4 ms·

Before I was aware of the opioid epidemic, I thought decriminalization was the right thing, because it would remove the criminal element (or reduce it), stop cr

Before I was aware of the opioid epidemic, I thought decriminalization was the right thing, because it would remove the criminal element (or reduce it), stop criminalizing users. I knew there were some drugs that were deadly. But opioids and now fentanyl are so addictive, so destructive that I think I only favor decriminalizing of less dangerous drugs. Also the drugs are so powerful, it's yet another weapon of mass destruction - kick some into the air system of a concert or airplanes, you could kill a huge number of people. I'd love to hear a rationale why decriminalization would make things better in this world of opioids and fentanyl.

codyb 8y ago
I think what you’d want to do in a case like this is make legal the not WMD strength stuff at affordable prices and constant purity. The idea being that the heroin market could grow and reduce the demand for the fentanyls and carfentanyls. Hopefully the addicted would want the safer stuff, especially if it was at similar prices or cheaper. Then you tax it, and use the money raised for public awareness and education to drive down the rate over time and offer out reach programs, counseling, and rehab services to the people buying the stuff. That seems like the sanest and most humane way to tackle both having these extremely potent and dangerous substances flying through our mail system while limiting damage over time, and helping as many as possible for whom they’ve already become addicted or are on that path.
- Latteland 8y ago
  You lay out a reasonable position where it might work. I salute you. That sounds reasonable and I could see that it might work. If it was cheap enough, anyone could get a prescription, treatment was also available, then it would drive down the price so much that there would be little incentive to use the illegal stuff. Sell controllable amounts, that is better than random death, plus random overdose.
mythrwy 8y ago
Well if it were done properly purity and dosage could be monitored along with people's condition leading to less fatalities and overall harm. Along with, as you say, removing the criminal element. Obviously a free for all probably isn't a great idea. But that's kind of what we have now isn't it? With the added bonus of jailing a few randos from time to time and absolutely no control over any of it. I realize these drugs are dangerous and addictive. Not sure there is an easy answer. If we really could ban them, sure, that would be great, but are we willing to do what it takes to do that? No, people would scream bloody murder, our society isn't set up for that kind of liberty infringement. But apparently it isn't set up for compassionate rational approaches either, so we will continue to pump money into swat teams and other half assed authoritative wack a mole measures which seem unlikely to ever really fix the problem. Meanwhile society as a whole suffers a plague of junkie fallout and likely winds up paying much more than they would would with a compassionate rational approach. I feel like I need to say, taking these kind of things in the first place is a bad idea imo, but people are doing it. So what do we do?
- Nasrudith 8y ago
  I think one good answer for a stop gap is physicians being allowed to perscribe anything with only outright malpractice as a limit without any imposed tautologies. A physician could say perscribe heroin to help an addict taper off or even to someone new and ask why they want to start and offer healthier doses while still being permitted to dispense according to judgement. For terminal patients or chronic pain cases near suicide it may legitimately be the best option in their case. Medicine is all about "normally it would be a bad idea (amputation) but because the alternative (certainly fatal sepsis pre-antibiotics) is even worse we are doing it". It would be a radical idea and put more pressure on doctors as a social system admittedly but it could be ideal for practicing medicine without dogmatic insistences codified into law despite evidence being increasingly clear they are wrong.
  - DanBC 8y ago
    > I think one good answer for a stop gap is physicians being allowed to perscribe anything with only outright malpractice as a limit without any imposed tautologies. You know how the US crisis started, right?
    - schrodinger 8y ago
      That’s how people inadvertently became hooked. The parent is talking about new patients that are already hooked. It’s a different story; you don’t stop being an addict once you’re hooked because your doctor won’t prescribe it.
      - DanBC 8y ago
        Sure, but it demonstrates the problem of "let doctors prescribe whatever they want". Addicts are not helped by ever increasing doses of prescribed opioid medication. There's an argument to be made for maintainance doses until they're ready to stop, and then medically assisted detox, but neither of those are doctors prescribing with no controls.
ashcza 8y ago
rationale: check out the result of Portugal decriminalizing all drugs in 2001: https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it https://www.theguardian.com/news/2017/dec/05/portugals-radic...
DanBC 8y ago
This is tricky because the opioid crisis starts from legally supplied opioids, and is made worse by lack of access to pain treatment and illegality of drugs. The continued illegality of drugs causes weird incentives. If a dealer has to smuggle opioids they're going to chose something easier to smuggle. Fentanyl is much easier than heroin to smuggle because you need so much less of it for a dose. Here's a photograph of a fatal dose of fentanyl (2mg): https://www.drugabuse.gov/about-nida/noras-blog/2018/05/true-deadly-scope-americas-fentanyl-problem https://www.drugabuse.gov/about-nida/noras-blog/2018/05/true... What the US needs is a huge increase in provision of specialist pain management treatment, free at the point of delivery. This would reduce the need for opioid prescribing (which mostly doesn't work for long term pain). That would reduce the market for opioids. The US also needs a huge increase in evidence based addiction treatment. At the moment there is huge amounts of money being spent on detox holiday-camps, which have very poor evidence, and not much at all on medically assisted withdrawal and replacement, which has much better evidence. The combination of addiction treatment and pain treatment would help remove the illegal market. These can be provided while opioids are illegal, but it's easier to do it if opioids are either decriminalised or legal. Legalisation does not necessarily mean "sold in Walmart next to the soda". It might mean "available to registered addicts to prevent them getting involved in acquisitive crime".
imtringued 8y ago
At some point punishments cease to work. Bigger risks of losing everything also mean bigger incentives to retaliate. A poacher threatened with capital punishment isn't going to stop hunting and turn himself in, he will just shoot the police and anyone who is going to report him, because there is nothing left to lose anyway. Stricter punishment against drugs means dealers choose drugs that are harder to detect. The smaller the quantity of drugs the better. Higher potency is preferred even if wrong dosage sometimes kills the clients and adding foreign substances like brick dust as cutting agent (which then cause the majority of health issues) becomes practically mandatory.

codyb 8y ago

I think what you’d want to do in a case like this is make legal the not WMD strength stuff at affordable prices and constant purity. The idea being that the heroin market could grow and reduce the demand for the fentanyls and carfentanyls. Hopefully the addicted would want the safer stuff, especially if it was at similar prices or cheaper. Then you tax it, and use the money raised for public awareness and education to drive down the rate over time and offer out reach programs, counseling, and rehab services to the people buying the stuff. That seems like the sanest and most humane way to tackle both having these extremely potent and dangerous substances flying through our mail system while limiting damage over time, and helping as many as possible for whom they’ve already become addicted or are on that path.

Latteland 8y ago
You lay out a reasonable position where it might work. I salute you. That sounds reasonable and I could see that it might work. If it was cheap enough, anyone could get a prescription, treatment was also available, then it would drive down the price so much that there would be little incentive to use the illegal stuff. Sell controllable amounts, that is better than random death, plus random overdose.

mythrwy 8y ago

Well if it were done properly purity and dosage could be monitored along with people's condition leading to less fatalities and overall harm. Along with, as you say, removing the criminal element. Obviously a free for all probably isn't a great idea. But that's kind of what we have now isn't it? With the added bonus of jailing a few randos from time to time and absolutely no control over any of it. I realize these drugs are dangerous and addictive. Not sure there is an easy answer. If we really could ban them, sure, that would be great, but are we willing to do what it takes to do that? No, people would scream bloody murder, our society isn't set up for that kind of liberty infringement. But apparently it isn't set up for compassionate rational approaches either, so we will continue to pump money into swat teams and other half assed authoritative wack a mole measures which seem unlikely to ever really fix the problem. Meanwhile society as a whole suffers a plague of junkie fallout and likely winds up paying much more than they would would with a compassionate rational approach. I feel like I need to say, taking these kind of things in the first place is a bad idea imo, but people are doing it. So what do we do?

Nasrudith 8y ago
I think one good answer for a stop gap is physicians being allowed to perscribe anything with only outright malpractice as a limit without any imposed tautologies. A physician could say perscribe heroin to help an addict taper off or even to someone new and ask why they want to start and offer healthier doses while still being permitted to dispense according to judgement. For terminal patients or chronic pain cases near suicide it may legitimately be the best option in their case. Medicine is all about "normally it would be a bad idea (amputation) but because the alternative (certainly fatal sepsis pre-antibiotics) is even worse we are doing it". It would be a radical idea and put more pressure on doctors as a social system admittedly but it could be ideal for practicing medicine without dogmatic insistences codified into law despite evidence being increasingly clear they are wrong.
- DanBC 8y ago
  > I think one good answer for a stop gap is physicians being allowed to perscribe anything with only outright malpractice as a limit without any imposed tautologies. You know how the US crisis started, right?
  - schrodinger 8y ago
    That’s how people inadvertently became hooked. The parent is talking about new patients that are already hooked. It’s a different story; you don’t stop being an addict once you’re hooked because your doctor won’t prescribe it.
    - DanBC 8y ago
      Sure, but it demonstrates the problem of "let doctors prescribe whatever they want". Addicts are not helped by ever increasing doses of prescribed opioid medication. There's an argument to be made for maintainance doses until they're ready to stop, and then medically assisted detox, but neither of those are doctors prescribing with no controls.

ashcza 8y ago

rationale: check out the result of Portugal decriminalizing all drugs in 2001: https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it https://www.theguardian.com/news/2017/dec/05/portugals-radic...

DanBC 8y ago

This is tricky because the opioid crisis starts from legally supplied opioids, and is made worse by lack of access to pain treatment and illegality of drugs. The continued illegality of drugs causes weird incentives. If a dealer has to smuggle opioids they're going to chose something easier to smuggle. Fentanyl is much easier than heroin to smuggle because you need so much less of it for a dose. Here's a photograph of a fatal dose of fentanyl (2mg): https://www.drugabuse.gov/about-nida/noras-blog/2018/05/true-deadly-scope-americas-fentanyl-problem https://www.drugabuse.gov/about-nida/noras-blog/2018/05/true... What the US needs is a huge increase in provision of specialist pain management treatment, free at the point of delivery. This would reduce the need for opioid prescribing (which mostly doesn't work for long term pain). That would reduce the market for opioids. The US also needs a huge increase in evidence based addiction treatment. At the moment there is huge amounts of money being spent on detox holiday-camps, which have very poor evidence, and not much at all on medically assisted withdrawal and replacement, which has much better evidence. The combination of addiction treatment and pain treatment would help remove the illegal market. These can be provided while opioids are illegal, but it's easier to do it if opioids are either decriminalised or legal. Legalisation does not necessarily mean "sold in Walmart next to the soda". It might mean "available to registered addicts to prevent them getting involved in acquisitive crime".

imtringued 8y ago

At some point punishments cease to work. Bigger risks of losing everything also mean bigger incentives to retaliate. A poacher threatened with capital punishment isn't going to stop hunting and turn himself in, he will just shoot the police and anyone who is going to report him, because there is nothing left to lose anyway. Stricter punishment against drugs means dealers choose drugs that are harder to detect. The smaller the quantity of drugs the better. Higher potency is preferred even if wrong dosage sometimes kills the clients and adding foreign substances like brick dust as cutting agent (which then cause the majority of health issues) becomes practically mandatory.