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It just makes me wonder what is the correct way to legislate opioids? Obviously, we need some legislation, otherwise we'll revert to the world of patent medici

It just makes me wonder what is the correct way to legislate opioids? Obviously, we need some legislation, otherwise we'll revert to the world of patent medicines. (Basically, cure-all patent medicines had opioids in them, and people didn't realize what they were taking.) Also, obviously, we shouldn't criminalize addiction to opioids. Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?

akira2501 3y ago
> It just makes me wonder what is the correct way to legislate opioids? Is legislation the primary problem with these addicts? Or are there other social factors involved? If so, then perhaps the legislation itself is the least important part of the puzzle. > Also, obviously, we shouldn't criminalize addiction to opioids. We don't.. it's just possession and sales that are criminalized. > can legally maintain an addiction What social interest is there in promoting that? > a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to? There's a real fantasy on Hacker News about what the debonair lifestyles of heroin addicts actually are and zero apparent understanding of the long term consequences of the same.
- gwbas1c 3y ago
  >> can legally maintain an addiction > What social interest is there in promoting that? Because the whole reason why we have the opioid crisis is because consuming any opioid without a medical reason is illegal. IE, if you have an injury, and are prescribed opioids, and then accidentally get addicted, your only legal option is to go through withdrawal. If you or I found ourselves in that situation, we'd probably go through withdrawal. Other people won't, and choose to violate drug laws in order to maintain their addiction. Edit: I just want to point out that plenty of people willingly do stupid things: They get addicted to cigarettes, become alcoholics, drive too fast, write mean comments on the internet... We don't force them to quit their vices. The same should apply to opioids too.
  - chimeracoder 3y ago
    I agree with your premise that the criminalization of opiates is the root cause of the opioid crisis today. > If you or I found ourselves in that situation, we'd probably go through withdrawal. I wouldn't be so quick to make that assumption if I were you. Most people who become opiate addicts involuntarily would have assumed they would never resort to illegal opiate use. That's a crucial piece of the puzzle: opiate users aren't a different class of person than you or any of the other users on this site. They're not cut from a different cloth. In all likelihood, most people on this site would respond the same way if put in the same situation. The only difference is that most are lucky enough that they haven't been put in that situation.
    - gwbas1c 3y ago
      > I wouldn't be so quick to make that assumption if I were you I could hardly function on the opioids (Lortab?) that I was prescribed after major surgery. I was relieved when my surgeon told me to stop taking them. Likewise, and I really hate the other opioids (Percoset?) I've been prescribed for minor dental surgery. One person I know really enjoyed them and ended up dying from the addiction. Clearly my head and body react differently than other people. I assume that akira2501 would be ultra-careful if he was in my situation.
    - I_Am_Nous 3y ago
      Unfortunately you never know how you'll react until you are in that situation yourself. Nicotine and caffeine aren't really addictive for me, but on a whim I tried some kratom capsules for back pain. After taking them daily for a week or so, I started feeling really drained after work. As a test, I took another capsule to see what would happen, and I started feeling better again. Threw away the rest of the capsules. If my physiology reacts in such a way, it means I was beginning to develop a physical addiction to it. To Kratom, of all things. It kind of opened my eyes to how quickly it can happen to people as well as how the desire to feel better and reduce suffering can easily lead us to ruin if we aren't careful and attentive.
  - akira2501 3y ago
    > Other people won't, and choose to violate drug laws in order to maintain their addiction. Fair enough, but I am simply unwilling to call "just letting them be addicted" a _solution_ of any sort whatsoever. I'm entirely disappointed with this level of social response. You can be saddened by the apparent hopelessness of their situation, but beckoning further destruction and squalor for lack of willingness to truly care about the problem genuinely upsets me. I understand that part of the concern is these people acquiring a "record" that will make their life difficult in the future. A simple mechanism that expunges these charges entirely upon proof of sobriety is all that's needed to solve this.
stingrae 3y ago
I don't think it is possible to allow people to legally continue the addiction because of growing tolerances to the drugs that require people to find stronger and stronger drugs or dosages. Watching first hand how opioids impact people in SF. I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.
- empath-nirvana 3y ago
  > It isn't humane to let people rot on the streets. Getting police involved in trying to solve social problems has its own inevitable tragic consequences. This is not a problem you can arrest people out of.
- chimeracoder 3y ago
  > I don't think it is possible to allow people to legally continue the addiction because of growing tolerances to the drugs that require people to find stronger and stronger drugs or dosages. This is counterfactual. There is zero basis for claiming that tolerances are increasing at a population level. The increase in potency of street drugs is due to the basic economics of the black market on the supply side, not a response to demand. > I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets. Forced treatment is itself inhumane. It's a "solution" proposed only by people who have little idea of what it looks like in practice, of how substance abuse works, or of what successful treatment actually entails. In reality, "forced treatment" dramatically increases the death rates of people subjected to it. If your problem is with people living "on the street", there are lots of simpler ways to address that problem than to subject them to a costly, expensive government response that will statistically end up killing them.
  - TerrifiedMouse 3y ago
    > This is counterfactual. There is zero basis for claiming that tolerances are increasing at a population level. The increase in potency of street drugs is due to the basic economics of the black market on the supply side, not a response to demand. I think he is just saying even if you legalize it and allow addicts to get drugs easily, it’s not viable long term as the addicts will develop tolerance to the drugs and will need ever increasing doses.
chimeracoder 3y ago
> Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to? You are describing maintenance programs. While methadone has been the maintenance drug of choice for programs in the US due to legal barriers, it turns out that heroin maintenance programs are even more effective than maintenance programs based on substitution. With a maintenance program, members come to the site to receive a legally-obtained, pharmaceutical-quality[0] supply of the drug. Depending on the program, they may either use it on-site (e.g. supervised injection) or bring it home. Crucially, the drug is provided free of charge, so members don't have to worry about how to come up with the money to pay for it. It turns out that these programs reduce crime rates among the members, because most crime that they are committing was in pursuit of the money for their basic needs[1]. Without having to worry about obtaining their drug, or the safety issues associated with the illegal drug market, many are able to find stable jobs, return to stable housing, and lead otherwise normal lives. This isn't new science - one of the first studied attempts was in the 1990s[2], and there have been many more papers published since, documenting the extraordinary benefits. The science behind it is rock-solid. The challenge, as always, is a political one. [0] Zero adulterants, no contaminants - just like the supply of morphine or fentanyl that is used in hospitals for inpatient treatment. [1] Yes, for someone addicted to opiates, the drug is a basic need: involuntary withdrawal is extremely dangerous even under medically supervised conditions, let alone in the conditions most people are forced to experience it. [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28595/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28595/
- gwbas1c 3y ago
  Exactly. Thanks for facts and references. I wish you were upvoted in this thread because this is the most insightful comment I've seen.
hackeraccount 3y ago
Putting addicts in jail because they're addicts is dumb but standing quietly to the side while a person spends their life addicted to opioids is cruel. I used to be sympathetic with that Bill Holiday song "Ain't nobody's business if I do." I'm doubtful about that now but I don't think anyone will stand for a half measure when there's a full measure available - and the last full measure is throwing someone in jail to protect them but that's dumb.
- gwbas1c 3y ago
  > Putting addicts in jail because they're addicts is dumb but standing quietly to the side while a person spends their life addicted to opioids is cruel. No, legal access to opioids to maintain an addiction also comes with addiction treatment options. See https://news.ycombinator.com/item?id=37679129 https://news.ycombinator.com/item?id=37679129

akira2501 3y ago

> It just makes me wonder what is the correct way to legislate opioids? Is legislation the primary problem with these addicts? Or are there other social factors involved? If so, then perhaps the legislation itself is the least important part of the puzzle. > Also, obviously, we shouldn't criminalize addiction to opioids. We don't.. it's just possession and sales that are criminalized. > can legally maintain an addiction What social interest is there in promoting that? > a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to? There's a real fantasy on Hacker News about what the debonair lifestyles of heroin addicts actually are and zero apparent understanding of the long term consequences of the same.

gwbas1c 3y ago
>> can legally maintain an addiction > What social interest is there in promoting that? Because the whole reason why we have the opioid crisis is because consuming any opioid without a medical reason is illegal. IE, if you have an injury, and are prescribed opioids, and then accidentally get addicted, your only legal option is to go through withdrawal. If you or I found ourselves in that situation, we'd probably go through withdrawal. Other people won't, and choose to violate drug laws in order to maintain their addiction. Edit: I just want to point out that plenty of people willingly do stupid things: They get addicted to cigarettes, become alcoholics, drive too fast, write mean comments on the internet... We don't force them to quit their vices. The same should apply to opioids too.
- chimeracoder 3y ago
  I agree with your premise that the criminalization of opiates is the root cause of the opioid crisis today. > If you or I found ourselves in that situation, we'd probably go through withdrawal. I wouldn't be so quick to make that assumption if I were you. Most people who become opiate addicts involuntarily would have assumed they would never resort to illegal opiate use. That's a crucial piece of the puzzle: opiate users aren't a different class of person than you or any of the other users on this site. They're not cut from a different cloth. In all likelihood, most people on this site would respond the same way if put in the same situation. The only difference is that most are lucky enough that they haven't been put in that situation.
  - gwbas1c 3y ago
    > I wouldn't be so quick to make that assumption if I were you I could hardly function on the opioids (Lortab?) that I was prescribed after major surgery. I was relieved when my surgeon told me to stop taking them. Likewise, and I really hate the other opioids (Percoset?) I've been prescribed for minor dental surgery. One person I know really enjoyed them and ended up dying from the addiction. Clearly my head and body react differently than other people. I assume that akira2501 would be ultra-careful if he was in my situation.
  - I_Am_Nous 3y ago
    Unfortunately you never know how you'll react until you are in that situation yourself. Nicotine and caffeine aren't really addictive for me, but on a whim I tried some kratom capsules for back pain. After taking them daily for a week or so, I started feeling really drained after work. As a test, I took another capsule to see what would happen, and I started feeling better again. Threw away the rest of the capsules. If my physiology reacts in such a way, it means I was beginning to develop a physical addiction to it. To Kratom, of all things. It kind of opened my eyes to how quickly it can happen to people as well as how the desire to feel better and reduce suffering can easily lead us to ruin if we aren't careful and attentive.
- akira2501 3y ago
  > Other people won't, and choose to violate drug laws in order to maintain their addiction. Fair enough, but I am simply unwilling to call "just letting them be addicted" a _solution_ of any sort whatsoever. I'm entirely disappointed with this level of social response. You can be saddened by the apparent hopelessness of their situation, but beckoning further destruction and squalor for lack of willingness to truly care about the problem genuinely upsets me. I understand that part of the concern is these people acquiring a "record" that will make their life difficult in the future. A simple mechanism that expunges these charges entirely upon proof of sobriety is all that's needed to solve this.

stingrae 3y ago

I don't think it is possible to allow people to legally continue the addiction because of growing tolerances to the drugs that require people to find stronger and stronger drugs or dosages. Watching first hand how opioids impact people in SF. I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.

empath-nirvana 3y ago
> It isn't humane to let people rot on the streets. Getting police involved in trying to solve social problems has its own inevitable tragic consequences. This is not a problem you can arrest people out of.
chimeracoder 3y ago
> I don't think it is possible to allow people to legally continue the addiction because of growing tolerances to the drugs that require people to find stronger and stronger drugs or dosages. This is counterfactual. There is zero basis for claiming that tolerances are increasing at a population level. The increase in potency of street drugs is due to the basic economics of the black market on the supply side, not a response to demand. > I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets. Forced treatment is itself inhumane. It's a "solution" proposed only by people who have little idea of what it looks like in practice, of how substance abuse works, or of what successful treatment actually entails. In reality, "forced treatment" dramatically increases the death rates of people subjected to it. If your problem is with people living "on the street", there are lots of simpler ways to address that problem than to subject them to a costly, expensive government response that will statistically end up killing them.
- TerrifiedMouse 3y ago
  > This is counterfactual. There is zero basis for claiming that tolerances are increasing at a population level. The increase in potency of street drugs is due to the basic economics of the black market on the supply side, not a response to demand. I think he is just saying even if you legalize it and allow addicts to get drugs easily, it’s not viable long term as the addicts will develop tolerance to the drugs and will need ever increasing doses.

chimeracoder 3y ago

> Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to? You are describing maintenance programs. While methadone has been the maintenance drug of choice for programs in the US due to legal barriers, it turns out that heroin maintenance programs are even more effective than maintenance programs based on substitution. With a maintenance program, members come to the site to receive a legally-obtained, pharmaceutical-quality[0] supply of the drug. Depending on the program, they may either use it on-site (e.g. supervised injection) or bring it home. Crucially, the drug is provided free of charge, so members don't have to worry about how to come up with the money to pay for it. It turns out that these programs reduce crime rates among the members, because most crime that they are committing was in pursuit of the money for their basic needs[1]. Without having to worry about obtaining their drug, or the safety issues associated with the illegal drug market, many are able to find stable jobs, return to stable housing, and lead otherwise normal lives. This isn't new science - one of the first studied attempts was in the 1990s[2], and there have been many more papers published since, documenting the extraordinary benefits. The science behind it is rock-solid. The challenge, as always, is a political one. [0] Zero adulterants, no contaminants - just like the supply of morphine or fentanyl that is used in hospitals for inpatient treatment. [1] Yes, for someone addicted to opiates, the drug is a basic need: involuntary withdrawal is extremely dangerous even under medically supervised conditions, let alone in the conditions most people are forced to experience it. [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28595/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28595/

gwbas1c 3y ago
Exactly. Thanks for facts and references. I wish you were upvoted in this thread because this is the most insightful comment I've seen.

hackeraccount 3y ago

Putting addicts in jail because they're addicts is dumb but standing quietly to the side while a person spends their life addicted to opioids is cruel. I used to be sympathetic with that Bill Holiday song "Ain't nobody's business if I do." I'm doubtful about that now but I don't think anyone will stand for a half measure when there's a full measure available - and the last full measure is throwing someone in jail to protect them but that's dumb.

gwbas1c 3y ago
> Putting addicts in jail because they're addicts is dumb but standing quietly to the side while a person spends their life addicted to opioids is cruel. No, legal access to opioids to maintain an addiction also comes with addiction treatment options. See https://news.ycombinator.com/item?id=37679129 https://news.ycombinator.com/item?id=37679129