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It feels like in the last few years I have been constantly hearing about new research showing “fun” drugs as cures to a wide array of medical conditions. There’

It feels like in the last few years I have been constantly hearing about new research showing “fun” drugs as cures to a wide array of medical conditions. There’s marijuana for chronic pain, mushrooms for depression, mdma for ptsd, and now ketamine. They are often talked about as if they have little or no harmful side effects. I’m glad we are moving away from the incredibly destructive drug policies that have been in place for so long but I fear the pendulum may be swinging too far the other way. The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry. Are we going to see similar harms from these drugs a few years after they gain more popularity? So far the evidence doesn’t show anything near this level of harm. I’m just skeptical of anything that seems too good to be true.

nickthemagicman 5y ago
What there a really are no or very few side effects?
- shadowgovt 5y ago
  (interpreting as "What if there really are no or very few side effects?") That would be great, but it would be something we learn on the other side of controlled trials.
- IBCNU 5y ago
  The idea of the pendulum swinging too far is a huge over-reaction. The pendulum has 40 years of swinging back to a "normal" state if you include the overprescribed industry of prescribing mood altering drugs to suburbanites, adderall, etc. Yes, the boomer and gen-x generations were raised in a lie: their doctors told them they could take drugs without side effects. However, this is now well known.
- narag 5y ago
  Ketamine seems to be a commonly used drug in emergencies because it's a safer anesthetic than propofol when you don't know specifics about the patient and can't determine dosage.
  - stouset 5y ago
    Ketamine is the world’s most commonly used anaesthetic, or at least it was as of some years ago. It’s on the WHO’s list of 100 essential medicines because it’s one of the very rare anaesthetics that doesn’t depress the respiratory system, making it extremely safe by comparison with many others.
- rscho 5y ago
  There are. Hypertension, arrhythmia, confusion, delirium... Mostly at anesthetic or at least pain killer dosage, though. Ketamine can in fact be a dangerous drug when you don't know what you're doing.
funnybeam 5y ago
A lot of the “fun drugs” were originally used for medical purposes and only banned because people started using them for fun
- bserge 5y ago
  A real shame. But I guess if you let people learn personal responsibility they won't need the government as much anymore.
  - acituan 5y ago
    > But I guess if you let people learn personal responsibility they won't need the government as much anymore Addiction is not a mere matter of personal responsibility but a complex bio-psycho-social phenomena. Oversimplified solutions from both sides of the argument does the most harm.
    - bserge 5y ago
      What goes around comes around.
      - acituan 5y ago
        Funny enough this is an area we can exert personal responsibility.
wyre 5y ago
Cannabis, psilocybin, and LSD have been used recreationally for decades with death rates approaching zero and there have been 0 cases of overdose. I was under the impression that these drugs were made illegal because their use promotes an anti capitalism mindset (see Timothy Leary being called the most dangerous man because of his research on LSD) and the medical industrial complex isnt able to extract as much money from them. I’ve never heard that opioids where once known to be non-addictive. Weren’t the Opium Wars started because China wanted Britain to stop selling them addictive opium? It’s fair to be skeptical, but the data is not there. Cannabis, MDMA, and ketamine all have high potential for addiction and the latter two potential for abuse but it is possible to find Ketamine clinics for safe administration. I’m not familiar if there is public MDMA treatment available.
- gunshai 5y ago
  >Weren’t the Opium Wars started because China wanted Britain to stop selling them addictive opium? Yes and out of the opium wars I believe is why the state of Hong Kong came into existence. China had contractual obligations to buy opium, I believe they ended up dumping it into the bay in sort of a Tea Party type scenario but it was the Chinese government who did the dumping. The opium wars are pretty damn fascinating. OH and if I'm not mistaken it was a contractual obligations with the East India Trading company and the British government backed the EITC by making a trade blockade.
- sandworm101 5y ago
  Oxycodone was pitched as non-addicting. Opioids generally were pitched as non-addicting because they were by prescription, under control of doctors. That protection scheme obviously failed miserably.
  - stouset 5y ago
    Oxycodone was created by a pharmaceutical company and marketed in a way that would earn them a profit. Marijuana and psilocybin have been around for literal ages with widespread use. LSD and ketamine are synthesized, but we have decades of experience with them.
irthomasthomas 5y ago
Sorry to burst your bubble but U.S. drug policy is not as progressive as you might think. Cannabis is still illegal under federal law. And right now America is petitioning the WHO for a GLOBAL ban on KRATOM, a herb which has been used in Asia for hundreds of years with no recorded deaths. It has been in use in Europe and America for a couple of decades and still there are no deaths recorded from pure Kratom use. Kratom can be used to treat or replace alcohol, cocaine and opiate addiction. It is a herb harvested from the leaves of a tree related to the coffee plant and has incredible pain relieving properties, as well as being a mild stimulant and mood regulator. For more info see this recent study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/ And please tell the FDA and WHO not to ban this awesome herb. The deadline for comments is August 9th. https://www.americankratom.org/ https://www.americankratom.org/
- tomato-sauce 5y ago
  Thanks for pointing this out. I don’t know enough about kratom to have an opinion on how it should be regulated. I will add a comment though. Just because I am fundamentally opposed to America regulating drug use outside of its territory.
  - fsckboy 5y ago
    https://www.drugabuse.gov/publications/drugfacts/kratom https://www.drugabuse.gov/publications/drugfacts/kratom
    - Texaner 5y ago
      I will assume anything written under such a link to be false unless proven otherwise.
- gunshai 5y ago
  Come to Oregon where we just decriminalized the party.
- loeg 5y ago
nicoburns 5y ago
> The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry. I definitely think the pharmecuetical industry pushing drugs is a big problem. But that doesn't mean we should deny people treatments that work. Instead we should fix the actual problem: innapropruate presceiptions. Note that opiods are mostly not a problem here in the UK for example. We're much stricter about when they're used. In any case, I think there's much less risk here. Ketamine is a somewhat addictive, but nowhere near as bad as opiods, and cannabis and especially psychedelics are pretty much not addictive. It doesn't seem too good to be true to me. It seems obvious that the chemicals which clearly affect the mind are the ones which are likely to have some use for... affecting the mind in a positive way. They've at least cleared the first hurdle!
- pitaj 5y ago
  The US has been cracking down on opioid prescriptions to the point that a lot of people can't get opioids for when they really need them for chronic pain and even after surgeries! In the meantime, opioid overdoses have continued to climb. Turns out that forcing people into the black market to deal with terrible pain is not a good policy.
  - lumost 5y ago
    No one has had a good approach for opioid addiction since the first cases of morphine addiction a century ago. Banning opiate use results in deaths, restricting prescriptions moves addicts to the black market, the status quo results in more addicts.
    - nicoburns 5y ago
      Portugal seems to have found a decent solution: addicts can get easy access to legitimate supply, but non-addicts can't. Seems to have dramatically improved the situation there.
      - bserge 5y ago
dghughes 5y ago
>I’m glad we are moving away from the incredibly destructive drug policies that have been in place for so long The point of the polices was to counter the incredibly destructive result of the surge of cocaine, crack, heroin use in the mid 1970s and early to mid 1980s. And the deaths from the drug use and the gangs fighting over the spoils. It really was a war. Mexico didn't seem to make it, I think the drugs won. I know for some people these days it's cool to poo poo the so-called "war on drugs" but to Gen X who lived through the surge it was not a great time. Every day some news of deaths, fights, we were constantly reminded of it. Something had to be done and the free-for-all didn't seem to be working. I guess just like psychology you hear of examples where the stern family raises a wild child and the carefree family raises a straight-edge child the program backfired. Drugs are chemicals just as is water and yes if a drug is useful then study it and use them for good if possible. But to others it seems many view all drugs as holy and that they can do no wrong is ridiculous.
- ihunter2839 5y ago
  "The point of the polices was to counter the incredibly destructive result of the surge of cocaine, crack, heroin use in the mid 1970s and early to mid 1980s." This would be plausible if the policies were focused on those drugs exclusively. However, I see the draconian policies targeted towards cannabis, hallucinogens, and amphetamines as pretty ample evidence that the "war on drugs" had much wider ambitions than curbing the usage of these hard narcotics. Edit) To your point of folks speaking harshly of our current drug policies - look at where we are now, 50 years later. A nationwide opioid crisis created by pharma companies. A generation, if not two, of young men and fathers locked up in prison with little to no room for upwards mobility. Communities, already economically deprived, losing stability, obliteration of the nuclear family core, and enduring oppressive policing policies. So yes, I think its entirely fair for a new generation to shit on the war on drugs. Even if the policy was formed with good intentions (which is, frankly, debatable), it is still bad policy.
- Klinky 5y ago
  The "War on Drugs" did little to solve the social causes of drug addiction and dealing, and mainly focused on expensive law enforcement operations and penalizing impoverished people further. With the opioid epidemic, white-collar drug dealers were free to make huge profits getting people addicted, with little repercussions for decades. The "War" was targeted to a very specific demographic.
elevaet 5y ago
One danger of chronic ketamine use is bladder damage.
- dllthomas 5y ago
  But note https://astralcodexten.substack.com/p/drug-users-use-a-lot-of-drugs https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
  - elevaet 5y ago
    I totally agree with the perspective in that blog. I just wanted to mention one of the known dangers of chronic ketamine use in the spirit of harm-reduction, because I don't think the bladder damage risk is that well-known, and sometimes people become seduced by the charms of ketamine and end up taking the drug far more often than when they set out.
- dkersten 5y ago
  From what I've read about people using Ketamine for antidepression, they tend to use a very small dose at as long an interval as possible while still being effective, while the reports of bladder damage seem to be when people use large quantities (a few grams) per day for months. That is, if you're using it medically, rather than for recreation, its probably not a risk. Even recreationally, unless you're abusing it, its likely not a big risk. I think a big part of the issue is that you quickly develop a tolerance to Ketamine, so if you're a daily user, there's a strong tendency to up the dosage to maintain its effect. If you're a casual user or are careful to spread it out to avoid tolerance buildup, I think it can be avoided. With that said, you're absolutely right that it is a danger that needs to be kept in mind, but from what I've read, if you're not abusing it, the risk seems low.
  - elevaet 5y ago
    You're right, taken in a medical context there would be no risk of this. Just wanted to put the bladder damage risk on the radar, so that people are aware that there are physical consequences to abuse. You know, a lot of people self-medicate and there's a fine line between self-medication, recreation, and abuse.
scythe 5y ago
>marijuana for chronic pain, mushrooms for depression, mdma for ptsd Is it that much of a surprise that psychoactive drugs treat psychogenic symptoms? In the particular case of pain, the two major available drug classes -- opioids and benzodiazepines -- mimic the activity of addictive recreational drugs opium and alcohol. THC is used per se instead of derivatives because of its price and safety record (contrast opium/alcohol). For depression/PTSD, psychiatry has thrown the kitchen sink at these conditions. It's more "newsworthy" when MDMA is used for PTSD than propanolol even though both serve essentially the same purpose: allowing the patient to discuss the traumatic experience without experiencing the emotional effects of that trauma, by blocking them physiologically. In this case, "blocking negative emotions" is a naturally desirable effect of a recreational drug (propanolol also blocks many positive emotions, rendering it less fun). Modifying emotions in depression doesn't seem like a surprise either, although psychedelics can be unreliable here (and this is well-documented). I expect some negative side-effects to appear, but I disagree that this is much of a change from the norm, except insofar as it upends a taboo. Methaqualone got its start treating insomnia, and the medical history of amphetamine is too long to fit in this comment. In fact, during the early history of psychedelics, there were developed "less recreational" analogues of the major drugs, such as diethyl-psilocin ("ethocin") and 5'-methoxy-MDA ("MMDA") which were considered as possibly safer adjuvants to psychotherapy. The rediscovery of these agents might benefit more from attention on their history of bona fide therapeutic use, rather than on their recreational past. Perhaps we shouldn't be so surprised when some psychiatric medications turn out to be recreational, and mitigate the consequences pragmatically, rather than reflexively recoiling from anything resembling euphoria. One thing you learn from Infinite Jest is that the mere materialism of emotion is especially unnerving insofar as it applies to happiness, but reality isn't going away anytime soon. What happened in this article with ketamine is quite different: test-tube evidence uncovered an effect that modifies a rare hereditary condition. I think the story here is really more about data-mining, and ketamine just happens to be interesting.
- PragmaticPulp 5y ago
  > Is it that much of a surprise that psychoactive drugs treat psychogenic symptoms? The surprising part is the growing narrative that these psychoactive drugs are basically miracle cures without downsides. Drugs like LSD are being explored as adjuncts to intense therapy spanning many sessions, but the pop-science portrayal of these drugs ignores that intense therapy and instead imagines that tripping on mushrooms or LSD is a cure for psychiatric illness. It also ignores the fact that bad trips are a very real possibility and worsening of psychiatric illness is not uncommon among illicit users of these drugs. There are plentiful reports of psychedelics causing weeks or months of dysphoria or even precipitating long-lasting episodes of major depression, and it’s not hard to find them either. If we want to get anywhere with these substances, we need to quit exaggerating their positive effects and downplaying their negatives. That’s a setup for failure when they’re further studied and the reality can’t match the unreasonably loft pop-culture presentation of these drugs as miracle cures that act alone without any downsides. It is, as the grandparent comment said, reminiscent of the early days of opioids when we were bombarded with stories about how they were miracle cures without downsides. The truth is that they’re helpful in controlled circumstances but can be harmful when overdosed or prescribed without supervision, which doesn’t sound that different then the situation with drugs like ketamine.
mam3 5y ago
The side effects are super well documentéd on drug-positive websites such as psychonaut wiki, erowid,... even r/drugs. Just look for it
PragmaticPulp 5y ago
> Are we going to see similar harms from these drugs a few years after they gain more popularity? I think we’re already starting to see this on a smaller scale. One of my friends is a therapist who does a lot of social work predominantly for low-income people coming from difficult situations. She encounters a lot of people who have become heavily dependent on marijuana under a mistaken impression that smoking multiple times every day is a good treatment for depression or anxiety. Many of them are under the impression than marijuana is a wonder drug that treats everything from psychiatric illnesses to cancer. Meanwhile they’re clearly too impaired and unmotivated to get their lives together due to being constantly high. She spends a lot of time convincing people to moderate their consumption or even abstain entirely. The results are great if she can convince them to stop, but that’s a difficult task. More worrisome is the increasing number of parents she sees who are trying to medicate their juvenile children with marijuana. Some of the stories she tells about parents who are convinced they’re doing their kids a favor by giving them THC edibles before school (supposedly for anxiety) are downright tragic. There is a growing mistrust of pharmaceutical companies and mainstream psychiatry that mirrors the rise of things like anti-vaxxers and belief in essential oils. Many companies are rushing to fill this demand for alternative medicine with products and services ranging from pushing heavy THC consumption to ketamine clinics that will give ketamine to anyone willing to pay a few hundred dollars per dose. In the case of this article the discovery of ketamine’s actions is more likely to spur development of new molecules that can be used without the obvious side effects of ongoing ketamine treatment (which is not as harmless as it sounds when repeatedly dosed over a lifetime).
- chillwaves 5y ago
  Did you ever compare the side effects of marijuana to the popular antidepressant, antianxiety and ADHD medications being given to children? > There is a growing mistrust of pharmaceutical companies and mainstream psychiatry that mirrors the rise of things like anti-vaxxers This statement seems to ignore the crisis brought by narcotic drugs. People should be skeptical of pharmaceutical companies. There is a long history of their drugs killing people. It's really not worth my time to post it all, but feel free to do a little research yourself. Comparing them to antivaxxers is inflammatory and inaccurate.
standardUser 5y ago
"They are often talked about as if they have little or no harmful side effect" Unlike all those "unfun" drugs? I think side effects are part and parcel of virtually all drugs. Do we need a special all-caps disclaimer anytime a drug is mentioned to remind people that side effects exist? If we did, most of the biggest disclaimers would be reserved for fully-legal, commonly-prescribed drugs.
bawolff 5y ago
> They are often talked about as if they have little or no harmful side effects. Most drugs have side effects, including all the legal pharmaceuticals. E.g. normal antidepressants aren't without risk. Anyways, that's why its important to study them - see where they lie on the risk-benefit trade-off curve. > The opioid epidemic was largely caused by the idea of them being non addictive I don't know which idiots thought these were non addictive. Like there was even the opium wars faught over this point in the 1800s. We've known of the danger since the 1700s.
- acituan 5y ago
  > Most drugs have side effects, including all the legal pharmaceuticals. E.g. normal antidepressants aren't without risk. Risk/no-risk dichotomy is misleading in that those categories do not consist of homogeneously comparable members. Nausea from an SSRI is not the same as triggering a first psychotic episode from psychedelic drug use, or pushing your neuroticism a standard deviation higher from stimulant abuse or getting stuck in opioid addiction.
  - bawolff 5y ago
    SSRI's are also linked to hallucinations and suicide. Of course not all drugs are the same, some are more risky than others, but its not like legality corresponds to the risk. I'm not saying that popular drugs are risk free. They definitely aren't. That's why its important to study them and understand what the risks are so people can make informed decisions about them (under the supervision of a doctor)
dkersten 5y ago
> and now ketamine Ketamine has been in medical use for a long time as an anesthetic and has also been shown to be beneficial for depression in recent years. Its not "now" Ketamine.
TulliusCicero 5y ago
What we're seeing is data from studies. What we need is yet more studies. Yes, there's probably negative side effects, but that's true for medicines in general.
stakkur 5y ago
Michael Pollan would like a word. I think you’re confusing ‘recent news’ with ‘a long history’.
samstave 5y ago
I'm not sure how old you are, nor your familiarity with the history behind Silicon Valley and "Drugs" --- >The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry. False - there was never the "idea" that these were non-addictive - it was an active, malicious, evil fucking LIE. --- One of the co-founders of Cisco, and one of the fathers of the Border Gateway Protocol (BGP), (as well as RIP, etc) - - which is aurguably the foundations of routing which makes the Internet possible, stated, in response to Hoffman's 100th birthday celebration (the discoverer of LSD): (Paraphrased, mostly: "I was opposed to drug testing of employees at Cisco as we scaled -- if it weren't for LSD we wouldn't have been able to come up with many of the complex concepts behind BGP" Here is one article on it: https://www.wired.com/2006/01/lsd-the-geeks-wonder-drug/ https://www.wired.com/2006/01/lsd-the-geeks-wonder-drug/ I know first hand how much Drug/"anti-Culture" is imbued in Silicon Valley, computing in general. I have done many a drug with many a people who have built the shit that the world lives and thrives on daily. There is a STARK difference between a mood altering suppressant such as an opioid and expand nootropic drugs, such as LSD and Shrooms. Both of which are IMO some of the most important psycho-actives we have. You are touching something (your machine) and consuming content (netflix etc) built by many people who have benefited, and thus had you benefit, from their experiences with 'altered-conscious'.... The Sackler Family is an evil piece of shit family that should be worse than in prison.... But The internet and Computing as we know it, would not exist if it were not for people who do not accept the simplicity of base reality and can operate at higher levels at times with the help of LSD/Shrooms. its funny how one may equate "harmful addiction" with the USE of such substance.... in fact, my counter-culture DNA has shown me my entire life - that "the establishment" literally is quelling human growth because of the fact that using these reveals the fragility and tenuous control they actually have. In fact, I am sitting here with a book that one of my best friends just sent me - "The Fabric of Reality" (by David Deutsch) and in all likelihood, this evening you will be using tech that he has helped build... The only thing that is "too good to be true" is when someone else tells you definitively that you must do and act "this way" because we said so. (Look at the fucking state of the world at this moment -- you think that all these governments and institutions know what the fuck they are talking about? - no...) Go microdose some shrooms for good measure.
okareaman 5y ago
> The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry That's not true. The new idea was that a manageable addiction was preferred to chronic pain. The theory was that addiction to opioids could be managed. That turned out to be not the case. People started selling pills and buying street heroin and it spiraled out of control.
- amanaplanacanal 5y ago
  I thought the new idea was that people who took opioids only for pain relief didn’t get addicted, which in hindsight is absolute nonsense.
  - okareaman 5y ago
    People didn't suddenly forget centuries of experience that narcotics were addictive. They thought that making them time release and long lasting they could manage the addiction. Pharmacies did downplay the cleverness of people when they want to get high. People found they could crush the pills and snort them for a quick rush. Those who weren't addiction prone found they could sell their pills for $80 a pill. It was off to the races after that. The real crime here wasn't trying to help those in chronic pain with a manageable addiction, it was the incredibly long time it took for pharma companies and govt regulators to do anything about the crisis, even as some pharmacies in Florida and West Virginia were selling millions of pills, far more than their local communities would warrant. The suspicion is that a lot of money was being made, so why rush to intervene.
  - pas 5y ago
    Managing acute pain is different from chronic pain. The 'new idea' you refer to is that people who get opioids in hospitals don't get addicted. Of course, the important difference is that when people get better after surgery their life is generally goin in a good direction. It's easy to stop using opioids when you are finally able to walk, work, move, live, love again. Chronic pain is basically the opposite. Where depression is almost guaranteed, and susceptibility to addiction is very high.
- 5y ago
DoreenMichele 5y ago
So far the evidence doesn’t show anything near this level of harm. I’m just skeptical of anything that seems too good to be true. People with rare diseases (and their families and caretakers) get excited about anything at all actually helpful, especially if it comes through official, approved medical channels, because they suffer a whole helluva lot every single day while listening to the medical community promise "cures" that never seem to arrive. It's an amazingly hard psychological thing to live with. On a Cystic Fibrosis list years ago, a parent said "My child turns 18 today. The life expectancy now is 36. When he was born, the life expectancy was 18." So gains get made but these are people who need a miracle cure and needed it "yesterday" who are, instead, getting incremental improvements at what feels like a glacial speed while they live tormented lives. So, yeah, they get excited. But that doesn't mean they are going to all throw caution to the wind and jump on the band wagon. Some that do -- or seem to -- are basically "already dead anyway" if they don't try something new and are happy to take a gamble in hopes of one last hurrah and at least it's more data for others like them if it doesn't help them.
beiller 5y ago
I think the harmful opoids were created due to heroin being illegal. The pharmaceutical version is purified and more potent in general, helping enshrine it as the go to for smuggling due to its smaller size/volume and then cut once it's imported to its destination. Just an opinion tho.
closeparen 5y ago
Recreational doses are quite a bit bigger than therapeutic doses. Take enough of any legitimate pharmaceutical and it’ll mess you up, too.
sneak 5y ago
A little reminder that the (legal) tobacco causes 7x more preventable deaths every day/week/month in the USA than the entirety of the opiate epidemic. The policies that govern substances in the US are not based whatsoever on health outcomes, only money and racism. That may change, but thinking of it as a one-dimensional pendulum is probably the wrong model for reasoning about it. Effective treatments for difficult diseases always seem too good to be true: take paracetamol for an example.

nickthemagicman 5y ago

What there a really are no or very few side effects?

shadowgovt 5y ago
(interpreting as "What if there really are no or very few side effects?") That would be great, but it would be something we learn on the other side of controlled trials.
IBCNU 5y ago
The idea of the pendulum swinging too far is a huge over-reaction. The pendulum has 40 years of swinging back to a "normal" state if you include the overprescribed industry of prescribing mood altering drugs to suburbanites, adderall, etc. Yes, the boomer and gen-x generations were raised in a lie: their doctors told them they could take drugs without side effects. However, this is now well known.
narag 5y ago
Ketamine seems to be a commonly used drug in emergencies because it's a safer anesthetic than propofol when you don't know specifics about the patient and can't determine dosage.
- stouset 5y ago
  Ketamine is the world’s most commonly used anaesthetic, or at least it was as of some years ago. It’s on the WHO’s list of 100 essential medicines because it’s one of the very rare anaesthetics that doesn’t depress the respiratory system, making it extremely safe by comparison with many others.
rscho 5y ago
There are. Hypertension, arrhythmia, confusion, delirium... Mostly at anesthetic or at least pain killer dosage, though. Ketamine can in fact be a dangerous drug when you don't know what you're doing.

funnybeam 5y ago

A lot of the “fun drugs” were originally used for medical purposes and only banned because people started using them for fun

bserge 5y ago
A real shame. But I guess if you let people learn personal responsibility they won't need the government as much anymore.
- acituan 5y ago
  > But I guess if you let people learn personal responsibility they won't need the government as much anymore Addiction is not a mere matter of personal responsibility but a complex bio-psycho-social phenomena. Oversimplified solutions from both sides of the argument does the most harm.
  - bserge 5y ago
    What goes around comes around.
    - acituan 5y ago
      Funny enough this is an area we can exert personal responsibility.

wyre 5y ago

Cannabis, psilocybin, and LSD have been used recreationally for decades with death rates approaching zero and there have been 0 cases of overdose. I was under the impression that these drugs were made illegal because their use promotes an anti capitalism mindset (see Timothy Leary being called the most dangerous man because of his research on LSD) and the medical industrial complex isnt able to extract as much money from them. I’ve never heard that opioids where once known to be non-addictive. Weren’t the Opium Wars started because China wanted Britain to stop selling them addictive opium? It’s fair to be skeptical, but the data is not there. Cannabis, MDMA, and ketamine all have high potential for addiction and the latter two potential for abuse but it is possible to find Ketamine clinics for safe administration. I’m not familiar if there is public MDMA treatment available.

gunshai 5y ago
>Weren’t the Opium Wars started because China wanted Britain to stop selling them addictive opium? Yes and out of the opium wars I believe is why the state of Hong Kong came into existence. China had contractual obligations to buy opium, I believe they ended up dumping it into the bay in sort of a Tea Party type scenario but it was the Chinese government who did the dumping. The opium wars are pretty damn fascinating. OH and if I'm not mistaken it was a contractual obligations with the East India Trading company and the British government backed the EITC by making a trade blockade.
sandworm101 5y ago
Oxycodone was pitched as non-addicting. Opioids generally were pitched as non-addicting because they were by prescription, under control of doctors. That protection scheme obviously failed miserably.
- stouset 5y ago
  Oxycodone was created by a pharmaceutical company and marketed in a way that would earn them a profit. Marijuana and psilocybin have been around for literal ages with widespread use. LSD and ketamine are synthesized, but we have decades of experience with them.

irthomasthomas 5y ago

Sorry to burst your bubble but U.S. drug policy is not as progressive as you might think. Cannabis is still illegal under federal law. And right now America is petitioning the WHO for a GLOBAL ban on KRATOM, a herb which has been used in Asia for hundreds of years with no recorded deaths. It has been in use in Europe and America for a couple of decades and still there are no deaths recorded from pure Kratom use. Kratom can be used to treat or replace alcohol, cocaine and opiate addiction. It is a herb harvested from the leaves of a tree related to the coffee plant and has incredible pain relieving properties, as well as being a mild stimulant and mood regulator. For more info see this recent study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/ And please tell the FDA and WHO not to ban this awesome herb. The deadline for comments is August 9th. https://www.americankratom.org/ https://www.americankratom.org/

tomato-sauce 5y ago
Thanks for pointing this out. I don’t know enough about kratom to have an opinion on how it should be regulated. I will add a comment though. Just because I am fundamentally opposed to America regulating drug use outside of its territory.
- fsckboy 5y ago
  https://www.drugabuse.gov/publications/drugfacts/kratom https://www.drugabuse.gov/publications/drugfacts/kratom
  - Texaner 5y ago
    I will assume anything written under such a link to be false unless proven otherwise.
gunshai 5y ago
Come to Oregon where we just decriminalized the party.
loeg 5y ago

nicoburns 5y ago

> The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry. I definitely think the pharmecuetical industry pushing drugs is a big problem. But that doesn't mean we should deny people treatments that work. Instead we should fix the actual problem: innapropruate presceiptions. Note that opiods are mostly not a problem here in the UK for example. We're much stricter about when they're used. In any case, I think there's much less risk here. Ketamine is a somewhat addictive, but nowhere near as bad as opiods, and cannabis and especially psychedelics are pretty much not addictive. It doesn't seem too good to be true to me. It seems obvious that the chemicals which clearly affect the mind are the ones which are likely to have some use for... affecting the mind in a positive way. They've at least cleared the first hurdle!

pitaj 5y ago
The US has been cracking down on opioid prescriptions to the point that a lot of people can't get opioids for when they really need them for chronic pain and even after surgeries! In the meantime, opioid overdoses have continued to climb. Turns out that forcing people into the black market to deal with terrible pain is not a good policy.
- lumost 5y ago
  No one has had a good approach for opioid addiction since the first cases of morphine addiction a century ago. Banning opiate use results in deaths, restricting prescriptions moves addicts to the black market, the status quo results in more addicts.
  - nicoburns 5y ago
    Portugal seems to have found a decent solution: addicts can get easy access to legitimate supply, but non-addicts can't. Seems to have dramatically improved the situation there.
    - bserge 5y ago

dghughes 5y ago

>I’m glad we are moving away from the incredibly destructive drug policies that have been in place for so long The point of the polices was to counter the incredibly destructive result of the surge of cocaine, crack, heroin use in the mid 1970s and early to mid 1980s. And the deaths from the drug use and the gangs fighting over the spoils. It really was a war. Mexico didn't seem to make it, I think the drugs won. I know for some people these days it's cool to poo poo the so-called "war on drugs" but to Gen X who lived through the surge it was not a great time. Every day some news of deaths, fights, we were constantly reminded of it. Something had to be done and the free-for-all didn't seem to be working. I guess just like psychology you hear of examples where the stern family raises a wild child and the carefree family raises a straight-edge child the program backfired. Drugs are chemicals just as is water and yes if a drug is useful then study it and use them for good if possible. But to others it seems many view all drugs as holy and that they can do no wrong is ridiculous.

ihunter2839 5y ago
"The point of the polices was to counter the incredibly destructive result of the surge of cocaine, crack, heroin use in the mid 1970s and early to mid 1980s." This would be plausible if the policies were focused on those drugs exclusively. However, I see the draconian policies targeted towards cannabis, hallucinogens, and amphetamines as pretty ample evidence that the "war on drugs" had much wider ambitions than curbing the usage of these hard narcotics. Edit) To your point of folks speaking harshly of our current drug policies - look at where we are now, 50 years later. A nationwide opioid crisis created by pharma companies. A generation, if not two, of young men and fathers locked up in prison with little to no room for upwards mobility. Communities, already economically deprived, losing stability, obliteration of the nuclear family core, and enduring oppressive policing policies. So yes, I think its entirely fair for a new generation to shit on the war on drugs. Even if the policy was formed with good intentions (which is, frankly, debatable), it is still bad policy.
Klinky 5y ago
The "War on Drugs" did little to solve the social causes of drug addiction and dealing, and mainly focused on expensive law enforcement operations and penalizing impoverished people further. With the opioid epidemic, white-collar drug dealers were free to make huge profits getting people addicted, with little repercussions for decades. The "War" was targeted to a very specific demographic.

elevaet 5y ago

One danger of chronic ketamine use is bladder damage.

dllthomas 5y ago
But note https://astralcodexten.substack.com/p/drug-users-use-a-lot-of-drugs https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
- elevaet 5y ago
  I totally agree with the perspective in that blog. I just wanted to mention one of the known dangers of chronic ketamine use in the spirit of harm-reduction, because I don't think the bladder damage risk is that well-known, and sometimes people become seduced by the charms of ketamine and end up taking the drug far more often than when they set out.
dkersten 5y ago
From what I've read about people using Ketamine for antidepression, they tend to use a very small dose at as long an interval as possible while still being effective, while the reports of bladder damage seem to be when people use large quantities (a few grams) per day for months. That is, if you're using it medically, rather than for recreation, its probably not a risk. Even recreationally, unless you're abusing it, its likely not a big risk. I think a big part of the issue is that you quickly develop a tolerance to Ketamine, so if you're a daily user, there's a strong tendency to up the dosage to maintain its effect. If you're a casual user or are careful to spread it out to avoid tolerance buildup, I think it can be avoided. With that said, you're absolutely right that it is a danger that needs to be kept in mind, but from what I've read, if you're not abusing it, the risk seems low.
- elevaet 5y ago
  You're right, taken in a medical context there would be no risk of this. Just wanted to put the bladder damage risk on the radar, so that people are aware that there are physical consequences to abuse. You know, a lot of people self-medicate and there's a fine line between self-medication, recreation, and abuse.

scythe 5y ago

>marijuana for chronic pain, mushrooms for depression, mdma for ptsd Is it that much of a surprise that psychoactive drugs treat psychogenic symptoms? In the particular case of pain, the two major available drug classes -- opioids and benzodiazepines -- mimic the activity of addictive recreational drugs opium and alcohol. THC is used per se instead of derivatives because of its price and safety record (contrast opium/alcohol). For depression/PTSD, psychiatry has thrown the kitchen sink at these conditions. It's more "newsworthy" when MDMA is used for PTSD than propanolol even though both serve essentially the same purpose: allowing the patient to discuss the traumatic experience without experiencing the emotional effects of that trauma, by blocking them physiologically. In this case, "blocking negative emotions" is a naturally desirable effect of a recreational drug (propanolol also blocks many positive emotions, rendering it less fun). Modifying emotions in depression doesn't seem like a surprise either, although psychedelics can be unreliable here (and this is well-documented). I expect some negative side-effects to appear, but I disagree that this is much of a change from the norm, except insofar as it upends a taboo. Methaqualone got its start treating insomnia, and the medical history of amphetamine is too long to fit in this comment. In fact, during the early history of psychedelics, there were developed "less recreational" analogues of the major drugs, such as diethyl-psilocin ("ethocin") and 5'-methoxy-MDA ("MMDA") which were considered as possibly safer adjuvants to psychotherapy. The rediscovery of these agents might benefit more from attention on their history of bona fide therapeutic use, rather than on their recreational past. Perhaps we shouldn't be so surprised when some psychiatric medications turn out to be recreational, and mitigate the consequences pragmatically, rather than reflexively recoiling from anything resembling euphoria. One thing you learn from Infinite Jest is that the mere materialism of emotion is especially unnerving insofar as it applies to happiness, but reality isn't going away anytime soon. What happened in this article with ketamine is quite different: test-tube evidence uncovered an effect that modifies a rare hereditary condition. I think the story here is really more about data-mining, and ketamine just happens to be interesting.

PragmaticPulp 5y ago
> Is it that much of a surprise that psychoactive drugs treat psychogenic symptoms? The surprising part is the growing narrative that these psychoactive drugs are basically miracle cures without downsides. Drugs like LSD are being explored as adjuncts to intense therapy spanning many sessions, but the pop-science portrayal of these drugs ignores that intense therapy and instead imagines that tripping on mushrooms or LSD is a cure for psychiatric illness. It also ignores the fact that bad trips are a very real possibility and worsening of psychiatric illness is not uncommon among illicit users of these drugs. There are plentiful reports of psychedelics causing weeks or months of dysphoria or even precipitating long-lasting episodes of major depression, and it’s not hard to find them either. If we want to get anywhere with these substances, we need to quit exaggerating their positive effects and downplaying their negatives. That’s a setup for failure when they’re further studied and the reality can’t match the unreasonably loft pop-culture presentation of these drugs as miracle cures that act alone without any downsides. It is, as the grandparent comment said, reminiscent of the early days of opioids when we were bombarded with stories about how they were miracle cures without downsides. The truth is that they’re helpful in controlled circumstances but can be harmful when overdosed or prescribed without supervision, which doesn’t sound that different then the situation with drugs like ketamine.

mam3 5y ago

The side effects are super well documentéd on drug-positive websites such as psychonaut wiki, erowid,... even r/drugs. Just look for it

PragmaticPulp 5y ago

> Are we going to see similar harms from these drugs a few years after they gain more popularity? I think we’re already starting to see this on a smaller scale. One of my friends is a therapist who does a lot of social work predominantly for low-income people coming from difficult situations. She encounters a lot of people who have become heavily dependent on marijuana under a mistaken impression that smoking multiple times every day is a good treatment for depression or anxiety. Many of them are under the impression than marijuana is a wonder drug that treats everything from psychiatric illnesses to cancer. Meanwhile they’re clearly too impaired and unmotivated to get their lives together due to being constantly high. She spends a lot of time convincing people to moderate their consumption or even abstain entirely. The results are great if she can convince them to stop, but that’s a difficult task. More worrisome is the increasing number of parents she sees who are trying to medicate their juvenile children with marijuana. Some of the stories she tells about parents who are convinced they’re doing their kids a favor by giving them THC edibles before school (supposedly for anxiety) are downright tragic. There is a growing mistrust of pharmaceutical companies and mainstream psychiatry that mirrors the rise of things like anti-vaxxers and belief in essential oils. Many companies are rushing to fill this demand for alternative medicine with products and services ranging from pushing heavy THC consumption to ketamine clinics that will give ketamine to anyone willing to pay a few hundred dollars per dose. In the case of this article the discovery of ketamine’s actions is more likely to spur development of new molecules that can be used without the obvious side effects of ongoing ketamine treatment (which is not as harmless as it sounds when repeatedly dosed over a lifetime).

chillwaves 5y ago
Did you ever compare the side effects of marijuana to the popular antidepressant, antianxiety and ADHD medications being given to children? > There is a growing mistrust of pharmaceutical companies and mainstream psychiatry that mirrors the rise of things like anti-vaxxers This statement seems to ignore the crisis brought by narcotic drugs. People should be skeptical of pharmaceutical companies. There is a long history of their drugs killing people. It's really not worth my time to post it all, but feel free to do a little research yourself. Comparing them to antivaxxers is inflammatory and inaccurate.

standardUser 5y ago

"They are often talked about as if they have little or no harmful side effect" Unlike all those "unfun" drugs? I think side effects are part and parcel of virtually all drugs. Do we need a special all-caps disclaimer anytime a drug is mentioned to remind people that side effects exist? If we did, most of the biggest disclaimers would be reserved for fully-legal, commonly-prescribed drugs.

bawolff 5y ago

> They are often talked about as if they have little or no harmful side effects. Most drugs have side effects, including all the legal pharmaceuticals. E.g. normal antidepressants aren't without risk. Anyways, that's why its important to study them - see where they lie on the risk-benefit trade-off curve. > The opioid epidemic was largely caused by the idea of them being non addictive I don't know which idiots thought these were non addictive. Like there was even the opium wars faught over this point in the 1800s. We've known of the danger since the 1700s.

acituan 5y ago
> Most drugs have side effects, including all the legal pharmaceuticals. E.g. normal antidepressants aren't without risk. Risk/no-risk dichotomy is misleading in that those categories do not consist of homogeneously comparable members. Nausea from an SSRI is not the same as triggering a first psychotic episode from psychedelic drug use, or pushing your neuroticism a standard deviation higher from stimulant abuse or getting stuck in opioid addiction.
- bawolff 5y ago
  SSRI's are also linked to hallucinations and suicide. Of course not all drugs are the same, some are more risky than others, but its not like legality corresponds to the risk. I'm not saying that popular drugs are risk free. They definitely aren't. That's why its important to study them and understand what the risks are so people can make informed decisions about them (under the supervision of a doctor)

dkersten 5y ago

> and now ketamine Ketamine has been in medical use for a long time as an anesthetic and has also been shown to be beneficial for depression in recent years. Its not "now" Ketamine.

TulliusCicero 5y ago

What we're seeing is data from studies. What we need is yet more studies. Yes, there's probably negative side effects, but that's true for medicines in general.

stakkur 5y ago

Michael Pollan would like a word. I think you’re confusing ‘recent news’ with ‘a long history’.

samstave 5y ago

I'm not sure how old you are, nor your familiarity with the history behind Silicon Valley and "Drugs" --- >The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry. False - there was never the "idea" that these were non-addictive - it was an active, malicious, evil fucking LIE. --- One of the co-founders of Cisco, and one of the fathers of the Border Gateway Protocol (BGP), (as well as RIP, etc) - - which is aurguably the foundations of routing which makes the Internet possible, stated, in response to Hoffman's 100th birthday celebration (the discoverer of LSD): (Paraphrased, mostly: "I was opposed to drug testing of employees at Cisco as we scaled -- if it weren't for LSD we wouldn't have been able to come up with many of the complex concepts behind BGP" Here is one article on it: https://www.wired.com/2006/01/lsd-the-geeks-wonder-drug/ https://www.wired.com/2006/01/lsd-the-geeks-wonder-drug/ I know first hand how much Drug/"anti-Culture" is imbued in Silicon Valley, computing in general. I have done many a drug with many a people who have built the shit that the world lives and thrives on daily. There is a STARK difference between a mood altering suppressant such as an opioid and expand nootropic drugs, such as LSD and Shrooms. Both of which are IMO some of the most important psycho-actives we have. You are touching something (your machine) and consuming content (netflix etc) built by many people who have benefited, and thus had you benefit, from their experiences with 'altered-conscious'.... The Sackler Family is an evil piece of shit family that should be worse than in prison.... But The internet and Computing as we know it, would not exist if it were not for people who do not accept the simplicity of base reality and can operate at higher levels at times with the help of LSD/Shrooms. its funny how one may equate "harmful addiction" with the USE of such substance.... in fact, my counter-culture DNA has shown me my entire life - that "the establishment" literally is quelling human growth because of the fact that using these reveals the fragility and tenuous control they actually have. In fact, I am sitting here with a book that one of my best friends just sent me - "The Fabric of Reality" (by David Deutsch) and in all likelihood, this evening you will be using tech that he has helped build... The only thing that is "too good to be true" is when someone else tells you definitively that you must do and act "this way" because we said so. (Look at the fucking state of the world at this moment -- you think that all these governments and institutions know what the fuck they are talking about? - no...) Go microdose some shrooms for good measure.

okareaman 5y ago

> The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry That's not true. The new idea was that a manageable addiction was preferred to chronic pain. The theory was that addiction to opioids could be managed. That turned out to be not the case. People started selling pills and buying street heroin and it spiraled out of control.

amanaplanacanal 5y ago
I thought the new idea was that people who took opioids only for pain relief didn’t get addicted, which in hindsight is absolute nonsense.
- okareaman 5y ago
  People didn't suddenly forget centuries of experience that narcotics were addictive. They thought that making them time release and long lasting they could manage the addiction. Pharmacies did downplay the cleverness of people when they want to get high. People found they could crush the pills and snort them for a quick rush. Those who weren't addiction prone found they could sell their pills for $80 a pill. It was off to the races after that. The real crime here wasn't trying to help those in chronic pain with a manageable addiction, it was the incredibly long time it took for pharma companies and govt regulators to do anything about the crisis, even as some pharmacies in Florida and West Virginia were selling millions of pills, far more than their local communities would warrant. The suspicion is that a lot of money was being made, so why rush to intervene.
- pas 5y ago
  Managing acute pain is different from chronic pain. The 'new idea' you refer to is that people who get opioids in hospitals don't get addicted. Of course, the important difference is that when people get better after surgery their life is generally goin in a good direction. It's easy to stop using opioids when you are finally able to walk, work, move, live, love again. Chronic pain is basically the opposite. Where depression is almost guaranteed, and susceptibility to addiction is very high.
5y ago

DoreenMichele 5y ago

So far the evidence doesn’t show anything near this level of harm. I’m just skeptical of anything that seems too good to be true. People with rare diseases (and their families and caretakers) get excited about anything at all actually helpful, especially if it comes through official, approved medical channels, because they suffer a whole helluva lot every single day while listening to the medical community promise "cures" that never seem to arrive. It's an amazingly hard psychological thing to live with. On a Cystic Fibrosis list years ago, a parent said "My child turns 18 today. The life expectancy now is 36. When he was born, the life expectancy was 18." So gains get made but these are people who need a miracle cure and needed it "yesterday" who are, instead, getting incremental improvements at what feels like a glacial speed while they live tormented lives. So, yeah, they get excited. But that doesn't mean they are going to all throw caution to the wind and jump on the band wagon. Some that do -- or seem to -- are basically "already dead anyway" if they don't try something new and are happy to take a gamble in hopes of one last hurrah and at least it's more data for others like them if it doesn't help them.

beiller 5y ago

I think the harmful opoids were created due to heroin being illegal. The pharmaceutical version is purified and more potent in general, helping enshrine it as the go to for smuggling due to its smaller size/volume and then cut once it's imported to its destination. Just an opinion tho.

closeparen 5y ago

Recreational doses are quite a bit bigger than therapeutic doses. Take enough of any legitimate pharmaceutical and it’ll mess you up, too.

sneak 5y ago

A little reminder that the (legal) tobacco causes 7x more preventable deaths every day/week/month in the USA than the entirety of the opiate epidemic. The policies that govern substances in the US are not based whatsoever on health outcomes, only money and racism. That may change, but thinking of it as a one-dimensional pendulum is probably the wrong model for reasoning about it. Effective treatments for difficult diseases always seem too good to be true: take paracetamol for an example.