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The Heroin Business Is Booming in America (bloomberg.com)
115 points by pmcpinto 188 days ago | hide | past | web | favorite | 184 comments



Anyone else notice that a common theme in the recent wave of handwringing over heroin and opioid addiction is that the victims we're asked to consider with compassion and understanding are almost always white? The tough on crime drug war rhetoric disappears so easily when the victims are "regular people" who fell prey to the pharma industry, not "junkies".

I'm not saying that we shouldn't treat these people with compassion -- exactly the opposite. The LA Times series in particular is a fantastic piece of reporting. Rather, I'm saying we should consider why the portrayal of this particular drug epidemic is so different than others, and how we can extend the same compassion to others who have also had their lives and families destroyed by drugs. We hear about these people because they're white. Meanwhile, what's happening to the people we don't hear about?


As a Black man in his late thirties, this is one of the most difficult things for me to accept. I'm from Dayton, OH. I grew up on the west side of Dayton, which is the side of town where most Black people in the city lived. My bitterness at seeing the way things are being handled now compared to the crack epidemic that swept through African American communities in the 80s has made me very spiteful. It's even more of a slap in the face because a large number of addicts (who are almost always white) come to the West side of Dayton to use their drugs. As a child, I hardly ever saw White people on the West side. Now, when I come back to visit, and I see a White person on the West side, I have a pretty good idea why they are where they are. It is a very difficult thing to come to terms with. My resentment over this situation has gotten to the point where I have decided not to offer help (other than a call to 911) to an addict who may have overdosed.

edited to correct grammar


I agree with your point 100% BUT there is one point to be made. Prosecute the Pharm Execs, Doctors who broke the law.

There is a smoking gun! Look at West Virginia and the pills that were prescribed. I am talking about 780,000,000 pain meds. In a state of 1.84 million residents, the shipments amount to 433 pain pills for every man, woman and child in West Virginia.

The death toll for this 5 year time between 2007-2012 is 1,728 West Virginians died from overdoses of hydrocodone and oxycodone.

http://www.nbcwashington.com/news/local/Drug-Wholesalers-Shi...

So you are 100% right about public perception. I live in a large city in PA and my In-laws come to visit from W.Va and I always tell them I see more people high in W.Va then in my Center City neighborhood and they always roll their eyes like I am crazy.


It is not going to happen, because they have politicians in their pockets and nobody will investigate that.


I sadly also agree with you 100%


You're definitely not the only one to notice, there have even been articles about it. It's pretty disgusting, but from a utilitarian perspective, caring for victims is better than not caring out of spite. About all we can do is hope that once we get this particular epidemic cleaned up, the next time one comes around that mainly affects poor blacks, we remember the lessons learned.


Not sure but the media during the crack epidemic sure focused on non-white people... And that just further perpetrated the idea and image that non-white people do drugs and thus are bad.

This seems like a way to raise awareness in a more responsible way.


It's very simple, people are more compassionate to people similar to them. And it's obvious why - similarity makes it easier to see yourself in others' shoes.


Do you happen to have a link to the LA Times series to which you're referring?


I'm thinking of this in particular: http://www.latimes.com/projects/oxycontin-part1/

EDIT: also I want to be clear that I don't think journalists are sitting at their desks saying "Uh oh, white people are in trouble! Sound the alarm!". This is great coverage, and it's a complicated issue.


That is an excellent report, thanks!


This is probably pop psychology but it always struck me that if you legalize marijuana you go a long way to solving the problem. My thoughts are...

1. It is reportedly a better pain killer in some cases than opioids so it keeps people off of the prescription opioids

2. It is nowhere near as addictive (possibly not addictive at all)

3. When people are already criminals (because they smoke weed) I think they are more likely to say "screw it" and try a harder drug. In the vein of, "I'm already doing something I can go to jail for, what's one more thing?" Legalizing keeps people out of the criminal class (increases barrier of entry to it)

I'm actually for legalizing all drugs like several other posters but I don't think society is ready for that.

I got in a argument with a close relative (a retired police officer) and another close relative (a doctor) about this on Easter. There arguments were entirely based on emotion and lot so logical fallacies. And understandably, they have both seen the darkest sides of what drugs can do. But criminalizing doesn't help those people.


> if you legalize marijuana you go a long way to solving the problem

Well, Colorado tried that. Recreational weed has been fully legal in Colorado since January 1, 2014. You can walk down any major street in Denver or Boulder and pass multiple outlets selling marijuana. And they've sold lots of it, according to the tax receipts raised.

The result has not been the sudden reversal of opioid addiction that you had hoped for.

In 2015, opioid overdoses in Colorado continued to increase at the same rate as prior to legalization of marijuana. That year, opioid overdoses killed more Coloradans than homicide. [0]

In 2016, the total number of opioid deaths dropped 6%, but the number of heroin overdoses continued to increase. [1]

Personal experience in Portland Oregon suggests that in that city, legal marijuana has not made a dent in the meth and heroin issues that are still affecting the city.

Maybe recreational marijuana laws have helped. Nothing in this data can disprove that maybe more people would have died without it. But it hasn't been a magic bullet. It hasn't yet gone "a long way to" solving the problem of heroin overuse.

[FWIW, I'm in favor of recreational marijuana legalization, but the problems of heroin have different roots and we can't expect legal marijuana to immediately solve those issues.]

[0] http://www.denverpost.com/2017/01/03/colorado-opioid-heroin-...

[1] http://www.denverpost.com/2017/03/07/colorado-opioid-heroin-...


> The result has not been the sudden reversal of opioid addiction that you had hoped for.

I didn't say "sudden". I think it would take time.

Addiction doesn't happen overnight. I am open minded and I am not going to ignore research if the research doesn't support my view. But my hunch is, it is too soon or too much damage has already been done and we need to take other steps to reduce usage not just legalization.

Incidentally I thought I saw some research that showed the opposite effect but I can't find the link right now... I'll take a look for it later and see if I can find it.


When ANYTHING is used to escape from emotional pain be it heroin, pot or food it is wrong and causes problems.


Intuitively, this makes sense. Anyone buying heroin/meth/whatever would've likely also been exposed to the option of buying marijuana just as easily among those alternatives when it was still completely illegal. If marijuana was a viable alternative for their drug of choice, I imagine they would've just stuck with that regardless of legalization, since it's cheaper and safer.

Hence I wouldn't really expect legalization of any drug X to improve problems with any drug Y in most cases. But if legalization itself helps with drug problems in general, I might expect that only legalizing drug Y would help drug Y's problems.


It will be interesting to see if this eventually puts a dent in the number of new opioid addictions - but that is a very different thing than addressing current addictions and/or transference from prescriptions to street drugs.

I suspect it will be about a decade before any really good analysis can be done on that aspect.


> the sudden reversal of opioid addiction

I don't think anyone (even the parent commentor) thinks that would happen. At best, I think we can only hope for prevention, and even that will require a lengthy period reeducation and destigmatization. Speaking from experience, it's nearly impossible to truly reverse opioid addiction. Preventing that addiction in the first place by utilizing other non-or-less-addictive pain control methods, such as marijuana, is our only hope.


Is there an easy way to collect and cross reference opioid deaths in non-prohibitive states? You seem familiar with the problem and the data - is Colorado's rate of overdose increase proportional to that of places like West Virginia, for instance?


I wouldn't take issue with your overall point, but the headline in your second link contradicts the article:

As prescription opioid deaths drop 6 percent in Colorado, heroin deaths rise 23 percent

vs.

Overall, the total number of opiate deaths — meaning deaths from both prescription painkillers like fentanyl or from illegal opiates like heroin — fell by about 6 percent, from 472 deaths in 2015 to 442 deaths in 2016.


Also, as an aside, heroin and opioids aren't not automatically fatal so that number is a subset of users. An important number is not just deaths but also hospital visits and new users are important.


> 1. It is reportedly a better pain killer in some cases than opioids so it keeps people off of the prescription opioids

No it isn't and no it won't. If you have serious pain issues, then cannabis will not help at all.

If you are just referring to a slight ache in your back in the morning, ok there is some research (clinical and anecdotal) that cannabis can be useful as as anti inflammatory. But you should not be getting opiods for this anyway.

Part of the problem IMO based on speaking to various people from various countries, the US is just far too happy to prescribe strong medication (generalisation I know but still) whereas for the same ailments in other countries you would get nothing. Whether this is do to the profitization of the US health care system, or whether when you are paying as much as people in the US are you want to feel like you are getting something in return. To be told, do a few stretches, take a parecetamol (tylenol?) may not seem like good value for money, even if it is the better advice (I have seen similar behaviour in some other countries where health care if more privatised)


>Part of the problem IMO based on speaking to various people from various countries, the US is just far too happy to prescribe strong medication (generalisation I know but still) whereas for the same ailments in other countries you would get nothing.

I noticed this when I got my wisdom teeth taken out in Japan. Typically in America, they knock you out and remove all four at once and give you powerful drugs after the procedure to help with the pain. When I got the procedure done in Japan I was originally scheduled to have four separate procedures, until I complained and even then it was moved down to two, one for each side of my mouth. The anesthesia was local and the drugs I got were extremely light. I was definitely in pain way longer than friends who got the procedure, but it was bearable and ultimately I think I'm better off for not being described a hard opioid.


I did it in the USA and it was all local anesthesia. I had a hard time even finding someone who would offer general anethesia.


A friend of mine gave her mother a lot of edibles that she made from marijuana she grew when she was suffering through cancer and in a lot of pain. Apparently she was happy until she passed. She had tried chemo at one point and had been miserable of course.

My grandma has arthritis and a lot of back pain and the doctor gave her morphine. I doubt anything is better than that but it does seem overly excessive, although stretches and tylenol as you suggest is definitely too weak for her.

I think there's a really nice place for marijuana as a pain medication.


You're absolutely right! Marijuana has a very useful place as one tool among many for palliative care.

I believe parent may be suggesting that marijuana should not be regarded as a universal substitute for any and all use palliative uses of opiates.


>> 1. It is reportedly a better pain killer in some cases than opioids so it keeps people off of the prescription opioids

> No it isn't and no it won't. If you have serious pain issues, then cannabis will not help at all.

Anecdotal evidence from working at cannabis dispensaries (and possibly some studies I've seen, but I'm not going to look 'em up.) suggest while you won't get off opiates for serious chronic pain, if you consume (usually edible) cannabis and opiates your dosage of the opiates can come down significantly and lead to better quality of life.


I got vicodin for headaches once (not even bad headaches, just regular headaches), so it depends what kind of pain you're talking about.


I've Psoriasis and Psoriatic Arthritis in my late 20's. Anecdotally I can say I never believed the hype about the effect of marijuana use on inflammation. After going straight in the past 30 days (job hunting), I can say I thoroughly miss not itching over my entire body 24/7 and not feeling fire in my hands. To quantify I have decided to only pursue jobs in legalized jurisdictions.


> ... between 1999 and 2010, states that permitted medical marijuana had an average of almost 25 percent fewer opioid overdose deaths each year than states where cannabis remained illegal.

Source: https://www.scientificamerican.com/article/could-medical-can...


It could just be that states with bigger opiate problems are less likely to ease restrictions on marijuana.


> 1. [Marijuana] is reportedly a better pain killer in some cases than opioids so it keeps people off of the prescription opioids

This is key. Prescription pain killers are the gateway drug to heroin, not marijuana. Many normal, working class people become unexpectedly addicted to opioids by using medications exactly as prescribed. Rush Limbaugh is probably the most high-profile example of this. The tighter rules on opioid prescriptions might have some effect, but it will likely take FDA approval of marijuana for this to be reversed.

> 3. When people are already criminals (because they smoke weed) I think they are more likely to say "screw it" and try a harder drug....

Somewhat agree here, but I don't think they try heroin because they're already doing weed. They do it because life is shit and heroin is a hell of an escape. When life is that bad it's really hard to see the downside to using hard drugs.

There are also some people that use heroin because of psychological issues or social pressure, but I think easy access to weed would reduce that as well.


I am pretty much with you. To add,

1. As far as I know, it doesn't actually kill pain, people just report that they no longer are bothered by the pain, or able to ignore it and still function. Which is probably better.

2. Fairly sure its not addictive at all in the pharmaceutical sense, and quite positive it can be in the way say World of Warcraft or other entertainment can be.

3. I actually buy the "gateway theory", but only because of this.

Opposition seems to be the result of habit and years of ascribing negative virtue to recreational drug use (probably discounting alcohol cause cognitive dissonance).


1. How can one still function if you don't care about most basic emotions like pain? Trickquestion, one can't.


I agree that cannabis legalization could help public health addiction problems.

One idea that I don't see brought up a lot is using cannabis in a rehab setting; basically trying to get people to replace one mind-altering substance with another. I don't think that should necessarily be a permanent solution but it seems more realistic than asking someone to go from doing drugs every day to being stone cold sober at all times. Cannabis could take the edge off and provide the mind altering feeling that some addicts seem to crave. [1]

In all fairness I'm sure there are failures in this idea but I think it's worth exploring once we accept that cannabis is just nowhere near hard drugs on the harm spectrum.

[1] https://www.theatlantic.com/health/archive/2017/01/teens-dru...


Pot would alleviate much of the heroin problem but with great advantages comes equal disadvantages. I suspect we will see these issues soon.

Point number two: Marijuana is addictive and individuals with marijuana addiction entering voluntary rehab is increasing:(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797098/)

Theory: The reason one does not get physical withdraws is that it is oil based, stored in the fat and slowly dissipates in about 2-weeks or so whereas heroin is water soluble and leaves the body within 24-hours...


Cannabis addiction (and I agree it exists) is not in the same league as opioid addiction.

Heavy smokers may feel different when stopping, may have a few sleepless nights due to dreams returning, may be irritable, feel bored, but it is not at all comparable to those coming off a heavy opioid addiction.

There is no equal disadvantage. If all heroin addicts were to magically over night turn into cannabis addicts and no longer be heroin addicts there will be many advantages and next to no disadvantages. Crime will go down. They will become employable, they will be able to lead "normal" lives. Disadvantages? I am not really thinking of any, let alone any that are equal


Marijuana absolutely can and does cause far more significant withdrawal than just a few sleepless nights. Under certain circumstances, the withdrawal can persist for much, much longer.

It's irresponsible to assume that marijuana is harmless and non-addictive or only mildly addictive, and too easy to justify as being benign, when juxtaposed wth the withdrawal process of harder drugs.


Not really, marijuana withdrawals are fairly tame and many people don't even experiences those. At most, a couple of weeks of irritability, appetite issues, and problems sleeping.

The psychological "withdrawal" can be much worse, but there is a whole range of regular things that can lead to those addictions. And it is often abused to hide other mental health issues, which can flare up while quitting.


You moved the goalposts. My response was to the claim of a "few" sleepless nights, which is far from the truth for the majority of long term regular users who quit. Instead, you said that there are, "at most, a couple weeks of" mild symptoms. This is simply not representative of the withdrawal scenario for long term heavy usage, both in duration and intensity.

I've seen first hand mentally stable folks who quit smoking marijuana after full time use for a number of decades. The withdrawal symptoms in these folks were far from mild, and lasted more than "at most a couple of weeks". Long term insomnia alone is a serious risk factor, due to their dependence on marijuana to maintain a regular sleep schedule.

While your generalization that marijuana withdrawal is tame may be true in many cases, particularly for light or short term use, it is false for long term daily users.


I moved the goalposts to "what our scientific research has found," not to some anecdotal evidence of a particularly bad psychological withdrawal someone you know had. That wasn't the drug's fault, and your friend could have done many innocuous tasks before sleep and had the same problems quitting.


> Point number two: Marijuana is addictive and individuals with marijuana addiction entering voluntary rehab is increasing:(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797098/)

Most people entering voluntary rehab do so under duress. Specifically, they are doing so as part of a plea bargain, to avoid serving prison time for a drug charge.


The study you pointed to for point number two are ten years old and predate pot being legal in any states at the recreational level.

Additionally those stats are often considered to be enormously skewed as one of the primary ways you can avoid a drug charge in some places is to "voluntarily" enter rehab for it. So while it looks like pot addiction is up, it is really that pot arrests are up.

This would also explain why in the study minorities seem to have a higher rate of "addiction", as they're more than twice as likely to be arrested for minor drug charges and thus more likely to be put in this situation.


   equal disadvantages
Are you suggesting negative effects of marijuana usage are comparable to that of opioids? That really doesn't match any of the research I know of.


> I'm actually for legalizing all drugs like several other posters but I don't think society is ready for that.

If society isn't ready for that, why are you for it?

(fwiw, I'm with you on marijuana, and hope to see the day when it's as legal as cigarettes - but people have been optimistic about marijuana for decades :/)


> If society isn't ready for that, why are you for it?

Not OP, but I think this means that it isn't a mainstream enough idea to get traction, and that it might be political suicide for an elected official to suggest it, not that society is ill-equipped to handle it if it did happen.

I share this position. I think it's a good idea to legalize most drugs, but I think actively working toward legalizing drugs other than marijuana today would not get much in the way of results.


Thank you, yes this is exactly what I meant.


>>why are you for it? Because there is no other solution. None.

The drug war has been a complete and utter failure from the viewpoint of society (those who have profited may disagree, but I hope we can agree their views can be ignored). IT has ruined lives, brought misery and suffering to many, all but destroyed some countries, helped wars continue long after they would have otherwise, unfairly targeted minorities.

And for what gains? None, absolutely nothing. Drugs are cheaper, purer and more available than ever. That is all the billions if not trillions of $ has achieved.


Ending the War on Drugs is not the same thing as legalizing all drugs. There are ways to fight addiction to things like methamphetamines and heroin without declaring all victims as the enemy.

We should absolutely change how we deal with drugs and addition, but I'm not convinced that straight legalizing things like meth is the right approach, either.


Because a person who uses rational thought based on evidence will be for decriminalizing recreational drug use, whereas society as a whole still works on emotion, rumor, cognitive dissonance, rhetoric, mendacity, and prevarication.

I actually hope to see the day when cannabis is more legal than tobacco cigarettes. When cannabis starts piling up the corpses, it can then be made as legal.


But OP didn't say decriminalizing recreational drug use; he said "legalizing all drugs".


Can you elaborate on how you perceive the two phrases to differ in their meanings?


To me, decriminalization of personal use means that I can smoke weed, or maybe even meth or shoot heroin, and not be punished for it. This would minimize the harms that come directly from the government enforcing drug policy, for something that typically is not going to hurt anyone but myself.

Whereas legalizing it would mean that I'm free to manufacture meth and heroin and market it, and sell it to others; I would still have an incentive to use some drugs' inherently and biologically addictive nature to profit myself at the expense of others.

I specifically say "inherently and biologically" because many things are addictive to a degree - alcohol, tobacco, video games, in-game purchases, gambling - and any of them can ruin some person's life. But they don't appear to be as universally addictive as, say, heroin or meth, which can have terrible repercussions even if you stop using them. It's a difference of degree, but it's a significant one, and I want to head off at the pass any argument that selling meth to my neighbors is no different than selling them sugary soda or cookie-clicker clones.


I don't think you can kill the black markets unless you allow anyone [that can meet the regulatory burden] to manufacture and distribute.

And you can't tax them too highly, either, or those black markets spring right back into existence. See moonshining or cigarette smuggling for examples. A 25% excise tax at the point of sale to the consumer is probably the highest you can go. Taxation is, after all, one of the ways in which prohibition was backdoored into existence, and the amount of the tax is the maximum possible profit margin for someone whose sole business is evading the tax.

That leaves open the question of how you keep the most dangerous drugs--generally the opioids--from ruining people. That's really a moot point until the end of prohibition seems imminent. If certain people won't consider any other option, it's useless to throw one out there for discussion.


Can't speak for OP, but in a more general sense, society as a whole will never be ready for some things that some individuals are for. That's why we (America) are a nation of laws, not of man. There will always be someone who doesn't like you, or what you do, or what you stand for, simply because it's all subjective.


Really? Sometimes, especially when I'm trying to quit, I wish cigarette smoking was forbidden in more places.


The drug war has failed. Legalize all drugs and tax them. Spend the tax money on rehab, schools, and public universities. We are just propping up drug lords in Latin America to feed our insatiable demand for drugs.


How does legalizing fix or reduce addictions? I understand it makes acquisition less taboo, and perhaps makes treatment a less taboo subject too, but it's not like legalization is a pancea for addiction. Booze is legal and we still have a massive alcoholism problem.


Legalization doesn't fix addiction. It fixes the sub-culture, the underground, the dark layers in society where addicts lurk in order to be able to continue their addiction.

Legalization brings these people into society, by removing the stigma associated with drug use, and makes it less of a problem to be swept under the rug. It makes it easier to contact addicts and get them into effective treatment programs. Right now, there is a huge wall between addicts and treatment: that wall is an entirely fictitious legal construct.


I want to agree with you, and I think I mostly do.

Unfortunately your comment also reminds me how enormous the barriers remain toward people recognizing alcoholism and having the will to treat it. There's an enormous amount of shame, stigma, and denial toward alcoholism, to the point that most who suffer from it still choose to hide that reality as much as they possibly can.

Even worse, the legality of it promotes a culture of celebration (advertising, fancy and elaborate liquor branding, snazzy bars, nightlife culture, bottle service, etc. etc) that is in so many ways uniquely destructive in its own right. Like everyone should be able to find joy in drinking, and those who struggle have something horribly wrong in them that carries the risk of denying them the good life, friends, social opportunities, cultural connection, and so on (suddenly mundane invitations to bars, cocktail parties, weddings, shows, dinner at a friend's home, drinks with co-workers, etc. become awkward and potentially dangerous).

There's a whole culture built around it: mainstream culture. And someone facing their problems with this particular drug face the prospect of losing access to the culture of their entire society. That's just daunting.

I don't think making alcohol illegal would help. But it's no walk in the park even legal. And poses some of its own unique challenges.


>I don't think making alcohol illegal would help.

We already tried this experiment once. Making alcohol illegal did two things.

It actually reduced consumption and alcoholism.

It greatly increased the amount of black market crime, and it drastically changed how it was consumed.

Harm in vice will always occur. We just have to decide if we want it in the form of overdose, or the form of black market versus police state violence.


Prohibition can also increase adverse events like overdose.

Heroin addicts usually know how much of their usual dealer's heroin, cut to a particular purity to take to get high without dying. If they take the same dose of a more pure drug, they overdose. If they take what they think is heroin, but is actually fentanyl, they overdose.

Likewise, during alcohol prohibition, liquor containing methanol was a common risk for poisoning when drinking black market alcohol. Even the cheapest grain alcohol at a college liquor store today will not contain a dangerous amount of methanol. Legal heroin would reduce this kind of risk in the same way; it would contain what it says it contains, in the concentration on the label and would not contain other harmful substances.


> Harm in vice will always occur. We just have to decide if we want it in the form of overdose, or the form of black market versus police state violence.

I think this is one of the key insights. Although, thankfully, I think it's more than a binary choice (either a) legal or b) illegal).

Regulated legality combined with heavy restrictions on marketing and sustained support for rehab / support / education seems to me the best of all worlds. Still keep things accessible enough to cut out the motivation for the black market. But don't let the less scrupulous side of legal society run amok and actively exploit that.


We've done work on tobacco. Sure there is still a culture around smoking and whatnot, but its generally accepted to be unhealthy and something that is a problem.


Just to add one more thing to this excellent comment: legalization also makes it much easier to undertake scientific studies/research of the effect of (currently) illicit drugs, which might actually help us understand them better. e.g. we know very well exactly how much alcohol is considered "safe" or causing least damage; but we still don't know about the long term effects of e.g. MJ.


> legalization also makes it much easier to undertake scientific studies/research of the effect of (currently) illicit drugs

Isn't this already possible in other countries? I would have thought this would already be possible in Portugal. [0]

[0] http://content.time.com/time/health/article/0,8599,1893946,0...


Psychology of drug use is rare and hard to find. We need to do a better job studying these dangerous drugs to learn to help addicts better.


> It makes it easier to contact addicts and get them into effective treatment programs.

Who do you expect will fund these treatment programs? I seriously doubt most addicts are equipped to pay for it.

You're talking about a country where a major political party actively works to remove funds from women's healthcare. [0]

I fully agree that these substances should be legalised for the reasons you mentioned, but I think it's laughable to think present-day politicians give a shit about these people. If anything, they'd probably face substantial lobby from police unions concerned legalisation would lead to job cuts.

[0] http://www.idahostatesman.com/news/business/article145926149...


"Who do you expect will fund these treatment programs? I seriously doubt most addicts are equipped to pay for it."

Prosecuting and jailing drug addicts costs a lot of money. You could move that money to treatment.


> "Who do you expect will fund these treatment programs?

The state should pay as part of the universal health care coverage IMO.

Treatment as a cost is cheap. Heroin would be next to nothing to purchase by a government. They can be tapered off or in very serious cases just maintained. When life is no longer 24x7 about finding your next fix, the person can live a relative useful and productive life. They do not need to steal, they do not need to commit crime to fund their habit. They do not need to go to prison where the cost per inmate exceeds by orders of magnitude the cost of treatment


No idea why this got downvoted. Because of "universal health care"? The prison system is already universal health care for mental patients and for drug addicts.


> Who do you expect will fund these treatment programs?

Well hypothetically there is a ton of money being spent on the war on drugs if drugs were legal that money or even a small portion of it could do wonders for treatment programs.


You know who cares about these addicts, their families, who are the voting constituents of these politicians. The heroin epidemic is the worst in many traditionally republican states. I think you may find there is more bipartisan support for fixing the heroin problem than there is consensus around hot button topics like abortion.


> You know who cares about these addicts, their families, who are the voting constituents of these politicians.

You're making the assumption that their families have the resources to pay for their treatment. Nearly half of Americans are one pay cheque away from not being able to make ends meet. [0] [1] [2]

Here's a poverty map of America: http://www.nytimes.com/newsgraphics/2014/01/05/poverty-map/

[0] http://www.marketwatch.com/story/half-of-americans-are-despe...

[1] http://money.cnn.com/2017/01/12/pf/americans-lack-of-savings...

[2] http://nypost.com/2016/09/27/why-even-half-the-middle-class-...


I am suggesting people will put political pressure on the government to help pay for treatment as part of the solution. As others here have suggested that if drugs were legalized the tax revenue could fund things like this.


Some of us have families. Some of us know addicts. Between these sets, there are enough humans willing to take responsibility and help the addict. Your problem?


Ironically, the AHCA would significantly cut spending on drug rehabilitation programs. So, basically, the GOP are telling their constituents they are going to help them, and then passing legislation that does the opposite. It doesn't surprise me at all. They are in the pockets of big pharma and big healthcare.


>Who do you expect will fund these treatment programs? I seriously doubt most addicts are equipped to pay for it.

Taxes on the drugs themselves would probably more than cover it.


> Taxes on the drugs themselves would probably more than cover it.

And you seriously think politicians will use this new revenue source for the treatment of addicts?

I predict they'll push another tax cut that benefits their major donors.


Perhaps we require that our legislators eat a cannabis cookie before opening any session of congress?

I have no idea what they would spent the tax revenues on, other than a Strategic Doritos Stockpile, but it couldn't be any worse than the budget they are likely to pass this year.


Well put.


> How does legalizing fix or reduce addictions?

It doesn't. It's partly an acknowledgement that, "It's really none of your business what people put in their own bodies."

You're implicitly saying, "I don't like the fact that you are addicted to X substance or action Y, so I think that gives me the moral justification to lock you in a literal cage for a very long time."

Legalizing drugs is about not putting people in jail for harming their own bodies and providing them with safer alternatives (IE, actual heroin instead of fentanyl, which is why we have this so-called "epidemic")

And for the record, never tried heroin, never will, it ruins lives. But I don't think we need to be putting people in jail for it. In fact, this only makes it worse.

Btw, ever wonder how much fentanyl it takes to kill you vs the amount of heroin? https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-fa... That's what's driving the huge number of deaths from "heroin".


> Btw, ever wonder how much fentanyl it takes to kill you vs the amount of heroin? https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-fa.... That's what's driving the huge number of deaths from "heroin".

Fentanyl is definitely a problem, but you can't point just to potency and say "this is why". Fentanyl is much more potent than most other painkillers, but it's also more expensive.

5 patches of 12 hour release 25mcg/hr fentanyl will cost $145 on prescription, before any street markup. That's about half what you see in that vial there (assuming your recovery method is 100% effective, no-one cuts it, etc, etc).


Mmmm, I'm not following your point.

I'm saying "If you cut a big bag of heroin with an amount of fentanyl in the correct ratio to not kill you, and shake it all up, you can't be very certain that the correct ratios are being evenly distributed. Therefore, when you split it all up into much smaller quantities, the ratio of fentanyl to heroin will vary." That's creating a situation where you really don't know what you're getting. I'm pointing to that as "this is what's driving heroin deaths".


Very true, the bonding and distribution can cause big problems.

What I'm saying is analogous to this:

Drug A requires 1kg to be lethal, and costs $100/kg. Drug B requires 100g to be lethal, but costs $5,000/kg.

It doesn't _automatically_ follow that you can say that Drug B is more likely to be a problem on the street, because mass/volume is not the _only_ factor in safety.

But, it certainly is one, yes.


Legalization benefits addicts in other ways - like safer environments for consumption[0].

Addicts that are presently shooting up in basements and bathroom stalls and under bridges can go to a place where they can receive an injection of a known dosage under supervision of medical professionals.

I'm all for fighting addiction, but that's a complicated and expensive fight. Fighting the crime and fighting overdoses, equally destructive problems to addiction, are much simpler fixes: legalize it.

[0]http://www.seattletimes.com/seattle-news/health/safe-injecti...


While I [would like to] agree that people have the right to put whatever they want into their own bodies, we cannot deny that there are negative societal externalities caused by individual addictions. Everything ranging from something as abstract as an increase in national healthcare spending to something as palpable as coming home to find that your house has been burglarized by addicts.


I think all of the issues that cause drug addicts to be expensive or harmful to society are externalities of the war on drugs. For your two examples:

Increased healthcare spend: But why don't we draw a line for alcohol and tobacco? Or people eating too much? All of these are legally sanctioned choices people make. It gets into slippery territory when you start telling people what they can or can't do because of the burden they'll place on the healthcare system. Slippery territory that leads to the situation we currently have.

People stealing your tv: Spend less money on chasing and locking up drug users and more money on chasing and locking up burglars. Also, if we're just talking about simple economics here, the cost of supplying the entire world with high quality, low price drugs would not be terribly high. It's like, "How many homeless alcoholics are robbing homes because they can't find a drink?" That could be paired with a general public education campaign about the realities of drugs (I mean, Trainspotting and Leaving Las Vegas are kind of about the same thing right?)

So I deny that there are negative societal externalities. I'll make an exception for the fact that families pretty much literally lose loved ones to addiction, and that's a pretty big one, but I think it gets into the kind of territory of "do you owe your family anything?" I would say no, if you want to throw away your life to drugs, that's not the state's business.

And again, I'm really not advocating anyone start doing any of these things, I'm advocating that the state stop locking people up for doing them. In order for that to happen, it requires a certain amount of acceptance.


I think you've made some excellent points, but you can't simultaneously deny the existence of negative societal externalities caused by individual drug use while acknowledging that the usage of drugs (including alcohol, tobacco, and excessive eating) imposes a cost onto society in the form of [just one example] increased healthcare spending.

I think my particular stance is that the war on drugs is a massive failure that props up prices, lowers quality, and destroys the lives of many young non-violent "offenders." This is probably quite similar to your position, but I think the primary difference is that I would not advocate lifting the prohibition against drugs like heroin, which can supposedly turn a person into an addict within a few sessions.

I think my position is ultimately something like this:

Should the state lock someone up for using heroin? No, it's their money and their body.

Should the state lock someone up for using heroin and then committing a crime? Yes, because of the crime.

Would the legalization of heroin cause an increase in number of people committing crimes? Yes, because of its addictive potential and the extremely difficult/potentially fatal withdrawals.

Whether or not that would actually be the case, I can't say.


And if we were to re-introduce alcohol prohibition we would still have a massive alcoholism problem _in addition_ to a massive crime problem, a massive tax evasion problem, an even worse health problem due to lack of production oversight and a massive enforcement overhead. Legalisation and regulation doesn't fix the addiction problem, but prohibition makes everything so much worse.


tl;dr: To put it one last way: if drugs were legal, the pharmaceutical industry would be free to iterate on making recreational drugs, that don't have the drawbacks of the things people currently make in back alleys.

The taboo truth is people do drugs because they are fun, and people want the drugs that are fun to do, and don't have negative health consequences. Many drugs are relatively safe to do (in small quantities) (or at least moreso than things like skydiving), provided drug purity.

Drugs that seriously harm health, are by and large things that people either get suckered into via the black market, or are things people turn to when they do not have access to safer alternatives.

And many of the negative health consequences and horrors of drug use, come from unpure drug quality, which in turn is a result of the illegal nature of drugs.

Let me put it this way: If it were legal to buy a non-addictive opiod and heroin, nearly 100% of people would choose the opiod. Out of pure self interest, people wouldn't choose the addictive substance, given a safer alternative.

Similarly, if people could choose between pure mdma, and meth, meth would nearly cease to exist.

But if you decide to use an opiod today, you're going to get a mix of heroin and all sorts of awful junk that you're going to pump into your veins. And if you buy mdma today, there's a huge chance there's going to be a lot of meth in there. Etc, etc, etc


Skydiving is actually fairly safe, see http://www.uspa.org/facts-faqs/safety for stats. There were 0.0061 fatalities per 1000 jumps in 2015 .


Yeah and there is very little risk of getting addicted to skydiving :). At least for most people.


The people that get into it usually lose years of their life to skydiving. Many quit their other hobbies and stop hanging around friends from their old life and even quit their jobs.

More similar than you'd think :)


> The taboo truth is people do drugs because they are fun

I don't agree with this.

This is true for some cases, yes. But it's just as common if not more common for people to take drugs to mask pain. It's not about the drug being fun, but about the overwhelming pain of life being temporarily numbed.

Some drugs start off as fun before becoming something more severe. Others are never fun - they're just coping mechanisms.


Err, you mean you only partially agree with this.

Of course my views my be slight jaded by the BS programs like D.A.R.E spouted off during the 80s. "Drugs are bad" "Use drugs once and die" "This is your brain on drugs". This propaganda pretty much ended any realistic talk about legal and illegal drug use. Some drugs are fun. Some people have to cope with massive amounts of pain in their life. Others do drugs because of a genetic predisposition to addiction.

Now we're just left with a massive mess with bad outcomes for everybody.


What is it that you mean by a 'non-addictive' opioid? They're all roughly equivalent in their addictive potential. Even those that are used to treat addiction, such as buprenorphine, cause physical and mental dependence.


There are a few ways to make opioids less addicting. The most common strategy is to slow down absorption rate, which reduces the conditioning associated with drug-taking behavior. This can be done mechanically (sustained release pills or polymers) or chemically ("tie" the active molecule with a deactivating group which the body hydrolyses) http://www.sciencedirect.com/science/article/pii/S1369702116...


Do you mean to suggest that OxyContin (extended-release oxycodone) is less of a problem, or less addicting, than Percocet (instant release oxycodone + APAP)?


It doesn't but neither does criminalizing fix or reduce addictions. Addictions are a health problem and quite possibly a mental issue but rarely a criminal problem.


Part of the problem of prohibition is that it drives up the potency of drugs which leads to the situation where you get fentanyl instead of heroin. This effect was coined the "iron law of prohibition" by economist Richard Cowan. More powerful drugs lead to stronger addictions and more accidental over doses.

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


In the early 1900s, when you could buy morphine at the corner drugstore, addicts took morphine daily and went about their lives, living out a normal lifespan.

Because of the iron law of prohibition, under prohibition, only the most potent, dangerous forms of the drug are available, so addicts use them, overdose, die, etc.

Look at the problems with lack of beer and wine during prohibition, and the availability of moonshine and methanol


Presumably you take some of the money you were spending on the drug war and put it into programs to deal with addiction.


That and the tax revenue.

A drug lord can sustain his business with high margins because of the high price however they couldn't compete against a major corporation producing the same thing even with a higher end tax rate if it was legal.

It's the reason why tobacco and alcohol markets are largely dominated by legitimate companies, economies of scale, distribution etc are all in favour of the legal entity (which isn't to say some tobacco and alcohol aren't sold without the tax, nothing is perfect).

So legalising drugs is a double whammy, you save a massive expenditure and the war on drugs and increase your tax revenue and force drug cartels into competing with legitimate businesses they simply can't compete with.

If I was doing it I'd ring fence the revenue from taxation into treatment and education and put the savings on enforcement either back into the general tax pot or shift the focus onto things like sex trafficking.

If nothing else the War on Drugs we have now simply isn't working, it has to be worth trying something else at this point.


True! The alcoholism is, like the drug use, a way to emotionally resolve a problem that feels otherwise unsolvable. But to know this openly, and then to try to find solutions, is the only way out. To stigmatize and punish turning to this desperate measure only increases the desperation and does nothing to address the underlying problem. If each person is both an individual but also a representative sample of some portion of the population, it is imperative to address their issues with open-minded efforts at problem solving so that when the circumstance arises in another person we are more prepared to help them find another way out.


People throw out legalization because they're used to the marijuana debate. But how do you legalize a drug like fentanyl? How do you pretend you're here to protect and serve when you legalize a drug that seems like it was designed to kill people in a single use? We need to rethink the laws, and have some effective changes lead by people who understand the problem and have nothing to gain financially. But there's never going to be carfentanil at Rite-Aid, and if there was, these cartels would compete. Maybe I'm wrong, but it doesn't seem as simple as pot.


This all ties back to the underground shoddy manufacturing. Yes, there's piles of stories about people dying from illicit fentanyl. The problem with fentanyl is the dosing; an effective dose is measured in micrograms.

What doesn't get reported with the same sensationalism is that fentanyl is actually used medically, quite successfully. My father had knee surgery a few years ago and was prescribed slow-release fentanyl patches. I'm hazy on the details, but I think it was something like 16ug released over 12 hours. It worked just fine.

I remember hearing recently about some fentanyl deaths in Vancouver that were traced back to a poorly manufactured batch of underground pills. The problem wasn't the average dose in the pills, it was that the fentanyl and filler and binder hadn't been mixed very well before being pressed. The result was that some of the pills had a bunch of fentanyl and some didn't.

While I'm not necessarily in favour of legalizing everything, being able to freely purchase pharmaceutical grade fentanyl pills would go a long way in preventing situations like this.


> But how do you legalize a drug like fentanyl?

No one is doing fentanyl by choice.

People are doing fentanyl on accident because it's in the heroin they're buying on the street. This really drove it home for me: https://www.statnews.com/2016/09/29/fentanyl-heroin-photo-fa...

That being said, I still don't think we should put people in jail for using it. Fentanyl is known to kill you. So is rat poison. Buyer beware.


It said in the article that people search it out.


>"How do you pretend you're here to protect and serve when you legalize a drug that seems like it was designed to kill people in a single use?"

This is a different, adjacent issue. However, it's not impossible to make a case for allowing people to purchase lethal substances. On the contrary, there are compelling arguments that people should have the freedom to choose death rather than be forced to continue living.


I think you only have to compare the Prohibition America with today's America to understand why the current system is much more preferable to former.

When alcohol was illegal, we had gangsters like Al Capone. They built their empires and profited massively from illicit activity (not just smuggling but also violent crimes) at the expense of the American government and people. They also didn't pay a single dime in taxes despite all the profit they made.

The parallel to that is today's war on drugs and the drug lords it has given rise to.


It is pretty disturbing to me we as a society have yet to learn the prohibition lesson. I believe that sensationalize of Al Capone and gangster culture in media leads people to not thinking the same stuff is happening today because they don't see shootouts and police chases in the street.


There's also a massive support group for alcoholics. I'd bet that if you discover someone stopped drinking because they were/are a alcoholic you wouldnt bat a eye. If you found out they were addicted to heroin you would have a very different view of them.


Improving community, social ties, and the economy reduces addictions.

The interior of the USA looks like post-Soviet-collapse Russia economically, and the way we've built cities and suburbs for the past 50 years has destroyed opportunities for beneficial community and social connection. Nothing will reduce addiction until those things are fixed. If heroin is unavailable people will go to prescription pills, alcohol, or even food, video games, etc.

Legalizing, taxing, and regulating drugs reduces crime, redirects money from criminals into law abiding enterprises and tax revenue that can be used to address the problems above, and allows the deployment of strategies to reduce the harm done by addiction.


This has probably been beaten to death, but I've found the tv series The Wire to be one of the best portrayals of the actual costs, both acute and diffuse, of waging war against your own people.

You are right in your hunch that it makes treatment a much less taboo subject. The real difference in outcomes comes from treating it as a health issue and not a criminal violation.


>How does legalizing fix or reduce addictions?

It doesn't directly, but instead of ineffectively spending billions on law enforcement and incarceration you could use that money and the new tax revenue to fund treatment and prevention programs.


Please watch this: https://www.youtube.com/watch?v=W8yYJ_oV6xk (Retired Police Captain demolishes the War on Drugs)


it doesn't. it simply saves trillions of dollars of spending and turns it into revenue.


Many of the opioid addicts in the US are people who got legal meds through irresponsible prescribing.

Legal opioids have caused massive addiction, and massive harm.

The drug war clearly isn't working, and all drugs should be legalised, but we need to recognise that legal drugs will cause harm.


> that legal drugs will cause harm.

The GP specifically said to "tax them and spend the money on rehab and education", so I assume he did recognize this.


That approach doesn't seem to have worked so well for alcohol.


I'm not sure. From what I've read it worked quite well in Scandinavian countries. For example, Norway, while consuming approximately the same amount of alcohol (with a slight upwards tendency, but with spirits usage going down in favor of wine), has had 20 years of non-stop reduction of deaths related to alcohol usage from 1980-2001 (http://www.who.int/substance_abuse/publications/en/norway.pd...). That, to an outsider like me, suggests that they have something that works, although I don't know exactly what it is.


The tax revenue isn't spent on rehab though


Compared to what? During prohibition? I'd say things are much better now than then.


Agreed - I've seen friends prescribed opiates by doctors when clearly they were in need of mental support as well (therapy, life coaching, etc).

I'm not sure how to overcome the fact that most people do not want to admit they need help or are not able to recognize it.


But the Heroin addiction crisis is the result of a legal drug trade--the prescription of Opioids.


OK, but we also need to fix this problem. It's an epidemic.


Russ Roberts' Econtalk podcast had a stunningly good interview with Sam Quinones about the opioid epidemic.

I am fairly libertarian on many things, but this is not a simple case of prohibition run amok. Heroin/opioid addiction is close to a loss of free will, aided by screw ups from big pharma and Government healthcare policies.

Really fascinating, sad, and difficult stuff.

http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...


> aided by screw ups from big pharma and Government healthcare policies.

And ignorant lawmakers who try to stigmatize instead of educate with regards to harm prevention, and the private prisons who would rather incarcerate addicts instead of rehabilitate them, and the willfully ignorant lawmakers who get kickbacks from those private prisons (and likely big pharma, who IMHO is willfully complicit in this epidemic).


I think it’s rather generous of you to call them “screw ups” from big pharma.


The interview goes into the history of pharma's search for a non-addictive opiate. I assume that started with decent motives, even if not altruistic. The research critically failed a lot of people. Among other things, says Quinones's, it "transformed football into a gateway to heroin addiction..."

The more recent big pharma position of "we never thought to ask why West Virginians are such good customers" deserves scorn, lawsuits, and prison time.


Maybe I'm crazy but I feel like the US goes on this uppers/downers cycle. Of course I'm probably seeing patterns where there are none, but we had heroin in the seventies, cocaine/crack in the eighties, heroin was back in the 90s, meth in the 00s, heroin in the teens.


I'm just pulling ideas out of thin air but I wonder if it connected with how good the economy is doing for the people buying drugs.


I hadn't noticed that pattern, but it is an interesting one.


Cincinnati was my home town, and its bad. People joke about it but I know at least 3 people on my friendslist that overdosed.

I'm glad the punishment for selling the drug is so high, often even sometimes receiving murder sentences for people that overdose but that isn't going to prevent people from buying / selling


One of my good friends was rear ended by someone on heroin this week. Cincinnati police didn't even bother stopping to do a police report. Less than 20 minutes later, he hit a parked car in St. Bernard and was arrested for DUI, Driving under suspension, and no insurance. The guy has a felony charge pending (and an arrest warrant out for him)...and CPD just drove off without even taking a second look.

I don't want to say that CPD has taken a blind eye to it, but, it seems that way.


CPD has been like this for as long as I can remember. I'm not sure if Cincinnati is a shit-hole because the police don't care, or the police don't care because the city is a shit-hole. I imagine it's a little bit of both.


If you go on the theory that your friends were going to use no matter what (I mean it's already illegal, so the law isn't stopping them), that the state is the cause of your friends death. They cannot buy any safe product of known quantities and thereby use an unsafe one.


>Millions of Americans got hooked on pain pills during a prescription binge that started in the 1990s and peaked around 2011. As states have tightened monitoring and doctors have reduced dosages, it’s become harder for addicts to get prescription painkillers, driving many to get their fix off street drugs.

I feel like the legalization of Marijuana years ago could have saved a lot of folks while helping them manage their pain. The Government found it easier to prosecute and jail people who struggled with chronic pain and mental illness than try to help. Now we have folks at the federal level who have never experienced an enlightened moment in their lives or have a shred of empathy for the sick. All they understand is how to help their friends in the Prison Industry, Law Enforcement and Pharma Industry.

Sad....


I'm not convinced that straight legalization of everything is the answer. It's clear however that what we're doing now isn't working. Unfortunately to those in favour of it it doesn't need to work. It's just a tool to be "tough on crime" and take a moral probably religious stance for the benefits of donors and constituents.

None of this will really change until those in favour of dismantling what is mostly the mass incarceration of African Americans are willing to exercise sufficient political force to get people elected.

But whatever the case, there are some clear problems that need to be fixed:

1. End this regime of stigmatizing felons. Stripping them of the right to vote, the scarlet letter "are you a felon?" question on job applications and so on. At some point, having served their time, the stigma should be gone.

2. End mandatory drug sentencing.

3. National legalization of recreational cannabis use. The arguments against cannabis are pretty thin. The war on marijuana that began in the 1970s made marijuana harder to get and more expensive such that when crack cocaine came along it and heroin were both more readily accessible and cheaper, which is crazy.

4. Decriminalize drug possession and start treating it as a medical rather than legal problem.

5. This is tricky but tackle the over-prescription of opiates in the US. This can easily go wrong as some people really do need opiates. It's clear that overall they're over-prescribed however. A lot of people addicted to prescription drugs or heroin began with a legal prescription.

6. Raise the bar required for drug trafficking charges. It's ridiculous how low the requirement can be in some jurisdictions. For example, possession of more than 6 grams of pills in Florida IIRC allows a charge of possession with the intent to distribute. That's approximately 60 pills and the actual dosage doesn't matter (60 5mg Oxy pills are treated the same as 60 80mg Oxy pills). This is particularly hypocritical as Florida has essentially legalized the dealing in opiates through loosely-regulated "pain clinics".

7. This is also difficult but we need to end the plea bargain culture, which usually means overcharging by prosecutors to extract a plea. Judging prosecutors based on conviction rate seems to be at the heart of this problem.

I honestly wonder how many hard drug addicts could be avoided by simply having ready access to cannabis.


This is a tough problem with no easy answer. Ive 2 friends with heroin problems that I fear may never fully stay clean. I don't think that jail is the right answer though.


If jail was structured around rehabilitation of the roots causes that led the individuals into the anti-social behavior that requires their isolation then it would be the proper place for someone who has been overcome by problems like this. Instead jail is punitive hell, meant to further isolate and devastate the individuals it consumes to intimidate the rest of the population.


And it's punitive forever. Your employment prospects once you have a felony conviction are severely limited.


So you're suggesting that anyone who is addicted to heroin should be jailed, as long as the prison system is trying to rehabilitate them from this alleged 'anti-social behaviour'? Surely a better system is to treat the addicts symptoms with programs that provide methadone or buprenorphine replacement and management, and also provide therapy or counselling as required.


Legalization would help in a couple ways. It should free up funds to redirect to something more productive around rehab. And, at least for newer addicts, it keeps them from having an arrest record that makes employment impossible. As it stands, it's quite difficult for anyone caught using to break the cycle. They can't get work, which leads to depression, which leads to continued drug use.


Legalize and tax/regulate production, purity, etc. Outlaw all marketing.

Invest all profits in the following:

1) Ensuring all children have an attuned attachment figure / parents have free (or even incentivized) training to learn how to attune emotionally.

2) Psychedelic therapy centers to help heal the underlying addiction along with support and integration.

3) Community gardens / organic food production & affordable housing.


> Legalize and tax/regulate production, purity, etc. Outlaw all marketing.

Why outlaw marketing? If all drugs are legal and regulated, there should be no issue with advertising them like any other legal and regulated product. The US already allows advertising for pharmaceuticals, it should allow advertising for every other drug.

And why should drug companies have to invest their profits in the programs you describe? No one forces beer companies to invest all of their profits in Alcoholics Anonymous, or MacDonalds to invest in weight loss programs.

Your comment implies that you believe certain drugs would present a societal harm if legalized, and that extraordinary efforts should be taken to mitigate that damage. But if so, why legalize them to begin with?


If you look at countries that aren't the US, this is exactly how they treat alcohol. e.g. Diageo run the DrinkAware campaigns [0], france forbids any marketing of alcohol (even going as far as to rename a major sporting tournament the H cup instead of the heineken cup, and forcing teams to not display their sponsors on their kits)

I'd argue that the US is wrong in allowing for pharmaceuticals as it does. In the UK, advertising is allowed for OTC drugs, but not prescription drugs [1]

> Your comment implies that you believe certain drugs would present a societal harm if legalized, and that extraordinary efforts should be taken to mitigate that damage. But if so, why legalize them to begin with?

Tobacco usage is associated with massive societal harm, and in european countries has very specific controls. In the UK, you cannot smoke in many places, there is no tobacco advertising allowed, all packaging must be plain (from this saturday I believe), and there is minimum pricing in place. I personally believe that people should be allowed to smoke if they choose to, but there is no denying that these measures have had a massive impact on the number of people who regularly smoke. (as an anecdote, almost all of my friends parents smoke, whereas almost none of my friends do)

[0] http://www.harpers.co.uk/news/fullstory.php/aid/6465/Diageo_... [1] https://www.gov.uk/guidance/advertise-your-medicines


I firmly believe alcohol marketing is a major contributor toward alcohol continuing to be one of the most destructive drugs in our society. It's glamorized in a a savvy and well-funded way that puts an incessant haze in our understanding of it as a a powerful, poisonous, and potentially debilitating substance.

You can find billboards that make bottles of liquor look like royal treasure passed down from the gods. It's ultimately poison in a bottle. This kind of glorification of it hurts people who don't have the ability to enjoy it without consequence (i.e. millions of people in the U.S.).


On one hand, who can forget this wonderful slice from South Park: https://m.youtube.com/watch?v=WrVLB3MtUjo

On the other, alcohol use is highly cultural. In Italy, everybody drinks. A glass of wine or two with lunch and dinner is totally normal. Yet I never have seen a sauced Italian.

Compare it to the Brits, who drink like fish. In fact, the ancient Romans repeatedly tried and failed to replace the local binge drinking culture with their own casual Mediterranean cafe culture.

The reason Americans drink too much is simply because American culture values getting sauced. Even responsible adults remember their adolescent years with some fondness and so there isn't much of a cultural impetus to stop drinking or to drink less.


People have been writing about the disastrous effects of alcohol abuse since long before billboards existed. Cultures throughout history made laws against drunkenness. In fact, abuse used to be so pervasive that 100 years ago the USA passed a constitutional amendment banning it!


Ideally you would put a Pigouvian tax on heroin in order to make up for all the harm done to non-consumers resulting from heroin use. Most heroin users wouldn't be able to afford heroin if you put such a tax. The only problem with this solution is that most heroin users tend to resort to crime if they can't afford to pay for the drug, so this really isn't a solution.


I generally hear people saying two things:

1. “The gov't isn’t/wasn’t able to competently police big pharma, so addiction will only get worse if we legalize drugs.”

2. “The gov’t is policing citizens too much, so addicts’ lives will get ruined if we don’t legalize drugs.”

I’d like everyone to consider the very real possibility that we’ll need to fix both problems before we reach a good place.


Or you should realize both problems cannot be fixed and we need to choose the option that will do the least harm. Reducing the abusive police state and treating increased numbers of abusers is likely a much better problem than the one we are currently experiencing.


I think a lot of it comes down to the pharmaceutical companies. Instead of legalizing drugs and getting into some infinite loop of creating new addicts and spending the tax money to rehab & educate them, etc., we need to regulate the pharmaceutical companies. Shocking: In U.S. real estate, service providers (title companies, home inspection companies, etc.) are not allowed to give "kick-backs" to Realtors. But, we have pharmaceutical companies providing HUGE kick-backs to doctors for prescribing their patients meds they don't need.


We invaded Afghanistan--the world's largest producer of poppies for heroin and opium--in 2001. Production has also been on the rise since then. An interesting correlation.


Opium production was virtually eliminated in Afghanistan before we invaded, by the Taliban, whom we thanked for doing such great work. We also granted Afghanistan $43 million to help farmers no longer profiting off poppy fields through a drought.

http://www.nytimes.com/2001/05/20/world/taliban-s-ban-on-pop...


Right. Which is exactly what I said. Production has been on the rise since 2001.


I wasn't disagreeing, I was embellishing.


Ah, I assumed the most pessimistic reading possible. Thanks for adding that!


I'm guessing it just moved to somewhere else in a big game of whack-a-poppy.


The cartels are growing it in Mexico now because they can't sell as much cannabis.


Most sources I can find say that the vast majority of heroin in the US comes from Mexico and South America.


The poppies used for heroin production can be grown in South America but most of it comes from Asia.


That's not what I see looking at reasonable sources. See https://www.unodc.org/documents/wdr2015/World_Drug_Report_20... for example.

The vast majority of worldwide poppy for opiates is Asia, but the US is unique in that most of the poppy source for their heroin is coming from Columbia and Mexico. It is odd. Canada, for example, gets most of it's heroin via Afghanistan.

The size of the lines in this map from the above mentioned resource is relative to the actual production source...where the poppies are, and where they end up as heroin. Note the fat lines from the south, and the thin one from the east.

http://i.imgur.com/hvYXYeQ.png


It does seem that most heroin consumed in the US originates in Mexico currently. However it is true that Afghanistan helps supply most (as in <90%) of the world's heroin, and their production is much greater than Mexico and South America as well.

> The vast majority of worldwide poppy for opiates is Asia, but the US is unique in that most of the poppy source for their heroin is coming from Columbia and Mexico. It is odd.

I think this is a signal that Mexican cartels have monopolized American markets. Smaller unaffiliated players are more likely to use trans-Pacific supply chains.

It also seems that the cartels have vertically integrated their operations such that they now grow opium poppies and aren't reliant on South American countries for raw materials.


Read the "Red Cocaine" book to understand this war. It's an old book but the players didn't change.


"It's one molecule away from heroin" I heard people say about oxycontein(sp?). If marijuana were legal, fewer people would be prescribed oxy, and therefore less gateways to heroin. The real gateway is the bad law of prohibition on marijuana.


Isn't it possible to create poison genes using CRISPR that are always dominant and will lead to a species extinction?

Why not apply this technology to completely eliminate Opioid plants?

P.S. I am sure there are many reasons why this won't work, but let's think big, okay?


Um, you're not thinking big enough, and there is a large number of failures of imagination you are experiencing.

First, opioids are actually really good when you don't abuse them. Just go break your leg and you'll see why.

Second, you are suffering from the sci-fy show "use space age technology yet still have modern problems" thing you see. If you can 'extinct' poppies, I can just as easily use CRISPR to stick those genes in anything else. It's not corn, it's my cash crop!

If you have supertechnology don't fix plants, fix people.


I like the idea of having poppies when doctors are fishing around in my body with scalpels or after I break a femur.

Eliminating would just punish those who don't make questionable life decisions.


So is there anything stronger than carfentanil?


Not clear. I seem to remember reading of a stronger fentanyl derivative within the last month or so, but can't immediately find the reference.

If you're interested in the status of fentanyl and its derivatives, as well as the directions being explored for their pharmaceutical use, here's a well-written, chemistry-heavy article [1]. Not paywalled.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137794/pdf/nih...


Interesting that the lethal dosage for rats is 100x higher than monkeys.


Yes, lofentanil is slightly stronger.


Maybe i'm an insensitive Mofo, but let the dumbasses OD and educate how dangerous these drugs are. Then maybe the next generation will be smarter.


Please make your point civilly and substantively or don't post.

https://news.ycombinator.com/newsguidelines.html


I think im way more selfish than you are. I much rather having them working to do things i will consume. If they die early, how am i to enjoy the produce of their work?

I certainly dont want to sacrifice my quality of life for the profits of a drugs salesman


I'm a Libertarian: legalize them all and let God sort it out.


Heroin, LSD, etc. use really doesn't affect me. I don't care if people use it, and don't want the government to waste money fighting it or whatever they do. I don't care if people manufacture it, as long as they follow all the usual regulations for dangerous chemical plants (like, don't have one in an apartment building). Anyone should be able to grow weed wherever they'd grow lettuce or whatever, no danger there. I also don't care if they sell it, as long as they collect sales tax and pay income tax, so that we can pay for welfare and healthcare and such.

Let's have a war on smoking instead. I live in New York, and people think it's perfectly acceptable to light a cigarette while walking down the sidewalk and spew their fumes all over everyone walking behind them. Let's punish that like we'd punish them for punching random people on the sidewalk. Hey, if someone hits me and they're not a trained boxer, I'll probably feel fine a few minutes later, but that cancer smoke builds up over time.

Then we can move on to exhaust-producing vehicles, and so on...


I don't recall any incidents of junkies robbing people to buy a pack of Marlboros.


Junkies wouldn't need to rob people of as many things if these drugs were cheap as dirt


They'd still rob people. Heroin is already very cheap. That's one of the drivers of people moving to it from prescription opiates.

Dropping the price further isn't going to make much difference.


Would you count people shoplifting them as that?




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