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Good write up. The US is really grappling with diseases of despair, and heroin/fentanyl addition is on of the biggest ones impacting the wellbeing of our societ

by wespiser_2018 5y ago

Good write up. The US is really grappling with diseases of despair, and heroin/fentanyl addition is on of the biggest ones impacting the wellbeing of our society. A massive slice of talent and raw human resource is just dying every year, but the solutions that have worked in other countries are just impossible to implement here due because the the methods that are known to work are politically dead on arrival. I'm a strong proponent of the US taking the approach the Swiss took to combat their opiate epidemic in the late 80s and early 90s. Anyone that is addicted to drugs can get the drugs they want, they just have to already be addicted first, and accept the drugs in a safe environment. It would be extraordinarily expensive, but cases like Jacks are already costing us much more than just giving him drugs, keeping him alive, then having healthcare professionals be there at exactly the moment he decides he's had enough. The effect on new users would be profound as well: as all the current users naturally age out of wanting to use hard drugs, the majority of drug dealers (other users themselves), won't have the capability to introduce new people to hard drugs. However, we seem to have this huge moral hang up in the US about giving addicts drugs, even though we know that will save lives and money by reducing crime and lowering overall healthcare costs. For all the money Jack's parents spent on rehab, and hours spent watching him, none of it could prevent them burying their son the day he got a bad bag of heroin. For a case like Jacks, only safe drugs and injection sites would keep him and the millions of people stable before they are ready to move on. The US is just not prepared to do what it takes to solve the opiate epidemic, and it's so frustrating to what tens of thousands of people die while we aren't anywhere near getting our act together. It's a Vietnam war in OD deaths, every year, and the Sacklers just walked with no criminal liability. Unless we do something drastic to reach these people, the opiate crisis is never going to go away.

germinalphrase 5y ago
“ The effect on new users would be profound as well: as all the current users naturally age out of wanting to use hard drugs, the majority of drug dealers (other users themselves), won't have the capability to introduce new people to hard drugs” Why do you believe this to be true?
- wespiser_2018 5y ago
  Pareto law effects on the consumption of drugs, and network effects that result from the fact that the majority of street level dealers are doing it for the sole purpose of supporting their habit? No life ruining class A felony is worth the money you get selling drugs, but people do it it all the time because they are sick with a disease and feel they must. New people will still be introduced to drugs, but there are definitely network effects in opiate addiction that can be mitigated when supply is transferred from an illegal source that requires people to organize and recruit new users with cash, to one that is organized and paid for by the government. It's not perfect, but even decriminalization has had a pretty remarkable effect on Portugal, at least that's what the latest studies are saying.
- yholio 5y ago
  Giving free, safe drugs will depress demand for illegal drugs: most dealers are users, and are pushed to a high risk criminal activity - drug dealing - in order to finance their expensive habit. They take extraordinary risk for this, including actively seeking out new clients. If you give out free product, you not only kill the primary demand, but most dealers themselves don't have a reason to continue taking risks - because they can benefit from the free product too. Purely profit oriented dealers will remain in the market, which is now much smaller and even riskier, since they can only sell to recreational users.
  - rkk3 5y ago
    > most dealers are users, and are pushed to a high risk criminal activity - drug dealing - in order to finance their expensive habit Source?
    - quickthrowman 5y ago
      The smaller the transaction amount, the larger chance that the dealer is going to have an addiction of their own. It’s easier for one wholesaler to sell to an addict (or several) that distributes small amounts to a bunch of other addicts, vs taking on all the volume yourself. Addicts usually know other addicts and have a strong incentive to sell, they need cash every single day. I doubt you’ll find a source, but the number of users distributing small amounts is probably larger than the amount of people pushing weight (who usually don’t use) This is based of my experience buying heroin in a mid-sized US metro area, fortunately far in my past. One without an open-air drug market, so deals were done in cars or alleys.
TimTheTinker 5y ago
> we seem to have this huge moral hang up in the US about giving addicts drugs For many people, what you're describing all comes down to the law of love. It is not loving to give a person more of the thing that is destroying them. Perhaps free methadone would be a better option? EDIT: care to comment? I'd like to know why people disagree.
- wespiser_2018 5y ago
  That's a pretty rudimentary analysis, and the "law of love" doesn't really hold much weight when you start looking at the prognosis for various treatment groups for people with opiate dependency. It's really the abstinence only attitude I was talking about: why is it a big deal to give someone medication for the rest of their live if we know it will keep them alive, healthy, and allow them to live a fulfilled life? Addiction is just like any other disease, and it turns out medication assisted therapy is very effective. Methadone works, and so do other medications, but it's only a partial solution. We need a rapid and massive expansion of these programs. We also need programs and medications to target people who go on Methadone, but keep going off. Why not give them Herion, if we can do it safely? What about if there is evidence they can become productive members of society? Again, it's my view that although people OD from drugs, it's really the prohibition of drugs that are killing people through the incredibly unsafe and unreliable drugs people get. Supervised opiates are not dangerous, and unlike other drugs, cocaine, meth, benzos, you can safely be on them for years at a time nearly no long term effects. At least the long term effects of staying on them pale in comparison to the consequences of an OD. 60,000 people OD per year. What we are doing isn't working!
- standardUser 5y ago
  More often than not, lives are in greater threat of being "destroyed" by the consequences of drug prohibition than the drugs themselves. Addiction is a serious health problem, but impure drugs that lead to overdose deaths, spreading disease through needle use, avoiding medical care for fear of legal consequences, going to jail and having a criminal record, and becoming involved in black market violence are all vastly more common threats to drug users than any drug.
somethoughts 5y ago
It'd be interesting if there were any country wide experiments that are similar to the approach that has been taken with tobacco. Basically legalize it for those over 18, slap it silly with warning labels and then tax the heck out it to make it prohibitively expensive. And raise the tax every year. And then fund ad campaigns and social media campaigns which make it generally look dumb and unfashionable as well as treatments. But perhaps the addictive qualities and treatment is much greater than tobacco.
- wespiser_2018 5y ago
  I'm not so sure about this. The most recent, and best, evidence we have on getting folks addicted to substances better is to put them on a coordinated treatment overseen by doctors and implemented by a variety of different healthcare professionals. Interestingly, I think if hard drugs were legal, very few people who don't already use them would go out tomorrow and give them a try, "just because", so its' not like we would have a complete societal meltdown if it happened. I just think the US should look to other countries, and start off by implementing what works there. Even that is radical!
- secondaryacct 5y ago
  I don't know. As a smoker, I m guilty of smoking, Im not really a victim even if one could argue it will be hard to stop - it's a lot of personal responsibility, a bit of laziness and a minority the product itself. With heroin, I d argue people are definite victims. It's absolutely not like tobacco, the craving is physically painful for long, not just the mild annoyance of tobacco. To give you a few exemples: it takes me 3 days to a week of being irritated to stop cigarets for a full year, cold turkey. For injected heroin, it's 2 weeks of extreme pain with possibility of hospitalisation, for Subutex, an alternative pill, it's around a month (so many addict complain it s easier to take a break from heroin than the progressively reducing alternative medicine). My dad is a pharmacist in France where we treat drug addicts who want to recover as victims and help them get alternative subutex or methadone for free: he told me he never saw someone truly stop. They can reduce and live with it, but they cannot possibly stop. Your increasing tax solution seems unfair, while it seems fair for me with cigarets: it's my fault and I can stop. Not an heroin addict. I dont have a magical solution, in France we focused on stopping the violence due to the craving with free Methadone in pharmacies and it changed the criminal landscape, but destroying the product supply at the source while keeping the last addicts on Methadone seems like the only path, if the goal is to free people from opioids in France. In the US it's different: opioids became a for profit pharmaceutical entreprise, and most of the crisis there is due to opium sold hidden as painkillers totally legally on a large scale.
standardUser 5y ago
"Anyone that is addicted to drugs can get the drugs they want, they just have to already be addicted first" All that does is create a perfect window for new users to use tainted black market drugs and die. It's also essentially a government endorsement of the black market and the violence that comes with it. I think we need to move past those cowardly policies and craft laws that respect the reality that drug use will always be part of society. Playing make-believe that we can stop drug production or sales is too expensive (in cash and life) and has been proven comprehensively ineffective over several generations.
- Retric 5y ago
  It seriously harms the black market for these drugs. Opioids are an escalating addiction so new users are simply less profitable. Eventually illegal opioids can consume an almost unlimited budget, but shift heavy users to government supply and suddenly it’s a much less profitable business. The Swiss are roughly 1/10th as likely to use opioids as Americans and of their users ~85% are in rehab. Relatively speaking it’s a tiny illegal drug market.
skyechurch 5y ago
>A massive slice of talent and raw human resource is just dying every year, but the solutions that have worked in other countries are just impossible to implement here due because the the methods that are known to work are politically dead on arrival. From the essay, it sounds like Jack was not possessed of any great "talent", or of any particular value as a "raw human resource". He was just a dude, probably easily replaceable from a HR perspective, and these are the sorts who, historically, we are willing to sacrifice in order to honorably lose a war on drugs. (If you want to know what kinds of sacrifices are required to win a war on opiates, Mao is the "best" recent example.) We live in a cruel economy, where the "losers" are left to find solace in electronic toys and mystery fentanyls sold as heroin. Mostly, the losers are determined ahead of time, and their numbers grow as the middle class shrinks. It's an inhumane system with inhumane outcomes built in. *I know I'm reading too much into your word choice, it's not meant as a personal attack, it's just useful as a jumping-off point for this post. If I were a better writer I would have figured out how to avoid this impression, but I'm not, so please take my word for it. I think you are basically right about the humane way to handle this.
- wespiser_2018 5y ago
  Sure, maybe one Jack isn't a big deal, but what about 1000 Jacks? How much economic output would 58,000 thousand early deaths be in a year where we have a labour shortage and a supply chain crisis on our hands? Jack might not be the best example of "raw human talent", but people like him contribute to the economy that are hard to measure, and of equal worth to anyone else. I'm of the opinion that we shouldn't compare lives, but I guess we could compare economic value, and for the thousands in lost lives, even working the most menial jobs, that's still tremendous worth in a country where our birth rate is shrinking faster than ever.
- Sebb767 5y ago
  > From the essay, it sounds like Jack was not possessed of any great "talent", or of any particular value as a "raw human resource". He was just a dude, probably easily replaceable from a HR perspective, I've seen a lot of smart people fall to drugs. Sure, if they get in too deep too early, they won't have a degree when they die, but they could have had one. And yes, as an HR person in a comparatively small company, this person is easily replaceable. On a country scale, however, you can't simply replace him - you need the numbers of highly educated smart people and you can't simply "hire" them back from another country. Look at the stereotype of the asian genius - disregarding the other factors, China simply has 3-5 times [0] the population, so they will statistically have 5 times the geniuses to start with. You can't compete when your best bets have a 5% chance to whither away due to drugs. > If you want to know what kinds of sacrifices are required to win a war on opiates, Mao is the "best" recent example. How so? I don't know what specifically you're pointing to, but given that other countries handle the situation better with less "sacrifices", I don't think they're necessary. [0] Depending on US or EU perspective.
scythe 5y ago
The invisible elephant in the US opioid policy discussion is the lacuna between the policy and its implementation. You have to find a human being to perform the work of enforcing the drug laws. The US has had drug addicts for a hundred years, and the attitude towards opioids hasn't changed very much, but the usage levels go up and down. There's a back-and-forth between "rehabilitation" and " incentivizing" that correlates poorly with the outcome. What correlates better with opioid use? Recently, the epidemic clearly started with overprescription and then exploded with fentanyl: https://www.cdc.gov/opioids/basics/epidemic.html https://www.cdc.gov/opioids/basics/epidemic.html It's important to notice that prescription opioid overdoses don't go down until 2017. This problem started with prescriptions and it won't end until the problem is fixed. Pills should be replaced with patches wherever possible. The other glaring issue is that the meteoric rise of fentanyl was not noticed until it got out of hand. This is a societal problem: drug messageboard users knew about the fentanyl crisis years before the regulators took any action. The regulatory system, viz. the DEA, has been starved for talent for decades because nobody wants to work for them. The enforcement-for-profit model of the civil asset forfeiture era of policing has driven talented and motivated people away from law enforcement careers. The people who are left are not qualified or motivated for the task at hand. Enforcement should be more proactive than it was. It should focus on real dangers, not culture wars. Opioids and dopaminergic stimulants are the drugs of self-destruction; everything else is a distraction. The most ironic thing to hear people chanting in an epidemic of poisonings brought on by illegally and irresponsibly manufactured high-potency addictive drugs is "abolish the police!". These people need the police. But nobody trusts the police. One quote we were all forced to memorize in school was: "A house divided against itself cannot stand."
- wespiser_2018 5y ago
  I don't disagree with your most of your assessment, except that I do think we should abolish the the DEA. The war on drugs has been going on for 50 years. At some point, we have to admit that drugs won, and address the crisis in the most effective way based on the best, most recent information available to us, which is that addiction is a disease and one that can be effectively managed. 20 years ago, sure, who cares about the DEA, they put dope and guns on the table and largely stayed out of peoples way. Now, we have around 60k thousand deaths per year from the opiate crisis that reaches almost everyone in America. Law Enforcement has no solution, just carry around Narcan while drugs come in through every major port and postal facility in the country. Let the cops do what they are good at: reduce violence, enforce property rights and keep communities safe, but stay out of healthcare. Give the DEA the best grads, and that won't change the fact that they are working in a system where they simply don't have the power to stop two consenting individuals engage in a prohibited behavior.
stef25 5y ago
It's a really complicated problem but one thing that just stands out to me is the role the doctors play: It's not normal to send people home with these massive prescriptions for opiates. Here in Europe doctors are very, very conservative with that stuff (and meds in general) while it seems to me that in the US if your "medical experience" even entails the slightest bit of discomfort people get all up in arms over it. Doctors are highly educated people who can no longer play the "I didn't know it was addictive" card. I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again. That's just criminal behavior from the part of the medical establishment.
- wespiser_2018 5y ago
  What's so fascinating to me, is that the current opiate epidemic is largely centered in the US, as we bear the majority of the deaths. That attitude of Drs. over-prescribing, it definitely happened in the US, to various degrees in different places, and not that long ago. Docs in the US tend to think they are above being marketed to, but Purdue Pharma knew better, and they paid their drugs reps a ton to go out to "everytown US" and convince doctors that they had made a non-addicting opiate. Enough docs bought it, and here we are. How did they do? Well, 20 years ago drug reps used to be able to take doctors on trips: to sports games, to see the dog races, to museum trips, the price of a day trip with you and one or two loved ones was to sit through an hour (or two) lecture by a rep that convinced you to to prescribe a drug. Not a bad deal! There were complex reasons why the opiate crisis started, but the environment was ripe for an upstart company like Purdue to come in, reformulate an old opiate, pretend the addiction problem isn't there, then sell a miracle drug because opiates are extremely effective short term analgesics. Long term, we're still paying for it! I've looked a lot into the opiate crisis, and it's a pretty bad stain on the US medical institution, particularly our medical science. We fucked up.
- bamboozled 5y ago
  I don't think it's a really complicated problem, other countries have tried different things that have worked. It's complicated for some people to admit the 'war on drugs' has failed maybe, but that's a different issues all together.
Clubber 5y ago
>It would be extraordinarily expensive I mean we spent $300 million a day for 20 years on Afghanistan, it can't be that expensive. >the Sacklers just walked with no criminal liability In fact, the media firestorm and the political response made heroin overdoses much worse because they "clamped down" on pills that at least had a dosage on it. Addicts then turned to heroin, which now has fentanyl in it.
- wespiser_2018 5y ago
  That's right! in 2011 they switched the formulation of OxyContin. The opiate crisis didn't start then, but it got a whole lot worse! The Sackler decision had a pretty big effect on me. It's hard not to grow up when I did, lose people you know to the opiate crisis, and not feel a deep sense of unfairness and wrong when the people responsible for so much suffering stay out of jail with a million dollars. As much as you can blame them for that one act, it's the iron law of drug prohibition at play: Meth becomes Crystal, and opiates become more concentrated. Easier to smuggle, better profit margins, it really only goes one direction: the drugs get more potent every year prohibition is in effect.
- spoonjim 5y ago
  Still many more annual overdoses of prescription pills than illegal drugs.
  - Clubber 5y ago
    >Still many more annual overdoses of prescription pills than illegal drugs. Not since around 2016, which is around when the panic with pills started and we started cracking down. It did put a small dent in pills but fentanyl is off the charts. We probably would have been better off, at least in terms of deaths, if we had just ignored the "opioid epidemic." https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.drugabuse.gov/drug-topics/trends-statistics/over...
    - spoonjim 5y ago
      Thanks for the correction.
sneak 5y ago
> The US is really grappling with diseases of despair, and heroin/fentanyl addition is on of the biggest ones impacting the wellbeing of our society. This is a false narrative. Tobacco use kills 7-8x more every day, week, and month in the USA. That's a legitimate industry, though, so that's not pushed on the news. Opiates aren't that big an issue, they're just the one the media tells you to care about.
- spoonjim 5y ago
  Absolutely ludicrous comparison. The people dying of opiate overdoses are much younger than cigarette deaths, and the smokers don't have their lives debilitated by their addiction.
  - denton-scratch 5y ago
    Really? COPD is an incurable and debilitating illness, almost always caused by smoking. Also, smoking causes death, which I would put in the "debilitating" category.
  - kashunstva 5y ago
    Well, there's limb loss due to ischemic peripheral vascular disease, lung carcinoma, various other upper airway malignancies, ischemic heart disease, obstructive pulmonary disease...
kenneth 5y ago
As a Swiss person who spent a few years in the 90s going to primary school on Langstrasse, watching junkies shoot up, and having to be careful in city parks to not step on the mountains of used needles… that is about the WORST idea I have ever heard. The Swiss experiment in the 80s and 90s was a complete disaster, and it wasn't until the 2010s that that part of Zurich was finally cleaned up. It attracted the worst junkies from all around Europe, it created a crime wave in a country that was crime-free. It didn't work, either, it just led to more addiction, death, and despair.
- wespiser_2018 5y ago
  That's fair: I've been to Zurich in 2019 a few times, and I was amazed by how clean it was. Remarkable. Even compared to a US, east coast city, it was much more cleaner than anything I've seen. However that doesn't mean the problems don't exist. I do think I got the dates wrong. What I'd like the US to do is adopt a similar liberal approach to prescribing medication assisted therapy, and go as far as we need to go in finding the medication that work for people, like is done today in CH. I don't think the "free firezone" approach is a good idea (akin to "hampsterdam" in The Wire), but getting addicts healthcare and a medically supervised substitute is what I meant. The big part of that in the US, IMO, is fighting the social stigma around adopting science based approaches large scale addiction management, and right now the only acceptable solution is to get people off drugs, then have them OD when they get back on. There is a better way!
- riffraff 5y ago
  FWIW, used needles were a common sight in my childhood and youth in the '80s/'90s in Italy too, and we didn't have such policy. I've literally not seen a used needle in at least a decade, but again, I'm not sure it's because of policy, it seems more likely that people have just, for the most cases, switched to different drugs.
  - stuaxo 5y ago
    Same in the UK, from Brighton and there has been heroine here on and off, certainly a used to see needles in the 80s.
holoduke 5y ago
There is no drugs policy what can reduce drug usage. The only way you can make sure it's not getting out of hand is to have a rich, smart and healthy society.
tonyedgecombe 5y ago
>I'm a strong proponent of the US taking the approach the Swiss took to combat their opiate epidemic in the late 80s and early 90s. I suspect you have your dates wrong, they didn't get a handle on their problems until the late nineties and early 2010s. https://ssir.org/articles/entry/inside_switzerlands_radical_drug_policy_innovation https://ssir.org/articles/entry/inside_switzerlands_radical_...
- wespiser_2018 5y ago
  Yes, I'm attributing the later successes to the early efforts. I did a quick google search when I posted the original comment and got the dates for the start of the program, which started as a mess, not much later when they finally introduced effective measures. The aspects of the Swiss approach I wish the US would take the most are the willingness to try something fundamentally different. For the Swiss, it took a few tries to ultimately work out, but I don't see why the current solutions to the problem they use wouldn't work in the US.
- tremon 5y ago
  You could both be right. That would mean it takes 20+ years of consistent policy to remedy the situation.
hilbert42 5y ago
"...and the Sacklers just walked with no criminal liability." The fact that they did, has to be amongst the top crimes of the century. That justice can fail so spectacularly is treason against the citizenry. Not only does it undermine people's belief in rightful justice but it also brings law, order and governance into disrespect. If you want to sow the seeds of anarchy then this is how to do it.
raxxorrax 5y ago
Plus, I don't think you can really overdose Heroin, people mostly die from contamination.
- yung_steezy 5y ago
  https://en.wikipedia.org/wiki/Median_lethal_dose https://en.wikipedia.org/wiki/Median_lethal_dose
  - raxxorrax 5y ago
    I stand corrected.

germinalphrase 5y ago

“ The effect on new users would be profound as well: as all the current users naturally age out of wanting to use hard drugs, the majority of drug dealers (other users themselves), won't have the capability to introduce new people to hard drugs” Why do you believe this to be true?

wespiser_2018 5y ago
Pareto law effects on the consumption of drugs, and network effects that result from the fact that the majority of street level dealers are doing it for the sole purpose of supporting their habit? No life ruining class A felony is worth the money you get selling drugs, but people do it it all the time because they are sick with a disease and feel they must. New people will still be introduced to drugs, but there are definitely network effects in opiate addiction that can be mitigated when supply is transferred from an illegal source that requires people to organize and recruit new users with cash, to one that is organized and paid for by the government. It's not perfect, but even decriminalization has had a pretty remarkable effect on Portugal, at least that's what the latest studies are saying.
yholio 5y ago
Giving free, safe drugs will depress demand for illegal drugs: most dealers are users, and are pushed to a high risk criminal activity - drug dealing - in order to finance their expensive habit. They take extraordinary risk for this, including actively seeking out new clients. If you give out free product, you not only kill the primary demand, but most dealers themselves don't have a reason to continue taking risks - because they can benefit from the free product too. Purely profit oriented dealers will remain in the market, which is now much smaller and even riskier, since they can only sell to recreational users.
- rkk3 5y ago
  > most dealers are users, and are pushed to a high risk criminal activity - drug dealing - in order to finance their expensive habit Source?
  - quickthrowman 5y ago
    The smaller the transaction amount, the larger chance that the dealer is going to have an addiction of their own. It’s easier for one wholesaler to sell to an addict (or several) that distributes small amounts to a bunch of other addicts, vs taking on all the volume yourself. Addicts usually know other addicts and have a strong incentive to sell, they need cash every single day. I doubt you’ll find a source, but the number of users distributing small amounts is probably larger than the amount of people pushing weight (who usually don’t use) This is based of my experience buying heroin in a mid-sized US metro area, fortunately far in my past. One without an open-air drug market, so deals were done in cars or alleys.

TimTheTinker 5y ago

> we seem to have this huge moral hang up in the US about giving addicts drugs For many people, what you're describing all comes down to the law of love. It is not loving to give a person more of the thing that is destroying them. Perhaps free methadone would be a better option? EDIT: care to comment? I'd like to know why people disagree.

wespiser_2018 5y ago
That's a pretty rudimentary analysis, and the "law of love" doesn't really hold much weight when you start looking at the prognosis for various treatment groups for people with opiate dependency. It's really the abstinence only attitude I was talking about: why is it a big deal to give someone medication for the rest of their live if we know it will keep them alive, healthy, and allow them to live a fulfilled life? Addiction is just like any other disease, and it turns out medication assisted therapy is very effective. Methadone works, and so do other medications, but it's only a partial solution. We need a rapid and massive expansion of these programs. We also need programs and medications to target people who go on Methadone, but keep going off. Why not give them Herion, if we can do it safely? What about if there is evidence they can become productive members of society? Again, it's my view that although people OD from drugs, it's really the prohibition of drugs that are killing people through the incredibly unsafe and unreliable drugs people get. Supervised opiates are not dangerous, and unlike other drugs, cocaine, meth, benzos, you can safely be on them for years at a time nearly no long term effects. At least the long term effects of staying on them pale in comparison to the consequences of an OD. 60,000 people OD per year. What we are doing isn't working!
standardUser 5y ago
More often than not, lives are in greater threat of being "destroyed" by the consequences of drug prohibition than the drugs themselves. Addiction is a serious health problem, but impure drugs that lead to overdose deaths, spreading disease through needle use, avoiding medical care for fear of legal consequences, going to jail and having a criminal record, and becoming involved in black market violence are all vastly more common threats to drug users than any drug.

somethoughts 5y ago

It'd be interesting if there were any country wide experiments that are similar to the approach that has been taken with tobacco. Basically legalize it for those over 18, slap it silly with warning labels and then tax the heck out it to make it prohibitively expensive. And raise the tax every year. And then fund ad campaigns and social media campaigns which make it generally look dumb and unfashionable as well as treatments. But perhaps the addictive qualities and treatment is much greater than tobacco.

wespiser_2018 5y ago
I'm not so sure about this. The most recent, and best, evidence we have on getting folks addicted to substances better is to put them on a coordinated treatment overseen by doctors and implemented by a variety of different healthcare professionals. Interestingly, I think if hard drugs were legal, very few people who don't already use them would go out tomorrow and give them a try, "just because", so its' not like we would have a complete societal meltdown if it happened. I just think the US should look to other countries, and start off by implementing what works there. Even that is radical!
secondaryacct 5y ago
I don't know. As a smoker, I m guilty of smoking, Im not really a victim even if one could argue it will be hard to stop - it's a lot of personal responsibility, a bit of laziness and a minority the product itself. With heroin, I d argue people are definite victims. It's absolutely not like tobacco, the craving is physically painful for long, not just the mild annoyance of tobacco. To give you a few exemples: it takes me 3 days to a week of being irritated to stop cigarets for a full year, cold turkey. For injected heroin, it's 2 weeks of extreme pain with possibility of hospitalisation, for Subutex, an alternative pill, it's around a month (so many addict complain it s easier to take a break from heroin than the progressively reducing alternative medicine). My dad is a pharmacist in France where we treat drug addicts who want to recover as victims and help them get alternative subutex or methadone for free: he told me he never saw someone truly stop. They can reduce and live with it, but they cannot possibly stop. Your increasing tax solution seems unfair, while it seems fair for me with cigarets: it's my fault and I can stop. Not an heroin addict. I dont have a magical solution, in France we focused on stopping the violence due to the craving with free Methadone in pharmacies and it changed the criminal landscape, but destroying the product supply at the source while keeping the last addicts on Methadone seems like the only path, if the goal is to free people from opioids in France. In the US it's different: opioids became a for profit pharmaceutical entreprise, and most of the crisis there is due to opium sold hidden as painkillers totally legally on a large scale.

standardUser 5y ago

"Anyone that is addicted to drugs can get the drugs they want, they just have to already be addicted first" All that does is create a perfect window for new users to use tainted black market drugs and die. It's also essentially a government endorsement of the black market and the violence that comes with it. I think we need to move past those cowardly policies and craft laws that respect the reality that drug use will always be part of society. Playing make-believe that we can stop drug production or sales is too expensive (in cash and life) and has been proven comprehensively ineffective over several generations.

Retric 5y ago
It seriously harms the black market for these drugs. Opioids are an escalating addiction so new users are simply less profitable. Eventually illegal opioids can consume an almost unlimited budget, but shift heavy users to government supply and suddenly it’s a much less profitable business. The Swiss are roughly 1/10th as likely to use opioids as Americans and of their users ~85% are in rehab. Relatively speaking it’s a tiny illegal drug market.

skyechurch 5y ago

>A massive slice of talent and raw human resource is just dying every year, but the solutions that have worked in other countries are just impossible to implement here due because the the methods that are known to work are politically dead on arrival. From the essay, it sounds like Jack was not possessed of any great "talent", or of any particular value as a "raw human resource". He was just a dude, probably easily replaceable from a HR perspective, and these are the sorts who, historically, we are willing to sacrifice in order to honorably lose a war on drugs. (If you want to know what kinds of sacrifices are required to win a war on opiates, Mao is the "best" recent example.) We live in a cruel economy, where the "losers" are left to find solace in electronic toys and mystery fentanyls sold as heroin. Mostly, the losers are determined ahead of time, and their numbers grow as the middle class shrinks. It's an inhumane system with inhumane outcomes built in. *I know I'm reading too much into your word choice, it's not meant as a personal attack, it's just useful as a jumping-off point for this post. If I were a better writer I would have figured out how to avoid this impression, but I'm not, so please take my word for it. I think you are basically right about the humane way to handle this.

wespiser_2018 5y ago
Sure, maybe one Jack isn't a big deal, but what about 1000 Jacks? How much economic output would 58,000 thousand early deaths be in a year where we have a labour shortage and a supply chain crisis on our hands? Jack might not be the best example of "raw human talent", but people like him contribute to the economy that are hard to measure, and of equal worth to anyone else. I'm of the opinion that we shouldn't compare lives, but I guess we could compare economic value, and for the thousands in lost lives, even working the most menial jobs, that's still tremendous worth in a country where our birth rate is shrinking faster than ever.
Sebb767 5y ago
> From the essay, it sounds like Jack was not possessed of any great "talent", or of any particular value as a "raw human resource". He was just a dude, probably easily replaceable from a HR perspective, I've seen a lot of smart people fall to drugs. Sure, if they get in too deep too early, they won't have a degree when they die, but they could have had one. And yes, as an HR person in a comparatively small company, this person is easily replaceable. On a country scale, however, you can't simply replace him - you need the numbers of highly educated smart people and you can't simply "hire" them back from another country. Look at the stereotype of the asian genius - disregarding the other factors, China simply has 3-5 times [0] the population, so they will statistically have 5 times the geniuses to start with. You can't compete when your best bets have a 5% chance to whither away due to drugs. > If you want to know what kinds of sacrifices are required to win a war on opiates, Mao is the "best" recent example. How so? I don't know what specifically you're pointing to, but given that other countries handle the situation better with less "sacrifices", I don't think they're necessary. [0] Depending on US or EU perspective.

scythe 5y ago

The invisible elephant in the US opioid policy discussion is the lacuna between the policy and its implementation. You have to find a human being to perform the work of enforcing the drug laws. The US has had drug addicts for a hundred years, and the attitude towards opioids hasn't changed very much, but the usage levels go up and down. There's a back-and-forth between "rehabilitation" and " incentivizing" that correlates poorly with the outcome. What correlates better with opioid use? Recently, the epidemic clearly started with overprescription and then exploded with fentanyl: https://www.cdc.gov/opioids/basics/epidemic.html https://www.cdc.gov/opioids/basics/epidemic.html It's important to notice that prescription opioid overdoses don't go down until 2017. This problem started with prescriptions and it won't end until the problem is fixed. Pills should be replaced with patches wherever possible. The other glaring issue is that the meteoric rise of fentanyl was not noticed until it got out of hand. This is a societal problem: drug messageboard users knew about the fentanyl crisis years before the regulators took any action. The regulatory system, viz. the DEA, has been starved for talent for decades because nobody wants to work for them. The enforcement-for-profit model of the civil asset forfeiture era of policing has driven talented and motivated people away from law enforcement careers. The people who are left are not qualified or motivated for the task at hand. Enforcement should be more proactive than it was. It should focus on real dangers, not culture wars. Opioids and dopaminergic stimulants are the drugs of self-destruction; everything else is a distraction. The most ironic thing to hear people chanting in an epidemic of poisonings brought on by illegally and irresponsibly manufactured high-potency addictive drugs is "abolish the police!". These people need the police. But nobody trusts the police. One quote we were all forced to memorize in school was: "A house divided against itself cannot stand."

wespiser_2018 5y ago
I don't disagree with your most of your assessment, except that I do think we should abolish the the DEA. The war on drugs has been going on for 50 years. At some point, we have to admit that drugs won, and address the crisis in the most effective way based on the best, most recent information available to us, which is that addiction is a disease and one that can be effectively managed. 20 years ago, sure, who cares about the DEA, they put dope and guns on the table and largely stayed out of peoples way. Now, we have around 60k thousand deaths per year from the opiate crisis that reaches almost everyone in America. Law Enforcement has no solution, just carry around Narcan while drugs come in through every major port and postal facility in the country. Let the cops do what they are good at: reduce violence, enforce property rights and keep communities safe, but stay out of healthcare. Give the DEA the best grads, and that won't change the fact that they are working in a system where they simply don't have the power to stop two consenting individuals engage in a prohibited behavior.

stef25 5y ago

It's a really complicated problem but one thing that just stands out to me is the role the doctors play: It's not normal to send people home with these massive prescriptions for opiates. Here in Europe doctors are very, very conservative with that stuff (and meds in general) while it seems to me that in the US if your "medical experience" even entails the slightest bit of discomfort people get all up in arms over it. Doctors are highly educated people who can no longer play the "I didn't know it was addictive" card. I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again. That's just criminal behavior from the part of the medical establishment.

wespiser_2018 5y ago
What's so fascinating to me, is that the current opiate epidemic is largely centered in the US, as we bear the majority of the deaths. That attitude of Drs. over-prescribing, it definitely happened in the US, to various degrees in different places, and not that long ago. Docs in the US tend to think they are above being marketed to, but Purdue Pharma knew better, and they paid their drugs reps a ton to go out to "everytown US" and convince doctors that they had made a non-addicting opiate. Enough docs bought it, and here we are. How did they do? Well, 20 years ago drug reps used to be able to take doctors on trips: to sports games, to see the dog races, to museum trips, the price of a day trip with you and one or two loved ones was to sit through an hour (or two) lecture by a rep that convinced you to to prescribe a drug. Not a bad deal! There were complex reasons why the opiate crisis started, but the environment was ripe for an upstart company like Purdue to come in, reformulate an old opiate, pretend the addiction problem isn't there, then sell a miracle drug because opiates are extremely effective short term analgesics. Long term, we're still paying for it! I've looked a lot into the opiate crisis, and it's a pretty bad stain on the US medical institution, particularly our medical science. We fucked up.
bamboozled 5y ago
I don't think it's a really complicated problem, other countries have tried different things that have worked. It's complicated for some people to admit the 'war on drugs' has failed maybe, but that's a different issues all together.

Clubber 5y ago

>It would be extraordinarily expensive I mean we spent $300 million a day for 20 years on Afghanistan, it can't be that expensive. >the Sacklers just walked with no criminal liability In fact, the media firestorm and the political response made heroin overdoses much worse because they "clamped down" on pills that at least had a dosage on it. Addicts then turned to heroin, which now has fentanyl in it.

wespiser_2018 5y ago
That's right! in 2011 they switched the formulation of OxyContin. The opiate crisis didn't start then, but it got a whole lot worse! The Sackler decision had a pretty big effect on me. It's hard not to grow up when I did, lose people you know to the opiate crisis, and not feel a deep sense of unfairness and wrong when the people responsible for so much suffering stay out of jail with a million dollars. As much as you can blame them for that one act, it's the iron law of drug prohibition at play: Meth becomes Crystal, and opiates become more concentrated. Easier to smuggle, better profit margins, it really only goes one direction: the drugs get more potent every year prohibition is in effect.
spoonjim 5y ago
Still many more annual overdoses of prescription pills than illegal drugs.
- Clubber 5y ago
  >Still many more annual overdoses of prescription pills than illegal drugs. Not since around 2016, which is around when the panic with pills started and we started cracking down. It did put a small dent in pills but fentanyl is off the charts. We probably would have been better off, at least in terms of deaths, if we had just ignored the "opioid epidemic." https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.drugabuse.gov/drug-topics/trends-statistics/over...
  - spoonjim 5y ago
    Thanks for the correction.

sneak 5y ago

> The US is really grappling with diseases of despair, and heroin/fentanyl addition is on of the biggest ones impacting the wellbeing of our society. This is a false narrative. Tobacco use kills 7-8x more every day, week, and month in the USA. That's a legitimate industry, though, so that's not pushed on the news. Opiates aren't that big an issue, they're just the one the media tells you to care about.

spoonjim 5y ago
Absolutely ludicrous comparison. The people dying of opiate overdoses are much younger than cigarette deaths, and the smokers don't have their lives debilitated by their addiction.
- denton-scratch 5y ago
  Really? COPD is an incurable and debilitating illness, almost always caused by smoking. Also, smoking causes death, which I would put in the "debilitating" category.
- kashunstva 5y ago
  Well, there's limb loss due to ischemic peripheral vascular disease, lung carcinoma, various other upper airway malignancies, ischemic heart disease, obstructive pulmonary disease...

kenneth 5y ago

As a Swiss person who spent a few years in the 90s going to primary school on Langstrasse, watching junkies shoot up, and having to be careful in city parks to not step on the mountains of used needles… that is about the WORST idea I have ever heard. The Swiss experiment in the 80s and 90s was a complete disaster, and it wasn't until the 2010s that that part of Zurich was finally cleaned up. It attracted the worst junkies from all around Europe, it created a crime wave in a country that was crime-free. It didn't work, either, it just led to more addiction, death, and despair.

wespiser_2018 5y ago
That's fair: I've been to Zurich in 2019 a few times, and I was amazed by how clean it was. Remarkable. Even compared to a US, east coast city, it was much more cleaner than anything I've seen. However that doesn't mean the problems don't exist. I do think I got the dates wrong. What I'd like the US to do is adopt a similar liberal approach to prescribing medication assisted therapy, and go as far as we need to go in finding the medication that work for people, like is done today in CH. I don't think the "free firezone" approach is a good idea (akin to "hampsterdam" in The Wire), but getting addicts healthcare and a medically supervised substitute is what I meant. The big part of that in the US, IMO, is fighting the social stigma around adopting science based approaches large scale addiction management, and right now the only acceptable solution is to get people off drugs, then have them OD when they get back on. There is a better way!
riffraff 5y ago
FWIW, used needles were a common sight in my childhood and youth in the '80s/'90s in Italy too, and we didn't have such policy. I've literally not seen a used needle in at least a decade, but again, I'm not sure it's because of policy, it seems more likely that people have just, for the most cases, switched to different drugs.
- stuaxo 5y ago
  Same in the UK, from Brighton and there has been heroine here on and off, certainly a used to see needles in the 80s.

holoduke 5y ago

There is no drugs policy what can reduce drug usage. The only way you can make sure it's not getting out of hand is to have a rich, smart and healthy society.

tonyedgecombe 5y ago

>I'm a strong proponent of the US taking the approach the Swiss took to combat their opiate epidemic in the late 80s and early 90s. I suspect you have your dates wrong, they didn't get a handle on their problems until the late nineties and early 2010s. https://ssir.org/articles/entry/inside_switzerlands_radical_drug_policy_innovation https://ssir.org/articles/entry/inside_switzerlands_radical_...

wespiser_2018 5y ago
Yes, I'm attributing the later successes to the early efforts. I did a quick google search when I posted the original comment and got the dates for the start of the program, which started as a mess, not much later when they finally introduced effective measures. The aspects of the Swiss approach I wish the US would take the most are the willingness to try something fundamentally different. For the Swiss, it took a few tries to ultimately work out, but I don't see why the current solutions to the problem they use wouldn't work in the US.
tremon 5y ago
You could both be right. That would mean it takes 20+ years of consistent policy to remedy the situation.

hilbert42 5y ago

"...and the Sacklers just walked with no criminal liability." The fact that they did, has to be amongst the top crimes of the century. That justice can fail so spectacularly is treason against the citizenry. Not only does it undermine people's belief in rightful justice but it also brings law, order and governance into disrespect. If you want to sow the seeds of anarchy then this is how to do it.

raxxorrax 5y ago

Plus, I don't think you can really overdose Heroin, people mostly die from contamination.

yung_steezy 5y ago
https://en.wikipedia.org/wiki/Median_lethal_dose https://en.wikipedia.org/wiki/Median_lethal_dose
- raxxorrax 5y ago
  I stand corrected.