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I supported legalizing all drugs, then the opioid epidemic happened (vox.com)
46 points by abhi3 239 days ago | hide | past | web | favorite | 102 comments



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.


The other common cause of OD is relapse. 30 day drug programs are not very good at getting people to quit, but they are good at lowering tolerance enough to make their previous doses life-threatening. This is another reason medical supervision of addicts saves lives.


But the opioid epidemic did not stem from addicts purchasing heroin on the street, but from doctors prescribing them, backed by government efforts to encourage their use, and industry lobbying and advertising.

That's a lot more powerful formula for starting a drug epidemic, than people buying heroin illegally off the street. At least there's no confusion about "experts" and "science" and "doctors" promoting something as safe and effective.


Right this is the problem. We need to ban all opioid prescriptions. 80% of heroin addicts got addicted because of the opioid prescriptions obtained legally. According to the documentary on HBO, drug companies made $5B on opioids in 2014 but the economic costs were $55B.

If people have chronic pain, we need to be more progressive and allow medical marijuana everywhere. (There are also quite a few studies that show that chronic pain is not helped with opioids anyway.) If people are in the hospital or end-of-life/hospice, then give them morphine or whatever they need but we need zero prescribable opioids.


For painkilling, MMJ may as well be aspirin when compared to powerful opiates. Over-prescription of powerful opiates is the issue. Banning all opiate prescriptions would be cruel, forcing people to the black market at best.


Yeah, banning opioids isn't the solution, unless you think people should needlessly suffer. I've had a hernia surgery and my wife had throat surgery, and I don't think that marijuana would have been the answer for the first several days after either surgery.


>> If people have chronic pain

Chronic pain refers to long term pain. Your hernia surgery is short term pain.

No-one credible is suggesting preventing using opioids for short term (such as post operative) pain (although it does seem that Drs in the US prescribe too much for this type of pain).


Sorry, I missed that part of it.


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.


Portugal decriminalized in 2001 and guess what happened[0]

[0]https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-h...


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.


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.


>> If you were able to get drugs from a pharmacy or dispensary or a regulated service, there would't (hopefully) be a black market

Medical marijuana is legal where I live, you can buy it at a regulated service, however there are plenty of people who still buy it on the street or produce more than they are legally able to and sell the excess.


Yeah, then the black market goes from some cartel pipeline to someone in your neighborhood. There's a huge difference in regards to funding violence.


Except Joe who grows weed in his cupboard isn't really capable of producing heroin let alone the extraordinarily dangerous opium derivatives that pharmaceutical are pushing on doctors.


If Joe can grow weed in his cupboard, he absolutely can grow poppies and produce opium. The process is not complex.


The required acreage to yield opium in significant quantities is way beyond a closet (or even a basement). Not to mention that heroin is ~1% of total opium weight.


If we're talking about Joe's personal use, a single poppy plant produces multiple doses, according to this[1] reference and some anecdotal drug forum dose suggestions, on the order of tens of mg.

1.https://erowid.org/archive/rhodium/chemistry/opium.html


>produces multiple doses

Could you tell me what number "multiple" is and what a "dose" looks like?

Are we talking about raw plant material that is opium, or refined heroin/morphine/codeine? The conflation of the word drugs and plant material seems like the most absurd gorilla in the room.

Off to do some coffee...


welcome to our grim cyberpunk (near-)future: https://www.wired.com/2015/08/dont-try-home-scientists-brew-...


Agreed, and this has been tried in Switzerland with positive results; to quote just one:

"The cost-benefit analysis showed a considerable reduction in costs for medical care and law enforcement; the benefits per day and patient amount to the double of the daily treatment costs in HAT (Frey et al 2000)."

in https://sencanada.ca/content/sen/committee/371/ille/presenta...


Agree. Control it, regulate it, distribute it. We do this with alcohol. It doesn't prevent people from getting addicted, but it certainly prevents people from having to resort to crimes to get the product because it's illegal.


The article isn't about committing crimes in order to get drugs, it's about people dying because pharma companies got greedy.

Additionally, alcohol kills more people than opiates every year, so I'm not sure that's a good sign for the effects of legalization.


Absolutely.

There's one sure way to control an epidemic like this: education. That means educating the populace on just how addictive and dangerous these drugs are, educating law enforcement to treat addicts as people who are sick instead of simply stigmatizing criminality, and educating the medical community so that these drugs aren't handed out so casually, and in cases where they are appropriate, that patients are closely monitored for signs of addiction.

And the latter would benefit greatly from the US restricting drug company advertising and lobbying (this crisis was helped along significantly because of Purdue's marketing of Oxy in the 90s) so that medical decisions are made based on science and not marketing... but we know what the odds are of that happening.


I think most people know heroin is dangerous. They start taking it because they don't have an incentive not to. A lot of people in places hit worst by the opioid epidemic don't have much of a reason to get up in the morning, whether that be for lack of job opportunities, a weak social network, or some more general malaise. If there life is already disappointing, there's no reason to not take heroin. The worst that can happen is that there life becomes bad, but it already is.


Many many people don't start with heroin, nor do they turn to drugs for the reasons you cite.

They start with back pain due to a workplace injury, for which a doctor immediately prescribes them a powerful opiod (and perhaps a companion drug to deal with the resultant constipation).

Because it's "medicine", these people don't fully understand the risk of addiction nor do they recognize the signs of addiction and tolerance as they develop. Meanwhile, the doctor shirks their duty by not remaining in constant contact with the patient to manage any dependency should it occur.

These individuals eventually become addicted because the drugs lose efficacy over time (and in the case of Oxy, don't actually work for as long a period of time in the body as claimed, forcing people to up their own dosage). And thus the spiral of addiction begins.

Because of the lack of public awareness and the shame and stigma of addiction, people don't seek out help. Instead they try to manage the problem themselves. Ultimately, once addicted they turn to street drugs because they're a) cheaper, and b) more readily available.


One thing to keep in mind is that opioid drugs are not effective in the long term treatment of chronic pain. I don't know why these drugs are prescribed for that purpose to be honest.


Agreed. Unless you're a cancer patient on palliative care, turning to opiods for long term pain management (particularly as a first line of defense, which so often seems to be the case) strikes me as completely insane.

Part of the problem is that, prior to the Oxy epidemic, the reality is doctors were probably under-managing pain, particularly for chronic pain sufferers.

Unfortunately, the reaction (again, in part due to drug company marketing) was to swing the other way and over-prescribe these drugs.


> A lot of people in places hit worst by the opioid epidemic don't have much of a reason to get up in the morning

There was a Reddit comment on this subject to the effect of "I don't think of a muffin as breakfast, I think of it as my reward for getting up and going to work instead of hanging myself." And that sentiment is probably coming from a software developer in NYC or SF or whatever, so imagine how things look for everyone else.


The problem is that it has been proven that it is easy for large pharmaceutical companies to deceptively represent these drugs. Oxycontin has been marketed as being effective at managing pain for 12 or sometimes even 24 hours, but this is not the case in many users and this is a big factor in why the drug is so addictive. http://www.latimes.com/projects/oxycontin-part1/

What about the Portugese model described in the article (legal for consumption, illegal to commercialize), with some of the funds spent on controlling drug related violence instead being turned towards treatment centers where addicts can get something like Methadone?


I strongly agree. I'm as anti-drug as it gets, but locking up non-violent drug users with rapists and murderers doesn't make sense. If our goal is to help drug addicts get clean, prison is a terrible strategy.

There's a kind of despair spiral that kicks in for some addicts. Life isn't going well, so they turn to drugs to ease the pain. Then they get arrested, sent to prison, and get labelled as a felon. Now they can't get a job or have a stable living arrangement and they turn back to drugs to get through the despair.

For these people, we need to break the cycle if we're ever going to help them get clean. Making their lives worse will only further entrap them.


Article:

> and legal painkillers are still linked to most opioid overdose deaths.

Your comment:

> People wouldn't overdose if they knew exactly how strong the drugs they injected were

Is your comment a knee jerk reaction to an anti-legalization headline because it doesn't appear to be related to the actual content or points raised in the article.


> People wouldn't overdose if they knew exactly how strong the drugs they injected were

This is not how tolerance works. The same dose can have vastly different effects depending on how long it was since your last dose, other drugs in your system and your body's natural tolerance that might be diminished by exhaustion or infection.

The dose someone uses to feel baseline today might have them completely dysfunctional in a few days or kill them after a couple of weeks.


Everything you said outside of tolerance is exceedingly rare. If you're not taking one of a handful of herbal supplements, you are extremely unlikely to have a measurably different response to the same dosage of opioid.

And the effects will not be vastly different. Just varied in intensity.


> If you're not taking one of a handful of herbal supplements, you are extremely unlikely to have a measurably different response to the same dosage of opioid.

If you've taken any common CNS depressant, such as alcohol, benzodiazepines, psychiatric drugs, drugs that are metabolized by the same pathways as opioids, even blood pressure medication or sedatives including antihistamines, you are going to potentiate the CNS depression from opioids.

> And the effects will not be vastly different. Just varied in intensity.

The scale of intensity of effects from a dose of an opioid varies from: enough to get a patient out of withdrawals to completely stopping breathing.

Titration of dose is the only way to more accurately determine a safe and effective dosing schedule for opioids.


I concede that I neglected drug interactions; however when you said vastly different effects, I interpreted it as meaning unique effects based on dosage, similar to something like DXM, as opposed to two ends of a relatively linear scale of analgesia->sedation->death. Which is untrue.


" People wouldn't overdose if they knew exactly how strong the drugs they injected were"

Opiates are highly unpredictable. The exact same 'homogenized' batch can kill you at any time. One dose you can slam half a syringe, next dose a day or two later, you can do 1/4 that amount and die.


Right, that's why people are dropping dead left and right from prescription opioids, hospital injections of morphine, opioid patches...

No drug has this kind of unpredictable physiological profile, you're spreading nonsense.

I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that.


People do drop dead from prescription opioids. Hospital injections of morphine are done under close supervision by trained staff. Fentanyl patches do kill.

> I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that.

That is an inherently unpredictable situation. We cannot predict or measure the subjective and changing tolerance a patient has to opioids.


The comment implied that repeated doses to a given person are wildly unpredictable. This is false.

Further, you absolutely can approximate how long tolerance lasts, but my point was that you can predict that your tolerance is reduced after abstinence, as opposed to the original comment which suggested that all dosing was unpredictable.


> The comment implied that repeated doses to a given person are wildly unpredictable. This is false.

I didn't imply that repeated doses are unpredictable.

Regular repeated dosages can be predictable as long as the patient remains stable with regards to infection/health and other drugs they ingest. Initial dosages, dosage increases and returning to a previously safe repeated-dose after cessation are not at all predictable.

This is why I mentioned titration in a previous comment: subjective response to drugs and subjective tolerance cannot be accurately predicted or measured.

This is also why drugs like Subutex are titrated when beginning suboxone treatment: a doctor cannot accurately measure tolerance to determine how much of the drug is needed to keep a person out of withdrawals.

> you absolutely can approximate how long tolerance lasts

Naloxone or naltrexone induced withdrawal rapidly diminishes tolerance faster than it would naturally.

This suggests that there's a function that can accurately output a safe and effective dose of opioids based on the variables of previous dosage and time since cessation. I'm arguing that there is a missing variable that's unable to be measured accurately: each person's subjective tolerance. That subjective tolerance depends on a multitude of factors that cannot be determined clinically.


I've only been trying to respond to this statement above, which wasn't yours

>The exact same 'homogenized' batch can kill you at any time. One dose you can slam half a syringe, next dose a day or two later, you can do 1/4 that amount and die.

Based on your elaboration, I suspect you agree with me that it is nonsense, and that opioids are far more predictible than it implies.

Still, I believe you are overstating the danger associated with opioid dosing. This subjective tolerance you speak of likely falls within a reasonable narrow normal distribution and is the reason that based on your weight and gender, doctors may estimate a safe effective dose without titration.

Also, I don't believe morphine injections are titrated.


"Based on your elaboration, I suspect you agree with me that it is nonsense, and that opioids are far more predictible than it implies."

You go tell that to my dead pal Carl Mauk, dead from Fentanyl patch. Proscribed, always changed on-time and never abused. Died getting it changed in the hospital.


"The comment implied that repeated doses to a given person are wildly unpredictable."

A. You missed the word 'homogenized' and B. I've had the mispleasure of watching people die on hospital-proscribed opiates taken at proscription times and amounts. Tolerance can change rapidly. The joys of drug counseling.


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.


>> 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.


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


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).


>I've come to view drugs and alcohol as symptoms. We've probably co-evolved with alcohol, since it's both genetic and correlated 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.

Maybe humans simply evolved to seek pleasure and the associated activation of reward circuitry, the same way they find it in food, leisure, sex, etc. Except the pleasantness is significantly stronger with drugs. Its unlikely that humans evolved to use any particular drug, since there are so many exogenous substances which mimic human neurotransmitters and/or interact with the brain.

There is no complex explanation for why humans use and abuse drugs. They feel good and many humans are notoriously irresponsible with regards to over indulgence.


Feeling good is an evolved trait. We feel good when we have sex because it propagates genes. If we could hold technological growth static, the drugs that lead to dependence, depression, and suicide would eventually become less addictive. We do this with food through our tongue and through throwing up when we ingest poison. I'd imagine it'd be something similar for harmful drugs. Although it may be something else, like evolving out the negative consequences. Perhaps that's why alcohol dependence is correlated with intelligence: Smart people can think of ways of avoiding over drinking so there was less selective pressure on anti-alcohol dependence genes.


You can't just advocate the sale of marijuana and in the same post suggest soft drinks should be banned. When I'm stoned a nice cold Coca Cola really hits the spot.

Happy holidays, by the way.

In all seriousness, banning something doesn't mean that we will learn to deal with it better in the future. Imagine if we'd banned cars back when speculators thought humans would go insane if their bodies exceeded 30 miles per hour!

Taxes are a great way to deal with a problem without banning it, which usually opens a black market anyway.

After all, before Prohibition, one of if not the biggest sole contributor to the U.S. Federal Government was the booze tax that dates all the way back to Alexander Hamilton.


As a proponent of liberty, I agree with you. But, I have also come to see raw sugar as a poison (no matter how much it seems to hit the spot).


There isn't any raw sugar in coke (in the States).


Sure there is. They call them "Mexican Cokes" and they come in bottles (12 oz.). I used to buy them by the case at Costco for ~18.

Also, I was using 'sugar' generically, and perhaps I should've said 'sugars' (i.e. mono- and di-saccharides)[0]. Fructose counts as a sugar in my mind. Maybe the naturally occurring substances we desire should not be extracted, and the other constituents that occur alongside our desired constituent has an evolutionary reason for being there.

[0] Sucrose is glucose + fructose:

https://en.wikipedia.org/wiki/Sucrose


I was thinking of cane sugar, which is more common in Asia (and elsewhere, I guess, but not in NA).


Cane sugar was, second only to cotton, responsible for continuing the slave trade here in the Americas. Cane sugar is sucrose, and I had made guess based on your previous comments that you were referring to cane sugar.

Edit: I should've just written"

cane_sugar==sucrose

sucrose==glucose+fructose

corn==fructose //(subsidized feed stock for ethanol used in fuel in the US)


I agree on a lot of levels, but I have a slightly different take. I would argue that, fundamentally, we are still pursuit predators. It's a deeply engrained cognitive trait to chase a goal over long periods of time, methodically fighting against things that are far larger than ourselves. We can adapt to any circumstances as long as our lives are framed in the context of a greater goal.

To that end, I posit that our ills of today ultimately boil down to two root causes: A lack of a national vision, and our weak public education system.

A national vision is key to strong social cohesion, it's a collective dream gives value to our work and builds a common sense of brotherhood. We overthrew the shackles of an empire chasing our dreams of democracy and freedom, and grew into an empire of our own while chasing manifest destiny. Immigrants flooded in riding industrialization to fulfill their dreams of upward mobility, and fostering a sense of inevitable progress. World War 2 ripped us out of the Great Depression, sending us back to Europe as liberators and defenders of democracy, while we fought back imperialism on the Pacific front. We were liberators and defenders of democracy, a free people united against tyranny. The Cold War coupled our social identity to economic implementations, but it also sent us to the final frontier of space and inspired an entire generation.

It doesn't matter that we were never really united. There was always a sense of direction, movement towards some end, and that was enough to give us something to fight for or against. The fight put our lives in context and gave us meaning, it united us as comrades in that greater fight.

That ended with the USSR collapse. Our imperial democracy suddenly found itself a hegemony that it was culturally unprepared to defend. As many here have experienced in business, the culture of expansion is radically different than the culture of an organization that's holding ground and focused on internal improvements... maintaining position requires greater maturity, a sense of collective ownership and sustainable long-term thinking. The Cold War socioeconomic coupling hindered our ability to transition towards the stability mindset, and, if anything, stigmatized ideas of collectivism just when we needed them the most.

We're left framing our lives in the context of post-Cold War capitalism: Faceless gears in a machine, an inward-facing culture of selfishness and greed that enables the gutting of our nation and our principles. Capitalism is an economic implementation, it is not a socioeconomic system.

I would argue that there are only two things required to put America back on track. Many things are broken, but they are symptoms of much simpler root causes.

* We need an expansive national vision to unite us behind a distant challenge: A new Space Race. Shift billions from defense spending to growing new industries, building a vision around settling the final frontier, and raising the next generation to look upwards in awe. Frame our culture around building the future and leading all of humanity into the great unknown.

* Reform and reinvest in public education as a foundational cultural institution. Focus K-12 on developing strong citizens that embody our democratic ideals of critical thought and cognitive independence. Instill students with principles and skills to navigate the modern world, rather than relying on short-term rote memorization against standardized tests. Work to refactor some careers out of college and into new trade schools, and change the high school narrative to put more emphasis on non-college education paths like tradeschools or civics.

That's all we need. A vision to inspire and put our lives in a greater context, public education to give our citizens the tools to be an educated electorate, and together they foster a culture that's capable of focusing inward and upwards.


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...


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


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.


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/ 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?


> 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...


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...


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.


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.


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.


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.


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.


Just to float the "thick skull" perspective here. Some people believe health care should be treated as a right. We find ourselves wedged into a situation where the damage to an individual caused by the actions of that individual become a cost that must be borne by others.

Not that I agree fully with either perspective. Its a difficult problem. "My body and mine alone" is a great perspective until you break it and need help beyond your own means to fix it.

Edit: Ahh- Thankyou. At this point I can safely say that this is a reliably unpopular opinion. I'm not sure why though. Would someone do me the courtesy of resolving the question for me after you hit that down button:

Why is it my body to unconditionally do with as I please but someone else's responsibility to fix it no matter what? I can't resolve the dissonance here but the notion seems repugnant to all sides of the debate. I'm a big proponent of basic universal healthcare but this seems a big drawback of this approach. I really would like to hear what people think I'm missing.


It's not someone else's responsibility to fix a person's health issues no matter what.. that sort of thinking, in my opinion, is at the root of an incredible amount of government overreach.

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.


The article is in favor of legalizing drug consumption (when it talks about being in favor of the Portugese model)


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.


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...


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!


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.


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.


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.


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.


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/

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


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.


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/

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?


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


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.


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


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-...

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.


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.


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.


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


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.


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.


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.


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


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


Just want to point out that the article is actually in favor of decriminalizing drugs.


Prohibition is the cause of the fetanyl epidemic. As enforcement increases so does potency because smaller portions are easier to smuggle. Fentanyl is ~50x stronger than heroin which means 50x the payoff for smuggling the same quantity, but it's also much easier to misjudge the dosage.

https://en.wikipedia.org/wiki/Iron_law_of_prohibition

Yes, opioids are terrible for the human mind and spirit, but the unintended consequences of prohibition make them that much worse.


While I agree that prohibition is harmful and creates huge black markets, we are no longer talking about recreational drug but an active public health crisis where people are buying literally poison that will kill them.

I'm not calling for an all out sudden prohibition but to rehabilitate those already addicted while eradicating further supply of fetanyl.

Heroin and fetanyl are two very different beasts. While heroin seems to have a long use life for it's addicts, fetanyl literally kills because of it's extreme potency.

Carfentinil, the elephant tranquilizer is 100x stronger than fetanyl. There's no way we as a society can allow this to flow freely. It's no longer a drug but poison that absolutely kills its users.


Most people dying from fentynl aren't buying it on purpose. They're heroin addicts who would gladly choose that if it were legal.

>Carfentinil, the elephant tranquilizer is 100x stronger than fetanyl. There's no way we as a society can allow this to flow freely

I'm glad you understand that potency is the issue, but you're advocating policy that causes potency to increase.


> They're heroin addicts who would gladly choose that if it were legal.

It seems more of a preference. Lot of heroin users dislike the fetanyl high and remain heroin users.

> I'm glad you understand that potency is the issue, but you're advocating policy that causes potency to increase.

I disagree. The policy that made sense for mild opiods, namely legalizing and regulation. However, we are dealing with an extremely harmful chemical-a tiny grain size of salt of carfentinil will kill. There's just no way this can be used recreationally and responsibly.


There's a really nice middle ground. In Portugal drugs are legal to possess but illegal to sell/distribute, so you can still go after the dealers and suppliers but not the addicts who are suffering. And they provide easy access to methadone, clean needles. There are places where they can shoot up with nurses to supervise for ODs, testing kits so addicts can verify their supply hasn't been cut with something nasty or unexpected. I'm not exactly pro-drug, but I think this approach is probably the best possible way to address the crisis and reduce usage in the long term.


When people talk about legalizing drugs they usually mean "soft" drugs like weed/LSD/mushrooms and not opioids/benzos.


IMO, legalizing hard drugs is more important than legalizing soft drugs, simply because so many people are dying from hard drugs. But legalizing hard drugs would mean that it's available via prescription, and a valid reason for getting a prescription would be "I'm addicted". The doctors responsibility would be to ensure that you know how to use the drugs safely, and ensure you're aware of the resources available to help you quit. But no moralizing, condescending lectures because that would do more harm than good.


Fetanyl & Carfentanil aren't hard drugs anymore, it's literally killing people. We are no longer talking about Heroin which are the classic hard drugs. I'm trying to argue for a clear distinction between those two groups.




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