilization. The best thing we can do is reduce the demand. These companies do not want to produce drugs that do not make them any profits, that's why so many life-saving drugs for very small market share are very expensive and barely marketed. If these companies have a cure for cancer, they're not going to make a big deal out of it because they'd be out of business. They'll look for drug treatments that ensure a lifetime use of drugs that sustain their business models.

dontreact 10y ago

I think the title is a _little_ clickbaity because the author does seem to support the Portugese model of decriminalizing all drugs. The arguments seem to be mostly against making it legal for large pharmaceutical companies to sell heroin, but some of the discussion here seems to be around the legality of consumption and decriminalizing drugs.

wand3r 10y ago

It's important to realize opiods are likely the best proof laws don't work. These are largely made and controlled by American companies. The whole supply chain. It's not like cocaine that is largely imported by diverse entities. These are made in America and "tightly" controlled yet they are available enough to be an epidemic. Drugs should be legal in my opinion.

loeg 10y ago

You know that the opioid epidemic has blossomed under the war-on-drugs / prohibition model, right? We're already trying prohibition, it isn't working anyway.

NotSammyHagar 10y ago

This is a great article that causes me to challenge some of my own assumptions. I have also been generally supportive of decriminilization of drugs because of the damage done with our prohibition. But the problems with opiods show me that if heroin was easily available it really could lead to too much use. So I think the problem that first needs to be addressed is that drug legalization needs to go through a non-legisltive process. If we have true techocrats (doctors & scientists) deciding what drug policies were, it would be much harder for drug companies like beer producers to force laws that they like. But we do live in that world of lobbying, so what's the thing to do to help control opiod use with more drug decriminalization? I do not know.

Neliquat 10y ago

I supported skydiving, then my buddy died base jumping. This article is a logical disaster for myrad reasons.

bdavisx 10y ago

All this talk about prescription OD's; how many people die from too much acetaminophen in the pills they are taking to try to get high from the opioids? I don't know the numbers, but they shouldn't count as an OD, it isn't the same thing.