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>The government should just regulate it, control purity and production and let people access small amounts for recreation/performance Famously, the US spent ab

• KarlKode 5mo ago
  I think a astronomically better example would be programs in the Netherlands, Denmark or Switzerland, where people heavily addicted to heroine can get into programs that will provide them with pharmaceutical heroine. Still prescribed by doctors (although specialized ones), but not just for pulling a wisdom tooth with huge margins for the Sacklers...
  • vintermann 5mo ago
    A problem LAR programs have had since the start is that although methadone is less attractive as a drug than heroin, it's still attractive, and basically the only way to figure out how much a heroin addict needs is to ask them. Leading to users asking for extra, selling the excess (to users who were not in the LAR program) and buying other drugs with the profits. For some years, more people died from methadone overdose in Norway than heroin. Sure, you could demand injection on site to reduce this problem. But that just makes the program less appealing. You could also just hand out the users' drug of choice directly (heroin) rather than the less harmful substitute, but at some point that starts counting as physician-assisted suicide, really.
    • scragz 5mo ago
      methadone is not a less harmful substitute, it's just the one that makes official people money. the withdrawals are worse.
  • Aurornis 5mo ago
    The last time I looked up the Swiss program it was only servicing a small number of people. Around 1500 in a country if 9 million. It also wasn’t prescribed like a typical medication but part of a program where they received other treatment as well. There was some exception where some people could get 2 days of it at a time to take home, but it wasn’t a free for all prescription where they could just talk to a doctor and get their monthly desired supply from a pharmacy. Many countries, including the US, use methadone for maintenance. As I understand it it’s not as enjoyable as some people’s opioids of choice but it’s still an extremely powerful opioid depending on the dose (easily fatal). So it’s not only the countries you mentioned that provide pharmaceutical opioids as maintenance treatment. The US does too, though the form is different.
    • thrownthatway 5mo ago
      > a small number of people. Around 1500 in a country of 9 million. What is this supposed to mean? That’s a completely nonsense statement to make because you’ve provided no data on problem opioid use in Switzerland. Is 1500 a lot? Not many? Average? Should all nine million be on the program?
      • consp 5mo ago
        I'd say it is about what you expect for a country with voluntary programs. In the Netherlands the original program like the Swiss, resulted in heroïne becoming a medication for heavily addicted people usable under supervision. In the Netherlands there are about 4000 people with medical prescriptions for heroine on a 18M population. Note that it is free, supervised and voluntary so ymmv in other countries. The conclusions of the original program with methadone in the 80s was that it resulted in hardly any reduction amongst heavy and problematic users and they were likely to go back to using heroine with all the associated problems, the heroine distribution program worked but needed some tweaking, thus the program was fully legalised and put into law resulting in supervised consumption (at the distribution point) with dosage control and medical checkups and far less issues.
        • thrownthatway 5mo ago
  • pseudohadamard 5mo ago
    Don't Spain and Portugal also have fairly progressive policies/programs for drug harm reduction? I remember reading about it a while back, but it was a US source and they were trying really, really hard not to have to say "you know, this might actually be a good way to handle it".
• idiotsecant 5mo ago
  Your opioid comparison is wildly apples to oranges. They were marketed and sold to consumers as safe, much more effective, and dramatically less addictive than it actually was. An industrial addiction machine ignored regulatory safeguards, built a 'pay for play' rewards structure to incentivize prescriptions, and a zillion other cartoonishly evil things . There is a world of difference between something like that and government dosed methadone, meth, etc. The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too. If the drug is socially stigmatized only true addicts will use it. Those are exactly the people you want to have access to it because they can be gradually tapered off on a controlled dosage, they can be targeted for interventions, and it keeps them from stabbing you and stealing your wallet to get more meth. Its incredibly counterproductive to just outlaw a thing that people need on a level that they will do almost anything to get it.
  • cryzinger 5mo ago
    I think another under-discussed factor in the opioid crisis is that opioids are cheap, but (American) healthcare to treat underlying pain is not. You might not be able to afford six weeks of physical therapy, surgery, etc., but you can probably afford $11.23 a month for a generic prescription.
    • keepamovin 5mo ago
      My view of a lot of the opioid crisis stuff aside from physical pain is psychological trauma - people self medicating as an alternative to doing the work. That’s why I think the psychoactive legislation that’s introduced recently about psychedelics is so important because those things can rapidly accelerate processing and healing psychological trauma. My view, is if this was done 20 - 30 years ago there wouldn’t be such a large demand for opiates. I take it further and say that probably some in the drug companies understand this already and were lobbying against the introduction of more curative psychedelic treatments so that they could sell subscriptions to painkillers.
      • jazzyjackson 5mo ago
• cyberax 5mo ago
  > A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War. Except that you're wrong. The war-on-drugs kept drugs under control. It did not _eliminate_ them, but they also were not available on every street corner. Once we stopped the war-on-drugs, the abuse rates skyrocketed. Not just opiods, but also meth. You can see it on the graphs in this article, the general wind-down of drug abuse policies started around 2008-2010.
  • hash872 5mo ago
    I think we're agreeing with each other?
  • thepryz 5mo ago
    I personally consider the war on drugs to be a colossal failure and there tends to be widespread agreement that the War on Drugs was somewhat effective at enabling enforcement, but ineffective or counterproductive at eliminating drugs or reducing long-term harm. What America continues to ignore, intentionally or not, is the root cause of drug addiction which tends to be a more complicated and nuanced
    • cyberax 5mo ago
      Well, now the war on drug is over and we see that the harms from _not_ doing it are worse. In 2023, overdoses overtook gun and traffic deaths _combined_. Surrendering to the drugs was a mistake. Yeah, we should have changed tactics. Zero-tolerance policies were terrible nonsense, long prison terms were not helpful, and we should have clamped on prescription pills way sooner. > but ineffective or counterproductive at eliminating drugs It was effective in _controlling_ their level. And alternative approaches are just not working.
      • fc417fc802 5mo ago
        It seems like you've already made up your mind what to believe. In particular you've failed to critically analyze the broader context in which overdose deaths went up and I also have to question your suggestion that the war on drugs in the US ever ended. Sure, marijuana is largely accepted at this point. Most other things you still buy from gangsters on a street corner or via the darknet and will still be arrested for having, frequently losing your job as a side effect. To overdose deaths, those largely correlate to the Sacklers (ie medical professionals inappropriately pushing product with a veneer of legitimacy) and to fentanyl. The latter is particularly deadly due to the combination of accessibility to amateurs with the inherent difficulty of safely compounding such a potent chemical as part of a clandestine operation.
• bananamogul 5mo ago
  Are you referring to the massive opiate abuse crisis that followed World War One?
  • gostsamo 5mo ago
    I believe the gp meant the last few decades and the crisis that culminated with the Purdue trial.
• tomjen3 5mo ago
  How many died because they were cut of from the supply that they had been told by doctors did not cause addiction?
• thrownthatway 5mo ago
  There are 193 countries, plus the Holy See.
  • thrownthatway 5mo ago
    Why the down votes? There aren’t 300 countries.
    • nswango 5mo ago
      Any exact number of countries is offensive to several groups of people.
      • thrownthatway 5mo ago
        Yeah true. I did intentionally not count the Gaza Strip. If that offends anyone, I’m good with that.
  • consp 5mo ago
    As members of the United Nations. That says very little.
  • easyKL 5mo ago
    Map Men: There are NOT 195 countries https://www.youtube.com/watch?v=3nB688xBYdY https://www.youtube.com/watch?v=3nB688xBYdY
• lukan 5mo ago
  "the Wiki page for the opioid crisis is quite clear that at least 50% of all deaths were due to perfectly legal, regulated opioids" Are you talking about this page? https://en.wikipedia.org/wiki/Opioid_epidemic https://en.wikipedia.org/wiki/Opioid_epidemic Could you then be more clear where exactly your claim came from? I did not find it, but rather this: "According to medical professionals, supervised injection sites are effective in reducing overdose deaths and the transmission of infectious diseases."
  • deleted 5mo ago
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  • hash872 5mo ago
    There's a US-specific one https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_States https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_... "From 1999 to 2020, nearly 841,000 people died from drug overdoses,[7] with prescription and illicit opioids responsible for 500,000 of those deaths" Here's a chart showing overdose deaths from all drugs in the US- yes there's definitely a large spike from 'synthetic opioids' at the end there that's probably all illegal fentanyl. But notice the blue line for 'prescription drugs' was very very steady for the entire length of the chart. That's an enormous number of deaths from completely legal, regulated drugs! https://upload.wikimedia.org/wikipedia/commons/f/fa/US_timeline._Drugs_involved_in_overdose_deaths.jpg https://upload.wikimedia.org/wikipedia/commons/f/fa/US_timel...
    • pcthrowaway 5mo ago
      > with prescription and illicit opioids responsible for 500,000 of those deaths" So... it's not saying 500K deaths are from prescription drugs, it's saying 500K deaths are from opioids (some of which were prescription) Also, in the chart you mentioned, it's not clear if the opioid deaths were from legally produced prescription opioids. Certainly fentanyl is one of the biggest killers, and fentanyl is used in medical settings, but the fentanyl killing people is usually not from legal drug manufacturers.
• chadgpt3 5mo ago
  What if they were legal but hard to get? Say, we stop/arresting for possession or use in private, stop giving dealers and producers harsh sentences, but still give them moderate to weak sentences, stop proactively searching for dealers and producers, allow companies to produce with strict KYC, and don't allow retail sale in stores?
  • nswango 5mo ago
    In California weed is legal but highly regulated. It's easy to buy weed in the legal market but very difficult to be licensed to sell or grow it. The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers. Note that the consumers who choose the illegal market are not in general socially excluded, habitual criminals or broken down addicts. Weed is widespread in almost all parts of society and probably less prevalent along dirt poor, mentally unwell or homeless drug users, who favour fent or meth. People with jobs and houses choose illegal weed because it's both cheaper and easier to get hold of.
    • cluckindan 5mo ago
      That’s not a feature of legalization, but convenience: illegal weed is easier to get hold of even in places where cannabis is not legalized at all.
    • Shog9 5mo ago
      California is probably the best example going of how not to "legalize" weed. However, this also highlights the primary difference between weed and meth, opiates: ease of manufacturing. The only other common drugs that come close are things like mushrooms and fermented beverages, and I'd argue both of those are still riskier.
    • dataflow 5mo ago
      Isn't it illegal in the entire US? The question doesn't seem to be whether you can obtain it legally, but how many laws you'd rather break in the process, and how much trace you'd like to leave behind. I imagine the illegal vendors are less likely to leave a discoverable trace (that could affect your future background checks etc.) than the "legal" vendors, which itself is an incentive to obtain it illegally even when it's cheaper and safer and easier to obtain less-illegally right next door. Which basically means the US hasn't really tried legalizing it at all. (Not advocating for any position here, just commenting on the facts.)
• tormeh 5mo ago
  Not every drug is an opioid. We have prohibition laws designed for opioids blindly applied to any (in the western context) nontraditional drug. The German law on drugs is literally called "the painkiller law", for instance.
  • deleted 5mo ago
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  • ck45 5mo ago
    It’s not, the BtmG literally means narcotics drugs act. https://www.bfarm.de/EN/Federal-Opium-Agency/Narcotic-drugs/_node.html https://www.bfarm.de/EN/Federal-Opium-Agency/Narcotic-drugs/... https://en.wikipedia.org/wiki/Narcotic_Drugs_Act https://en.wikipedia.org/wiki/Narcotic_Drugs_Act
    • tormeh 5mo ago
      The meaning has drifted, appropriately enough. Betäubungsmittel originally meant painkillers, as you can tell from the word. It's just that now every recreational drug is labeled as such.
      • ck45 5mo ago
        You seem to be confusing the words "Schmerzmittel" (analgesic, pain killer) and "Betäubungsmittel" (narcotic). Those two classes of substances are not the same.
        • 0bytes 5mo ago
          It can also mean anesthetics, which coincidentally would include cocaine as a strong local anesthetic, but not a narcotic in the pharmacological sense.
        • atombender 5mo ago
          "Betäubung" has a similar etymology as "narcotic". Both mean to numb the senses or put to sleep (hence e.g. "narcolepsy"), and in German it's therefore also used for sedatives and anesthetic drugs. In modern use, "narcotic" has also semantically shifted to include any illegal drug, as with "Betäubungsmiddel". Interestingly, in both cases the semantic shift seems to have been caused by the enactment of laws to control drugs. The legal term these days is probably "controlled substance" in English, but "narcotic" now definitely refers to many drugs that are not medically narcotic.
• SequoiaHope 5mo ago
  I don’t think it’s fair to say we tried letting people access it for recreational or performance use. The insurance companies and doctors became drug pushers without an explicit acknowledgment of what was happening. Easy access to drugs without being able to discuss what was really happening is worse than prohibition sure, but that’s not informed consent. Informed consent is the patient tells the supplier what they’re doing and the supplier is trained to handle that. Our doctors are not drug shamen or addiction specialists, but we could imagine a situation where these are the people providing drugs, safe drug sites, and free counseling. Otherwise the solution is men with guns and weird geopolitical shit. Also the government gets to decide what drugs people can take which I disagree with in general. There has to be a better way.
  • deleted 5mo ago
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  • MagicMoonlight 5mo ago
    Doctors prescribed drugs and everyone became addicted, do you seriously think Nestle is going to pull their punches when they can sell people crack? They’ll be outside funeral homes, outside schools, offering free graduation crack. Ads on every bus, hot women handing it out in the street.
    • amanaplanacanal 5mo ago
      Selling it in adults-only dispensaries, along with banning advertising seems like the best idea. I'd ban tobacco, liquor, and gambling advertising too while we are at it.
    • SequoiaHope 5mo ago
      This doesn’t happen with regulated cannabis. This is just wild fantasy.
• autoexec 5mo ago
  > When you make drugs legal & easy to get, lots & lots of people do them- who develop life-shattering addictions and OD en masse. They also build tolerance and then move on to even harder stuff. That depends on the drug. Both it's addictiveness and its destructiveness. It's likely true for meth. I doubt it's true for weed. It's demonstrably not true for many of the OTC drugs that have been easy to get for hundreds of years without the collapse of society
• stymaar 5mo ago
  WTF. This is complete nonsense. Opioids have never been made legal for recreational purpose. They were sold as painkillers by pharma corporations lying about their addictive effects and promoted through marketing campaign targeting doctors to prescribe them. I has nothing to do with the topic of recreational drugs.
  • Denatonium 5mo ago
    Many opioids, including opiates, used to be OTC. I personally know someone who used to smoke paregoric (camphorated tincture of opium), which was OTC in the US until 1970. I believe 1970 was also the year when amphetamine (Benzedrine) inhalers stopped being OTC.
  • solumunus 5mo ago
    Do you think opioids have been illegal for eternity?
    • stymaar 5mo ago
      They are talking about the current opioid crisis, and they are making the story up.
• pitaj 5mo ago
  And yet, as the DEA and other agencies tighten distribution of opioids, deaths continue to increase.
  • mx7zysuj4xew 5mo ago
    People are being cut off from legitimate pharmaceutical sources and are driven to black market drugs like fentanyl and heroin
• Glohrischi 5mo ago
  I'm not aware that anyone every tried to do it right. Like how about you have to do a short course which actually explains to you how a drug works, how to use it correctly, what are potential downsides, what are markers of overuse/wrong use. And the other main issue with opioids and co: some people really have constant / chronic pain. Do you know how exhaustive it is to constantly have pain? How annoying it is that you can't just go to bed and sleep? But also we can't play devils advocate to say "you are not allowed to do drugs to num whatever issue you have" and also "but i don't want to take time and effort of helping you". Oh i don't want you to kill yourself! But i don't want to spend time tomorrow afternoon either with you. Our society is very hypcritical in this sense. Honestly i think people just don't want to see homeless people or fentapoeple. Its not about helping, its just about not being disturbed by them.
• sleight42 5mo ago
  I wonder what sort of environment and conditions contribute to large populations seeking to use opioids in the first place? Theory: this is a socioeconomic problem rather than a public health problem. Our systems care too little for people. The easiest solution then is for people to self-medicate. It's easier to deny people a harmful salve that they feel they need than to provide them the social supports that they deserve.
  • buu700 5mo ago
    Exactly. It's more helpful to look at this from the perspective of solving problems that push people toward unhealthy choices than from the perspective of how we can limit the freedom of adults for their own good. A few other thoughts: 1. US tobacco policy is far more liberal than the War on Drugs, yet which of the two is a successful case study in curbing harmful addiction? 2. The recent opioid epidemic is far more complex than "the government tried legalizing opioids and it failed". Whatever policies did exist weren't legalization of opioids, and didn't exist in a vacuum. You can't model that policy without factoring in the wide availability of contaminated street drugs and absence of safer OTC cannabis alternatives. More importantly, the drugs weren't merely available, but actively pushed in a way that should have been legally discouraged. 3. The above analysis completely ignores the most important point raised in the top-level comment: prohibition simply redirects capital from businesses that are regulated to those that are not. Say what you will about Big Pharma, but they usually don't go around hanging mutilated bodies from bridges. 4. Even if drug prohibition were the optimal policy for reducing addiction rates, at some point protecting people from their own choices ceases to be a valid excuse for harming the rest of us. We've punished countless marijuana users who mostly aren't addicts, inflicted terror and destabilization upon our neighbors to the south, and created what at least half of America believes to be an illegal immigration crisis. 5. The claim that drug prohibition even helps the people it's ostensibly supposed to help is extremely dubious. We're subjecting addicts to more dangerous substances than the ones they're actually seeking out, and locking up the ones who survive. Maybe there's a narrow slice of people who really want narcotics but lack the motivation to navigate black markets, but otherwise who is this all for? We're hurting everyone in our confusion just to enrich a cabal of warlords.
  • phatskat 5mo ago
• AnthonyMouse 5mo ago
  > Famously, the US spent about 15-20 years attempting this with opioids. They were widely available to people via a pseudo-medical process, or via secondhand dealing. Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. There is a pretty decent argument that this was still a result of pseudo-prohibition, which goes like this: Opioids were easy to get a prescription for, but still required a prescription (and were covered by insurance), and were still highly restricted in who could manufacture them. That made the margins high, and consequently created a perverse incentive for the manufacturers to want patients taking the high margin insurance-funded opioids rather than a cheap commodity out-of-pocket NSAID or acetaminophen. Because they still required a prescription, getting people taking them meant they had to capture the prescribing physicians, who now get their own perverse incentives. Not only marketing/kickbacks/incentives from the pharma companies, if something over the counter would work and that's what you recommend, the patients buy a bottle at Walmart for $5 whenever they need it and you never see them again, but prescribe something stronger and you get to bill their insurance again and again every time they need another appointment to re-up. But "ask your doctor" was supposed to be the thing you do to get sound advice. Give the medical establishment a profit incentive to over-recommend the addictive thing and what do you expect? Meanwhile if they were all available at the convenience store for the same price, nobody would have the incentive to push the addictive one, and then when you ask your doctor (or for that matter anyone else) what they recommend, they would generally tell you not to take opioids unless you really need them.
  • jjfoooo4 5mo ago
    Surely both manufacturer and convenience store have incentive to push the addictive product in this scenario. In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves. Have you ever taken an opioid? The idea that unfettered access would result in less addiction and death is a pretty remarkable POV
    • lobf 5mo ago
      >The idea that unfettered access would result in less addiction and death is a pretty remarkable POV It's not that crazy, but it has to be coupled with accessible recovery programs. The classic tale (one that people in my life have gone through) is the prescribed opiates -> street heroin when the scrip runs out / when they change the oxy recipe so that it doesn't dissolve in water anymore so you can't shoot it. This is obviously much more dangerous than getting oxy from your doctor, so the logic of "keep people from seeking heroin on the street" actually does make sense to me from a public health perspective.
• shellfishgene 5mo ago
  The US is also currently rerunning this experiment with gambling/sports betting. Also does not seem to turn out so well...
• steve-atx-7600 5mo ago
  See also Oregon https://www.nationalreview.com/corner/oregons-experiment-with-drug-decriminalization-failed-by-its-own-standards/ https://www.nationalreview.com/corner/oregons-experiment-wit...
• pstuart 5mo ago
  This is a tired trope but must be made: society has accepted that drugs can be dangerous but we won't stop people from using them -- leading with alcohol and tobacco. Yes, restrict access to youth and avoid reckless advertising, but still the people's choice. If the drugs are pure, and health problems that occur with abusing them (overdoses and addiction) are treated as health issues rather than criminal issues, then it's all a solvable problem. Heroin being illegal didn't stop my brother from dying on it.
• cucumber3732842 5mo ago
  In low doses most hard drugs that are uppers are pretty decent performance enhancing drugs. It's dumb that society can't get energy drinks and stuff with "low enough you can't realistically abuse them because you'll spend too much time going to piss" amounts of cocaine, amphetamines, etc.
  • cindyllm 5mo ago
    [dead]
• wutwutwat 5mo ago
  Look at alcohol. How many lives are negatively affected because of alcohol being freely available? By numbers alone when something is legal there are people who will participate who would otherwise never go near it if it were illegal. We're seeing this with weed right now imo. Because it's legal, people will try it. And because we live in a country where it is celebrated, encouraged, and every holiday seems to be an excuse for folks to get hammered, A LOT of people will try it. How many would never touch it if it were illegal? How many wouldn't drink and drive and kill themselves? How many innocent people in the other car, completely sober, would still be here? Because remember, booze, or drugs in general, impact more than just the user. Their families, friends, and other random people can be impacted. How many kids grow up with a drunk parent, unable to properly express or process emotions, might not have to grow up unable to maintain healthy friendships because they don't know what they look like, or won't be taken advantage of because they have a caretaker/fixer mentality because that's what they had to do as a kid. We know making booze illegal doesn't work, and that's not what I'm suggesting here. I'm not even suggesting anything. I'm just saying, the blast radius of booze impacts a lot of people beyond the alcoholic, and statistically, a portion of those lives negatively impacted are the direct result of alcohol being legal. I can speak from firsthand experience the impact of an alcoholic single parent growing up, which would be the reason I look at this topic the way I do. Would I have been given a more healthy and "normal" childhood had booze been illegal? Idk. But some kid out there would have, which might be all that matters.