
I supported legalizing all drugs, then the opioid epidemic happened - abhi3
http://www.vox.com/policy-and-politics/2017/4/20/15328384/opioid-epidemic-drug-legalization
======
seibelj
I don't see how forcing addicts to purchase heroin on the street is safer than
getting it prescribed by a doctor. People wouldn't overdose if they knew
exactly how strong the drugs they injected were, they OD when the drug is
unexpectedly powerful, especially when laced with fentanyl.

I don't think you should be able to purchase heroin at 7/11, but certainly
there is something better than total prohibition. If you want to keep killing
people, force addicts to buy opiates on the street.

~~~
TerminalJunkie
If you were able to get drugs from a pharmacy or dispensary or a regulated
service, there would't (hopefully) be a black market to supply the drugs which
creates untold violence.

I have a completely untested theory that the number of deaths would be less
with a well regulated legalization of drugs than with an unregulated black
market where gangs and organized crime supply the demand for illicit
substances.

~~~
qbrass
There's already a black market for prescription drugs.

Because there's still a barrier to access, providing a way around it still
provides profit.

~~~
NotSammyHagar
There's a black market because most people can't just get a prescription from
a doctor, they have to lie or get someone else's drugs, there isn't enough
legal availability to rule it out.

------
3pt14159
I've come to believe that the unabomber, though horribly misguided in terms of
tactics and conclusion, was right about one thing:

Maybe one day things will be different, but for now, humans are not designed
to live in the manner that they do. We were meant to climb and run. Maybe even
to work the soil and to create wine. But evolution isn't fast enough to keep
up with the rate of change of technology. We're in cars and looking at
computers. We're comparing ourselves to the best people on the planet. We're
pulling out the fibre from our food and loading it up with sugar and trans
fats.

I've come to view drugs and alcohol as symptoms. We've probably co-evolved
with alcohol, since it's correlated both to genetics and with intelligence.
Maybe it's the method that evolution allows people to be honest enough for
social cooperation, while being dishonest enough to cheat on a spouse
occasionally.

But when it comes to drugs like opioids, I tend to think it's people filling a
void from a lack of self worth. Overweight, stressed financially due to easy
credit, depressed, usually sick in some way.

Banning opioids isn't going to help any more than banning cocaine has helped.

So how to get out of it? Make use more similar to how we used to live and take
away or tax the things that we haven't adapted to yet.

Opioids should be taxed, highly regulated, and we should start working on
mental health and education, but we also need redesigned cities with more
reliance on self-propulsion (bikes, skiing, walking, running).

We need redesigned food laws that focus on _consequences_ not on arbitrary
labelling requirements. We should outright ban foods for children that we're
sure destroy their lives, like soft drinks or fruit juice. (Yes, fruit juice.
Without fibre it's just empty sugar. Kids get enough Vit C in a single apple.
One in four children in the US has pre-diabetes and one in four seniors have
full blown diabetes, we need to start treating refined sugar as a poison.)

I'm sure a certain part of the epidemic is people not knowing that these were
hyper-addictive and then getting addicted, but I don't really think it's the
primary cause.

Also, we should start using safer drugs that we've evolved around for pain
management and therapy. Magic mushrooms, cannabis, etc.

~~~
bluedino
>> We're in cars and looking at computers.

We had opium problems since morphine/heroin have been around. Plenty of people
were using in the late 1800's and it wasn't banned until the early part of
last century.

~~~
tylermac1
200 years in the grand scheme of human evolution is nothing.

~~~
narrowrail
My understanding is that opium became a problem once tobacco, and its method
of consumption (i.e. smoking), became a global commodity in the 16th century.
Opium was previously orally ingested, but when smoking it became the norm, the
near-instant gratification caused an epidemic (mostly in China; see the Opium
Wars/ British East India Company).

------
bonniemuffin
Rat park is highly illuminating in this conversation, and suggests that drug
addiction is just a symptom. When people (or animals) are forced into a life
of social and cultural isolation, drugs become the most appealing thing they
have available. If we could find a way to give people a social/cultural
support system that's more appealing than drugs, we might be able to reduce
addiction without prohibition.

[http://www.brucekalexander.com/articles-speeches/rat-
park/14...](http://www.brucekalexander.com/articles-speeches/rat-
park/148-addiction-the-view-from-rat-park)

~~~
loeg
Rat Park doesn't replicate. Don't read too much into it.

------
gjmacd
I'm still very pro-legalization because most of the epidemic is born out of
legal prescription drugs, then people move to stronger illegal drugs. So here
you have a legal means and illegal means working in simpatico to fuel an
epidemic. Stopping one isn't going to stop the other... it's not about the
legalities, it's about humans. Some humans are wired for addiction more than
others. Once they get on a substance, regardless of how, it's going to only to
set these "pre conditioned" folks towards their addiction. Treating the drug
as the issue is only going to continue the process and make it harder for
acceptance of this disease. Recovery and prevention is what people need to
learn. Trying to make something illegal isn't going to stop people -- we've
seen this with alcohol (arguably just as big of a problem). It's interesting
how as a society we treat opioid addiction differently BECAUSE drugs like
Heroin are deemed illegal -- the stigma around "illegal" detracts from the
root cause of the issue and therefore stunts any idea of a solid course
towards acceptance and then hopefully treatment or a cure. I can only feel
that if we treated all drugs as legal and the addiction as a health crisis, we
might have made better strides. Lastly, we did the "War on Drugs", it didn't
work -- let's look at that data and realize that it's not a problem of
substance and access, it's a problem of human nature. Spending money on
supporting the illegal nature of something like this only continues to
perpetuate the problem.

~~~
dontreact
The article is in favor of making consumption legal (as in Portugal).

However, the Portugese model (which has had some success) also depends on not
making drugs like fentanyl and heroin commercializable. This is really what
the article means by "making drugs illegal". Which is somewhat deceptive, but
I do think that is the argument actually made in the article.

Given the massive misrepresentation of Oxycontin as a drug effective at
treating pain for 12-24 hours with a single pill which has caused so much
addiction: [http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/) Do you not see some
issues with giving these companies which have already successfully deceived
the public another set of dangerous products like Fentanyl and Heroin?

------
lisper
> Faced with an excessively harsh criminal justice system and a legal industry
> that carelessly causes drug epidemics, I have come down somewhere in the
> middle of these two extremes.

But the middle is where we are now. Opioids _are_ highly regulated. It _is_
illegal to possess them without a doctor's prescription. The regulatory regime
is so strict that some doctors are afraid to prescribe them at all [1]. And
yet, here we are.

The free-market answer is to allow civil suits against drug manufacturers for
damages caused by overdoses. That's not a perfect solution either, but it's a
hell of a lot better than what we have now. At least it doesn't produce
perverse incentives the way all other proposed solutions do.

[1] [http://www.health.com/health/condition-
article/0,,20189399,0...](http://www.health.com/health/condition-
article/0,,20189399,00.html)

~~~
sehugg
_The free-market answer is to allow civil suits against drug manufacturers for
damages caused by overdoses._

We'll see how that goes -- Cherokee Nation sues drug firms, retailers for
flooding communities with opioids:
[https://www.washingtonpost.com/investigations/cherokee-
natio...](https://www.washingtonpost.com/investigations/cherokee-nation-sues-
drug-firms-retailers-for-flooding-communities-with-
opioids/2017/04/20/03d04a74-2519-11e7-b503-9d616bd5a305_story.html?tid=ss_tw&utm_term=.c3911f5ba16b)

------
junto
I recently visited my gran, who told me she has prescriptions for Co-codamol
and Tramadol.

She had no idea how addictive they were and was popping them down like candy.
The doctor had given her no warning as to how addictive they are. I told her
to speak to her GP and that she should consider disposing the tablets at her
local pharmacy.

A recent study showed that on average it takes 10 days for a patient to become
dependent and addicted to opiates like these and weaning people off them is a
horrible experience for the patient.

------
whiddershins
I don't think we have enough evidence to conclude the legality of the opioids
is the reason for the number of overdoses. I think it is better explained by:

1) the nature of these drugs, they are definitely more addictive and possibly
more dangerous than nearly every common street drug. Many street drugs are
either not addictive at all, or have very low addiction rates. These opioids
are likely more addictive than heroin.

2) that these drugs are first prescribed by doctors, which clouds people's
judgment about how dangerous they are, making it more likely people may become
addicted

3) then in the coup de grace, they are illegal to purchase recreationally,
which forces addicts to the black market where it is much more difficult to
get consistent dosages, which greatly increases the rate of overdose.

The article lacks intellectual rigor.

------
Danihan
Philosophically and ethically you can't tell anyone what they are allowed to
put in their body. It's _their_ body. They can do what they want with it.

It seems so basic to me, but people can't seem to get it through their thick
skulls. Stop trying to legislate other people's bodies.

Take steroids, for instance. Who should be allowed to decide what levels of
hormones I have in my body? The answer is me, and me alone. It's my body, for
fuck's sake! Same applies to all drugs.

~~~
pault
I tend to agree with you, but just to play devil's advocate: what about
negative externalities of personal consumption? How do you assign
responsibility for burdens on health and social services caused by drug abuse?
Someone has to pay to clean up those issues, and while the majority of drug
users may be able to maintain their habits without major issues, the minority
is a handful. I favor decriminalization, but I can see how a government, faced
with the bill, and with only the power to legislate, would try to legislate
the problem away.

~~~
Danihan
You make a completely valid point, but I can't help but find it very ironic
that that socialization of medicine is used as justification for maintaining
government overreach in the war on drugs.

Along the same lines, if someone weighs 500 pounds and yet eats 6000 calories
day, it's the same issue. How much should society intervene on people who are
absurdly self-destructive. How much freedom should people have to damage
themselves so much that society has to pay to rescue them from themselves.
There are lots of places you could draw that line.

------
armenarmen
Ok. So I've had more than a handful of friends and family OD on opiates.

They were in accidents, got hooked on prescribed painkillers. Then they were
for a while able to buy pills from "pain clinics" relatively cheap, safe, and
pure opiates.

THEN the pill mills got shut down. This didn't magically stop them from being
dope fiends. It made them have to go for street versions. Heroin.

Which is less safe and less pure. Then they started dying. You gotta explain
to me how not having access to consistent doses that aren't cut with poison
and are bought from legitimate businesses is somehow better than the
alternative.

The drug war is bullshit and it turns addicts into corpses.

------
justaaron
ummm, this is why we need to _end_ the war on drugs, hello!?

1) cut out the cartels 2) inform the public A) Opioids are for dying people in
pain, or losers... B) "Drugs" are not a monolithic equal evil. Opioids
actually _do_ suck the life out of well-meaning people, see letter A

The author here seems to follow the "bills of rights only exist until
something really extreme like terrorism negates them" school of thought...

panic before thought...

Heroin costs pennies a dose to produce, and should be available for free
injection in a walk-in clinic

1) whereas something like 100% of all overdoses are related to the fact that
no one actually knows the street heroins potency and the difference between
the effective-dose and the deadly-dose is inside of 1 magnitude of 10...
something like double perhaps? hello

2) whereas one saves a lot of car stereos, eliminates many petty crimes like
muggings, and basically all the crap that an unemployed non-independently-
wealthy junkie does to maintain their habit...

no brainer...

------
coretx
People revert to opiods because of better alternatives either being too
expensive or not available. The designer dope industry can supply alternatives
for all kinds of populair drugs. Including MDMA, amphetamines, opiods, khat,
cocain and more. These alternatives can be created at a dirt cheap pricepoint
and often come with significantly reduced health impacts; by design. The
actual production and R&D of these synthetic substances however is illegal,
and so are the precursors and the precursors of the precursors, increasing the
price up to the point they can no longer compete with primitive and more
unhealthy alternatives such as for example heroin. No matter how you spin it,
the "War on Drugs" costs much more money & lives than drugs at large. Let's
respect citizens thus the right to self determination - Legalize & Regulate
all the things!

------
loeg
You know that the opioid epidemic has blossomed under the war-on-drugs /
prohibition model, right? We're already trying prohibition, it isn't working
anyway.

------
wand3r
It's important to realize opiods are likely the best proof laws don't work.
These are largely made and controlled by American companies. The whole supply
chain.

It's not like cocaine that is largely imported by diverse entities. These are
made in America and "tightly" controlled yet they are available enough to be
an epidemic.

Drugs should be legal in my opinion.

------
dontreact
I think the title is a _little_ clickbaity because the author does seem to
support the Portugese model of decriminalizing all drugs. The arguments seem
to be mostly against making it legal for large pharmaceutical companies to
sell heroin, but some of the discussion here seems to be around the legality
of consumption and decriminalizing drugs.

------
mikhailt
Maybe I've skimmed this too fast but I saw nothing in the article that looks
at the source of people doing the drugs in the first place.

I had friends that did drugs merely because they were in bad situations and
there was no public support they could reach out before resorting to doing
illegal things to avoid feeling hopeless.

There are people that got roped into doing these specific drugs because of the
hell they went through with injuries/diseases and the painkillers gave them a
bit of sanity. Do we have public programs that assign mentors and counselors
to these people for a year or longer?

Regulations, criminalization, legalization will never ever deter drug use in
this country as long as we continue to have lackluster support systems for
these folks. We need to stop looking at the drugs and start looking at the
people and stop treating them as subhumans.

~~~
dontreact
The article doesn't argue in favor of making drug consumption illegal. Given
the success that large pharmaceutical companies have had in deceptively
marketing Oxycontin: [http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

Why should the government allow them to commercialize and sell even more
dangerous drugs that are not needed clinically?

~~~
mikhailt
I think you're missing my point. I'm not talking about legalization or no
legalization at all. The article is fully clear on pros and cons for them, the
article just doesn't go further to explain why there is "demand" in the first
place.

And if the government regulates these companies, it will not stop these folks
from getting it elsewhere.

That's the point I'm trying to make, as long as there is demand, there will
always be supply. This is pretty much a fact since the beginning of
civilization.

The best thing we can do is reduce the demand. These companies do not want to
produce drugs that do not make them any profits, that's why so many life-
saving drugs for very small market share are very expensive and barely
marketed. If these companies have a cure for cancer, they're not going to make
a big deal out of it because they'd be out of business. They'll look for drug
treatments that ensure a lifetime use of drugs that sustain their business
models.

~~~
dontreact
Pharmaceutical companies spend a lot of money trying to increase the demand
for these drugs: marketing and sales reps. In the case of Oxycontin, it even
looks like they used deceptive practices to do so: marketing the drug as
effective at treating 12-24 hours of pain even when this is not the case:
[http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

Seems to me like something similar could happen if these companies were
allowed to commercialize drugs like fentanyl and heroin, so in a sense this
article is making arguments relevant to demand.

However, I do agree that more should be done to try and curb the demand d for
drugs. What do you think would be some good policies that could do that?

------
anentropic
Isn't this a failure of the USA health care system rather than a failure of
legalization...?

------
gremlinsinc
I think drugs should be legal --or not prosecutable to the 'addict' they are
the victim imho -- dealers/sellers that's a whole 'nother story.

The issue at large is one where drugees are going through mental health crisis
and the last place they need to be is jail/prison -- they need help, mentally.
It's proven though that legalizing Marijuana has shown a decrease in opioid
use in the states where it's legal, so there's that.

------
pcmaffey
Tldr; Don't give big pharma another product. They're an irresponsible, poorly
regulated system, directly to blame for the opiod epidemic.

------
abcdefghijklm
Funny that I've been reading HN for years and never posted until an article
about drugs, but that's how it goes sometimes. I was just talking about this
with my wife last night during an NPR story about opiod addiction and wondered
if there was quantitative evidence about the cost/benefit ratio of opiods, as
opposed to anecdotal stories, valuable as they might be.

I found this article from a year ago:
[https://blogs.scientificamerican.com/mind-guest-
blog/opioid-...](https://blogs.scientificamerican.com/mind-guest-blog/opioid-
addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/)

Some key points, all direct quotes from the article:

1\. Typically, young people who misuse prescription opioids are heavy users of
alcohol and other drugs. This type of drug use, not medical treatment with
opioids, is by far the greatest risk factor for opioid addiction

2\. In general, new addictions are uncommon among people who take opioids for
pain in general. A Cochrane review of opioid prescribing for chronic pain
found that less than one percent of those who were well-screened for drug
problems developed new addictions during pain care

3\. The vast majority of people who are prescribed opioids use them
responsibly—recent research on roughly one million insurance claims for opioid
prescriptions showed that just less than five percent of patients misused the
drugs by getting prescriptions for them from multiple doctors.

4\. If we want to reduce opioid addiction, we have to target the real risk
factors for it: child trauma, mental illness and unemployment. Two thirds of
people with opioid addictions have had at least one severely traumatic
childhood experience, and the greater your exposure to different types of
trauma, the higher the risk becomes.

5\. The reality, however, is that as long as there is distress and despair,
some people are going to seek chemical ways to feel better.

So in summary:

I am NOT saying that you don't know someone who developed an opioid addiction
without prior risk factors.

I am saying that it seems in aggregate, this is a new phase of a common
societal issue: lots of people are unhappy, for any number of reasons, and
seek the most available fix. That used to be other drugs, then we cracked down
on those drugs. Now it's opioids, and we're likely about to crack down on
those. But something will be next, because we haven't solved the real problem.

------
bdavisx
All this talk about prescription OD's; how many people die from too much
acetaminophen in the pills they are taking to try to get high from the
opioids? I don't know the numbers, but they shouldn't count as an OD, it isn't
the same thing.

------
NotSammyHagar
This is a great article that causes me to challenge some of my own
assumptions. I have also been generally supportive of decriminilization of
drugs because of the damage done with our prohibition. But the problems with
opiods show me that if heroin was easily available it really could lead to too
much use. So I think the problem that first needs to be addressed is that drug
legalization needs to go through a non-legisltive process. If we have true
techocrats (doctors & scientists) deciding what drug policies were, it would
be much harder for drug companies like beer producers to force laws that they
like. But we do live in that world of lobbying, so what's the thing to do to
help control opiod use with more drug decriminalization? I do not know.

------
Neliquat
I supported skydiving, then my buddy died base jumping. This article is a
logical disaster for myrad reasons.

------
such_a_casual
Only children think that making X against the rules makes X go away.
Regulation and first world health care (ie free health care) are some steps
you can take to address the problem. Making addicts criminals shows
irresponsibly poor leadership.

~~~
armenarmen
I agree entirely with your first point. Sadly though, the free healthcare bit
works against a sensible legalization path.

The pearl clutching puritans have a legitimate gripe with drug use if they,
the taxpayers, are forced to fund the fallout of drug abuse. Turning a
personal, though be it poor, decision to use hard drugs from a personal issue
into a public one.

------
brilliantcode
I used to be very pro-legalization of all drugs in my early 20s but I've
shifted completely after seeing so many Fetanyl overdose cases in Vancouver as
well as now we are seeing Elephant tranquilizers make its way. Some drugs are
just too damn harmful to even be consumed by it's end users.

The thing about opiod is that it completely warps the human mind. Outside of
managing extreme pain, it really should be banned.

For those who are addicted, they should not be viewed from a legal platform
but medical care that actively tries to rehabilitate them.

Agreed. I can't believe some people still view drug use as criminal behavior.
These are people who otherwise are out of coping resources and variety of
other factor. It should be handled with medical assistance, not locking them
up and creating life long criminals/addicts in the process.

I think Portugal is a great demonstration of what I've illustrated - helping
addicts while going after the supply and providing a publicly accessible harm
reduction platform and alternative to hard drugs.

Vancouver has safe injection sites but it's hard to go after the dealers as
they are highly decentralized and blends right in or often protected by layers
of addicts who sell to support their own high.

~~~
AQuantized
You can be pro-legalization without being "pro-drug." In the sense that
criminalizing drugs doesn't necessarily reduce usage.

~~~
armenarmen
It's funny how often people conflate these. I can be pro freedom of religion
but an atheist. Support of the freedom to do anything != an endorsement

