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I've often thought that substance access needs to be completely deregulated, for drugs of abuse as well as other medications. This would increase access and com

I've often thought that substance access needs to be completely deregulated, for drugs of abuse as well as other medications. This would increase access and competition among providers, and avoid rent-seeking kinds of economic problems in the health care market. It would also lead to better treatment of substance use problems, and kill cartels by decreasing their monopoly on production and distribution. In doing so, you could move to a kind of competency-based system akin to what happens with people who have dementia or cognitive impairments. Basically, you're legally entitled to buy whatever meds you want, until you're deemed incompetent to make that decision. Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions about the substance use purchasing due to addiction. This might sound kind of draconian, but decisions about competency could be make pretty thorough, requiring a petition, stringent evaluation criteria involving panels and a judicial decision. It would also be dramatically less restrictive than the current system, that basically assumes everyone is incompetent to make drug-related decisions based on the specific drug. It would also emphasize that the lack of competency is a health-related problem, and not a criminal problem.

emmab 9y ago
> Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions about the substance use purchasing due to addiction. These would be abused. People would be told that they're categorically unable to consent for being LGBT.
- sulizilxia 9y ago
  Without meaning to be dismissive, I doubt that would happen in the US at least at this point in time. And to the extent it did happen, there would be bigger problems to worry about. Determinations of competency already happen in the US for all sorts of reasons. I'm not saying it's perfect by any means, and that it doesn't get abused, but the abuse of that system pales in comparison to abuses under the current drug enforcement and regulation system. Personally, I am for complete unrestricted deregulation, but I can see issues around liability for providers, arguments about actual competency to decide, etc., and treating it like other forms of competency decision seems like one mechanism to address that. Medically speaking it seems like the same situation to me as competency issues due to other forms of neuropsychological incapacitation.
pizza 9y ago
I can only see this ending up like the earlier psychiatric practice of mass-lobotomization did. The same types of alliances of ethicists, the judicial system and mental health professionals collaborated then, too. They really believed that they were doing the humane thing by taking the matter of competency into their own hands and justifying what can only be called torture in the name of therapy. The existence of any social or institutional mechanism that gives one esteemed category of people the right to deny someone else's rationality is always abused. Not even only abused with small probability, it becomes the norm. Therapeutic authoritarianism produces labels like "drug addict" which only results in widespread persecution of people who don't follow society's preference of correct drug usage; soon people who are the wrong weight might also become deemed 'incompetent to make good-hearted decisions based on the specific drug', or their specific religion, or their "oppositional-defiance disorder" etc.. Could you imagine if we said "people who go to work everyday are helpless because their incompetence prevents them from seeing that they are only doing it because their brain has been rewired to make them depend on their salary for satisfaction" or the seemingly innocuous but even more insidious version, "oh, I did hear that new studies showed that some people are just genetically predisposed to employment.. it's not their choice, it's a disease, you know. Haven't you heard about the long-term epigenetics in the reward center? The brain becomes rewritten!" The thing called addiction is itself little more than the fear that drugs make a person incapable of choice, their free will. Not surprisingly, in pursuing the desire to correct individual behaviors with state-sanctioned superstition, a decades-long nightmare of rights violations and moral duty to dehumanize 'addicts' in the name of therapy ensued. It's like using thermite to put out a candle. Any transformation of the approach to drug use that forfeits the people it's supposedly benefiting from the regularity of the guaranteed rights granted to all of society is doomed to be the opposite of their freedom..
- smallnamespace 9y ago
  > The existence of any social or institutional mechanism that gives one esteemed category of people the right to deny someone else's rationality is always abused. Unless you qualify that statement more, I read it as a blanket indictment of basically any institution with any decision-making power over individuals. This logic can be equally used to indict: - courts (because they can throw people in jail and take away their rational decision-making power) - the military (killing people obvious removes their ability to make decisions) - taxation (removes the ability to rationally how to allocate a portion of their resources) - laws (it restricts the freedom of rational individuals to decide right and wrong for themselves) A heuristic that is so broad that it can be used to paint nearly every social relation in a negative light is not a useful heuristic, because it doesn't let us profitably separate the chaff from the wheat. The question should not be whether turning addiction into a medical rather than criminal problem would be completely free of abuse. It will not be, because humans and human institutions are imperfect. The question is whether this would be better than the status quo, and it seems like it would be. What's worse -- no longer having the right to purchase certain drugs, subject to the decisions of a medical bureaucracy, or letting the legal system imprison you for years, like we currently do?
hutzlibu 9y ago
"Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions" Isn't that allready pretty much the case? If a person gets demented, cracy, whatever - then other people around them notice and take action. Hospital, Judge s. There are also other issues than drugs, like driver license, firearms, childcare etc. Not that it is really easy to determine if a person is sheep-like. Lots of gray area and abuse in that area, so barriers are quite high. (is a suicidal person for example crazy? I think not necessarily, only in rare exceptions) But I very much agree, that a normal, mature person should have every right to consume whatever he or she wants. While beeing still fully responsible for all her action s ...
KGIII 9y ago
There are loads of problems with that. I agree, in principle, but I'll give you an example of a problem that already is happening. Not every drug you take is limited to impacting just you. A good example is antibiotics. We are having serious issues with drug-resistant bacteria. Allowing people to just take antibiotics of their own free will is absolutely certain to increase the number of drug-resistant bacteria. This will, with absolute certainty, result in an increase people being killed through no fault of their own. Could this be prevented? Nope. One might say people could be educated and that they'd make the right choices, but the very idea of that is farcical. The planet is not populated with people who make bright choices and exhibit a propensity for long-term thinking. I very much believe in allowing autonomy over self, and I've strongly supported these ideals. However, that has to have limits in a functioning society. As much as I'd like to say we should be able to take all the drugs, there is a need to draw some lines. We can move those lines, and I think we should, but eliminating them entirely is absolutely certain to harm innocent people at a level I am unwilling to support.
- craftyguy 9y ago
  > Not every drug you take is limited to impacting just you. A good example is antibiotics. Is there anyone addicted to antibiotics? No? Red herring.
  - KGIII 9y ago
    Red herring? It was a direct response to your comment about making all drugs, including prescription drugs, deregulated. It was YOU who mentioned, specifically, drugs of abuse and other medication.
    - craftyguy 9y ago
      That wasn't my comment..
  - occultist_throw 9y ago
    Actually, yes. It turns out there's some HIV antiretroviral that, instead of being ingested, is smoked proves one hell of a high. The problem is that in Africa where these drugs are readily available, they are being smoked. The worry is, that HIV will mutate and become immune to those ARV's.
Broken_Hippo 9y ago
I agree that most recreational drugs should be legalized, even if I would never take them. Some would require a few tests to check how much you can safely take, along with education about safe use and so on. This would include a few prescription drugs - such as "study drugs" - that are taken recreationally. Some things might require limits on frequency of purchase to limit side effects. I think this does help for not only addiction, but to help folks not freaking overdose or get a different drug than promised. They should have the same purity and strength standards as something like alcohol or prescription drugs. A few prescription drugs could easily be considered safe for the public to use, some of which might require a pharmacist's advice. This would include things like birth control pills, 400 or 800mg ibuprofen, erectile dysfunction pills, and things I have never really considered. But I disagree with most prescription drugs being sold without a doctor's orders. Some drugs are outright dangerous to overuse - antibiotics, for example. Some (most) drugs are really helpful to the right patient, but they need some medical oversight. Lithium, a psychiatric drug, needs to be monitored through blood tests to make sure the dose is within the therapeutic range. Some antifungal pills (as well as a range of other medicines) can cause liver damage. Sleeping pills have their own risks, as do prescription cough syrups. And so on. These aren't things folks are taking in their spare time for the fun of it. I think the actual solution is to make sure folks can afford their doctor's visits and medicines as well as having a comprehensive protections to make sure folks can take care of their health, including paid sick days (more for parents, since they are responsible for other's health as well and can't exactly leave the 7-year-old at home).
atmosx 9y ago
> I've often thought that substance access needs to be completely deregulated, for drugs of abuse as well as other medications.*. Now paracetamol (depon) in Greece costs 0.75 EUR. In Greece the market is regulated. In the UK where the market is not regulated and you have pharmacies selling burgers to survive while the same drug costs more than 5 EUR. How is that possible? :-) The monopoly you speak of in distribution (pharmacies) happens when you deregulate the market because few big players end up owning what was distributed among thousands. I agree that more steps need to be taken, but I don't think deregulation has ever worked the way you'd think it did, for the health industry. Ultimately many decisions stem from your personal belief on the topic: - Do you think that drugs ought to be social goods and regulated? (social welfare) - Do you think that drugs ought to be public goods and not regulated? (private welfare) Also note that drug research costs, a lot. Especially if done correctly. It is a fair for some firms to retain the patent for a few years (say 5?).
- OscarCunningham 9y ago
  https://www.tesco.com/groceries/en-GB/products/255488740 https://www.tesco.com/groceries/en-GB/products/255488740
  - atmosx 9y ago
    This costs 1.5 EUR GR: http://beautyland25.ecrater.co.uk/p/22341811/depon-maximum-paracetamol-1000-mg-pain-and http://beautyland25.ecrater.co.uk/p/22341811/depon-maximum-p... I would not buy or use paracetamol from Tesco. I prefer the one made by Bristol-Mayers, which I know and trust.
- DanBC 9y ago
  You can buy 16 paracetamol for less than 50p. https://www.mysupermarket.co.uk/tesco-price-comparison/Medicine/Tesco_Paracetamol_500mg_Caplets_16.html https://www.mysupermarket.co.uk/tesco-price-comparison/Medic...
- smcl 9y ago
  What do you mean "pharmacies selling burgers"? I'm rarely the [Citation Needed] guy but come on that's an outlandish claim that needs to be backed up somehow
_ph_ 9y ago
I strongly disagree. Yes, most substances should be decriminalized. But they should not be completely deregulated. Not even alcohol or tobacco are deregulated. And for a good reason, we don't want to give 10year olds free access to alcohol for example. Many drugs should be taken only under supervision of a medical professional. So the current system of doctors and pharmacies overall is a good system. We might give pharmacists more powers - they tend to be more knowledgeable about pharmaceuticals anyway, but drugs don't belong on supermarket shelves.
white-flame 9y ago
> This would increase access and competition among providers, and avoid rent-seeking kinds of economic problems in the health care market. That would also incentivize increasing total substance use to make a profit, just like for-profit prisons create an incentive to increase the incarceration rate to make a profit. Any checks you make against use (like those competency tests) would be undermined by that incentive.

emmab 9y ago

> Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions about the substance use purchasing due to addiction. These would be abused. People would be told that they're categorically unable to consent for being LGBT.

sulizilxia 9y ago
Without meaning to be dismissive, I doubt that would happen in the US at least at this point in time. And to the extent it did happen, there would be bigger problems to worry about. Determinations of competency already happen in the US for all sorts of reasons. I'm not saying it's perfect by any means, and that it doesn't get abused, but the abuse of that system pales in comparison to abuses under the current drug enforcement and regulation system. Personally, I am for complete unrestricted deregulation, but I can see issues around liability for providers, arguments about actual competency to decide, etc., and treating it like other forms of competency decision seems like one mechanism to address that. Medically speaking it seems like the same situation to me as competency issues due to other forms of neuropsychological incapacitation.

pizza 9y ago

I can only see this ending up like the earlier psychiatric practice of mass-lobotomization did. The same types of alliances of ethicists, the judicial system and mental health professionals collaborated then, too. They really believed that they were doing the humane thing by taking the matter of competency into their own hands and justifying what can only be called torture in the name of therapy. The existence of any social or institutional mechanism that gives one esteemed category of people the right to deny someone else's rationality is always abused. Not even only abused with small probability, it becomes the norm. Therapeutic authoritarianism produces labels like "drug addict" which only results in widespread persecution of people who don't follow society's preference of correct drug usage; soon people who are the wrong weight might also become deemed 'incompetent to make good-hearted decisions based on the specific drug', or their specific religion, or their "oppositional-defiance disorder" etc.. Could you imagine if we said "people who go to work everyday are helpless because their incompetence prevents them from seeing that they are only doing it because their brain has been rewired to make them depend on their salary for satisfaction" or the seemingly innocuous but even more insidious version, "oh, I did hear that new studies showed that some people are just genetically predisposed to employment.. it's not their choice, it's a disease, you know. Haven't you heard about the long-term epigenetics in the reward center? The brain becomes rewritten!" The thing called addiction is itself little more than the fear that drugs make a person incapable of choice, their free will. Not surprisingly, in pursuing the desire to correct individual behaviors with state-sanctioned superstition, a decades-long nightmare of rights violations and moral duty to dehumanize 'addicts' in the name of therapy ensued. It's like using thermite to put out a candle. Any transformation of the approach to drug use that forfeits the people it's supposedly benefiting from the regularity of the guaranteed rights granted to all of society is doomed to be the opposite of their freedom..

smallnamespace 9y ago
> The existence of any social or institutional mechanism that gives one esteemed category of people the right to deny someone else's rationality is always abused. Unless you qualify that statement more, I read it as a blanket indictment of basically any institution with any decision-making power over individuals. This logic can be equally used to indict: - courts (because they can throw people in jail and take away their rational decision-making power) - the military (killing people obvious removes their ability to make decisions) - taxation (removes the ability to rationally how to allocate a portion of their resources) - laws (it restricts the freedom of rational individuals to decide right and wrong for themselves) A heuristic that is so broad that it can be used to paint nearly every social relation in a negative light is not a useful heuristic, because it doesn't let us profitably separate the chaff from the wheat. The question should not be whether turning addiction into a medical rather than criminal problem would be completely free of abuse. It will not be, because humans and human institutions are imperfect. The question is whether this would be better than the status quo, and it seems like it would be. What's worse -- no longer having the right to purchase certain drugs, subject to the decisions of a medical bureaucracy, or letting the legal system imprison you for years, like we currently do?

hutzlibu 9y ago

"Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions" Isn't that allready pretty much the case? If a person gets demented, cracy, whatever - then other people around them notice and take action. Hospital, Judge s. There are also other issues than drugs, like driver license, firearms, childcare etc. Not that it is really easy to determine if a person is sheep-like. Lots of gray area and abuse in that area, so barriers are quite high. (is a suicidal person for example crazy? I think not necessarily, only in rare exceptions) But I very much agree, that a normal, mature person should have every right to consume whatever he or she wants. While beeing still fully responsible for all her action s ...

KGIII 9y ago

There are loads of problems with that. I agree, in principle, but I'll give you an example of a problem that already is happening. Not every drug you take is limited to impacting just you. A good example is antibiotics. We are having serious issues with drug-resistant bacteria. Allowing people to just take antibiotics of their own free will is absolutely certain to increase the number of drug-resistant bacteria. This will, with absolute certainty, result in an increase people being killed through no fault of their own. Could this be prevented? Nope. One might say people could be educated and that they'd make the right choices, but the very idea of that is farcical. The planet is not populated with people who make bright choices and exhibit a propensity for long-term thinking. I very much believe in allowing autonomy over self, and I've strongly supported these ideals. However, that has to have limits in a functioning society. As much as I'd like to say we should be able to take all the drugs, there is a need to draw some lines. We can move those lines, and I think we should, but eliminating them entirely is absolutely certain to harm innocent people at a level I am unwilling to support.

craftyguy 9y ago
> Not every drug you take is limited to impacting just you. A good example is antibiotics. Is there anyone addicted to antibiotics? No? Red herring.
- KGIII 9y ago
  Red herring? It was a direct response to your comment about making all drugs, including prescription drugs, deregulated. It was YOU who mentioned, specifically, drugs of abuse and other medication.
  - craftyguy 9y ago
    That wasn't my comment..
- occultist_throw 9y ago
  Actually, yes. It turns out there's some HIV antiretroviral that, instead of being ingested, is smoked proves one hell of a high. The problem is that in Africa where these drugs are readily available, they are being smoked. The worry is, that HIV will mutate and become immune to those ARV's.

Broken_Hippo 9y ago

I agree that most recreational drugs should be legalized, even if I would never take them. Some would require a few tests to check how much you can safely take, along with education about safe use and so on. This would include a few prescription drugs - such as "study drugs" - that are taken recreationally. Some things might require limits on frequency of purchase to limit side effects. I think this does help for not only addiction, but to help folks not freaking overdose or get a different drug than promised. They should have the same purity and strength standards as something like alcohol or prescription drugs. A few prescription drugs could easily be considered safe for the public to use, some of which might require a pharmacist's advice. This would include things like birth control pills, 400 or 800mg ibuprofen, erectile dysfunction pills, and things I have never really considered. But I disagree with most prescription drugs being sold without a doctor's orders. Some drugs are outright dangerous to overuse - antibiotics, for example. Some (most) drugs are really helpful to the right patient, but they need some medical oversight. Lithium, a psychiatric drug, needs to be monitored through blood tests to make sure the dose is within the therapeutic range. Some antifungal pills (as well as a range of other medicines) can cause liver damage. Sleeping pills have their own risks, as do prescription cough syrups. And so on. These aren't things folks are taking in their spare time for the fun of it. I think the actual solution is to make sure folks can afford their doctor's visits and medicines as well as having a comprehensive protections to make sure folks can take care of their health, including paid sick days (more for parents, since they are responsible for other's health as well and can't exactly leave the 7-year-old at home).

atmosx 9y ago

> I've often thought that substance access needs to be completely deregulated, for drugs of abuse as well as other medications.*. Now paracetamol (depon) in Greece costs 0.75 EUR. In Greece the market is regulated. In the UK where the market is not regulated and you have pharmacies selling burgers to survive while the same drug costs more than 5 EUR. How is that possible? :-) The monopoly you speak of in distribution (pharmacies) happens when you deregulate the market because few big players end up owning what was distributed among thousands. I agree that more steps need to be taken, but I don't think deregulation has ever worked the way you'd think it did, for the health industry. Ultimately many decisions stem from your personal belief on the topic: - Do you think that drugs ought to be social goods and regulated? (social welfare) - Do you think that drugs ought to be public goods and not regulated? (private welfare) Also note that drug research costs, a lot. Especially if done correctly. It is a fair for some firms to retain the patent for a few years (say 5?).

OscarCunningham 9y ago
https://www.tesco.com/groceries/en-GB/products/255488740 https://www.tesco.com/groceries/en-GB/products/255488740
- atmosx 9y ago
  This costs 1.5 EUR GR: http://beautyland25.ecrater.co.uk/p/22341811/depon-maximum-paracetamol-1000-mg-pain-and http://beautyland25.ecrater.co.uk/p/22341811/depon-maximum-p... I would not buy or use paracetamol from Tesco. I prefer the one made by Bristol-Mayers, which I know and trust.
DanBC 9y ago
You can buy 16 paracetamol for less than 50p. https://www.mysupermarket.co.uk/tesco-price-comparison/Medicine/Tesco_Paracetamol_500mg_Caplets_16.html https://www.mysupermarket.co.uk/tesco-price-comparison/Medic...
smcl 9y ago
What do you mean "pharmacies selling burgers"? I'm rarely the [Citation Needed] guy but come on that's an outlandish claim that needs to be backed up somehow

_ph_ 9y ago

I strongly disagree. Yes, most substances should be decriminalized. But they should not be completely deregulated. Not even alcohol or tobacco are deregulated. And for a good reason, we don't want to give 10year olds free access to alcohol for example. Many drugs should be taken only under supervision of a medical professional. So the current system of doctors and pharmacies overall is a good system. We might give pharmacists more powers - they tend to be more knowledgeable about pharmaceuticals anyway, but drugs don't belong on supermarket shelves.

white-flame 9y ago

> This would increase access and competition among providers, and avoid rent-seeking kinds of economic problems in the health care market. That would also incentivize increasing total substance use to make a profit, just like for-profit prisons create an incentive to increase the incarceration rate to make a profit. Any checks you make against use (like those competency tests) would be undermined by that incentive.