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The impact of cannabis access laws on opioid prescribing (doi.org)
343 points by hckr_nj 22 days ago | hide | past | web | favorite | 188 comments



> Analyzing a dataset of over 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level, we find that recreational and medical cannabis access laws reduce the number of morphine milligram equivalents prescribed each year by 11.8 and 4.2 percent, respectively.

As a former marijuana user this seems obvious to me. I don’t understand why federal legalization has been so difficult. There are many benefits despite the potential of unknown risk.

Maybe my beliefs are a little out there. I wish for all drugs to be decriminalized. Portugal’s model seems to be working quite well.

https://time.com/longform/portugal-drug-use-decriminalizatio...


> I don’t understand why federal legalization has been so difficult.

Look into the history of laws surrounding marijuana in the United States and you'll start to understand the politics behind it.

For example, here's a statement from John Ehrlichman[1], Assistant of Domestic Affairs to former president Richard Nixon.

> “You want to know what this was really all about?” he asked with the bluntness of a man who, after public disgrace and a stretch in federal prison, had little left to protect. “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

1: https://en.wikipedia.org/wiki/John_Ehrlichman


The most evil aspect of the thing is that it was enshrined in international treaties, which lead to instability in the nations that were too gullible, or were just strong armed by stronger nations into enforcing these laws (e.g. what happened with many Latin American countries).


> which lead to instability in the nations that were too gullible

It still happens today. I spoke to some Canadians who served in Afghanistan. They initially liked having some Americans on patrol with them. The Americans could call in better air power. But the Americans started burning all the marijuana plants, which the locals had only started growing growing because they knew the Americans had been burning poppy fields.


True, but that framework seems to have lost its teeth in recent decades. Uruguay, Portugal, Canada and many US states are flagrantly violating international law with no consequences.


"The complexity of modern federal criminal law, codified in several thousand sections of the United States Code and the virtually infinite variety of factual circumstances that might trigger an investigation into a possible violation of the law, make it difficult for anyone to know, in advance, just when a particular set of statements might later appear (to a prosecutor) to be relevant to some such investigation." - Supreme Court Justice Breyer

"What’s often overlooked, however, is that these legal victories would probably not have been possible without the ability to break the law." - Moxie Marlinspike

[1] https://moxie.org/blog/we-should-all-have-something-to-hide/


Pretty sure this quote has been discredited. Some reporter said he said it, but after he died, so it can’t be confirmed. His family says that quote doesn’t sound like him at all. Even if he did say it, it’s one guys opinion and doesn’t reflect gov’t policy.


It's an incontrovertible historical fact that the prohibition of opium and and cocaine was substantially racially motivated.

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


Don’t disagree, but that doesn’t prove racism was Nixon’s reason for the war on drugs.


A simple google search will turn up many credible articles all of which show pretty substantially that Nixon was very much racist, and that many of his policies were... colored... by his racism.

e.g. https://www.newyorker.com/news/q-and-a/how-a-historian-uncov..., https://www.cnn.com/2016/03/23/politics/john-ehrlichman-rich...


One of Nixon's chief advisers admitted in an interview years later that the war on drugs was explicitly targeted at black people[0]. Criminalizing blacks was a primary objective of this policy.

0: https://qz.com/645990/nixon-advisor-we-created-the-war-on-dr...


This is the same quote as above. Reporter does interview, waits until the guy dies, then says “he said this”, while people who knew him said “I don’t think so”.


It likely was a motive, but it doesn't necessarily make the quote real. I have trouble believing Nixon or his advisors would give a supervillain monologue like that, personally, even if those were their exact intentions.


Well as one of the earlier links said

>Nixon advisor: We created the war on drugs to “criminalize” black people and the anti-war left

so it was more their political enemies in general rather than a race. Not to say it wasn't part racist.


read the whole thread man. I don't think anyone here doubts that drug enforcement in America is racially motivated, but you're the third person to cite that very dubious quote.


The association between drugs and racial minorities has been established long before then - pick any random Anslinger quote about drugs, and it'll have something racial. So it would be perfectly consistent.


I don't know about that quote being discredited, but I believe I've read a few comments from rayiner here that make a pretty convincing argument that when Nixon coining the term "War on Drugs" in 1971, it was part of an effort against organized crime and was preceded by a decade of rising violent crime. And, if I recall his argument correctly, that it was Reagan who really amped up the 'war'.

My take is that both narratives are simultaneously true. That different people involved had different motivations, some people having multiple motivations. The dimensional of the true series of the events is too high for any human to comprehend, so we instead study lower dimension projections of the truth. Like flatlanders looking at a cylinder; some think it looks like a rectangle and some thinks it looks like a circle. There can be underlying truth to multiple perspectives that may seem mutually contradictory at lower dimensions.


> Pretty sure this quote has been discredited.

By whom? (Citation?) This is the first time I'm hearing that.



So it was a direct quote from an article that was wholly consistent with contemporary sources. The only “controversy” is that the quote can’t be independently verified by StackExchange users because the guy died 20 years ago.


The top answer even throws shade on the "it doesn't sound like my father" response.


Thanks for this - the link is worth following and the top comment well worth reading.


You’re leaving out the fact people who knew him said “That doesn’t sound like something he’d say at all”.


Yeah and Ted Bundy's parents were adamant that he was a sweet boy who would never hurt a soul.


So given the choice between a reporter claiming he said something and the person’s family and coworkers saying he didn’t, you’d go with the reporter?


I read the article linked in the SE link you posted and there is nothing about "coworkers". It's only Ehrlichman's children who said it was uncharacteristic of their father.


I remember Ramon Reiser defending his child, Hans Reiser. Children and parents are far from unbiased in this sense, and one source is no source.


Your assertion is that it's been summarily discredited by a speculative though not unreasonably inferential comment on StackExchange?


Why is marijuana so illegal and stigmatized in China?


The Opium Wars probably have something to do with it. https://en.wikipedia.org/wiki/Opium_Wars


Anti drug sentiment is common throughout Asia, not just China.


That’s not entirely true. There’s a long and enduring tradition of religious and recreational use of drugs in India (cannabis, charas, opium, datura). It was the British who applied their misguided Victorian morality on indigenous use.


It seems probable that being close to China in a variety of ways (geographically, socially, etc) may have allowed the Opium Wars to induce anti-drug sentiment in other Asian countries as well. There are probably also other reasons for it, but I'd expect that to be one of the reasons.


Alcohol is still popular, though, for whatever reason.


This is pure speculation on my part - but -

Organized crime in China has long been closely associated with mysticism and minority religions. Hashish, associated as it was with foreign traders and genuinely scary secret societies like the Hashashin*, may have set off alarm bells back in the day that are still taken seriously today.


I haven't been able to wrap my head around why Sweden is so against it wither.


We do as the Americans do. We take a lot of ideas from there, with a bit of a lag. It might change in a few years, but on the other hand, smoking MJ is not that common here and mostly low status people do it. While in the US it seems to be pretty common across the board.


How would that really explain much, considering that decades of administrations beyond Nixon continued the war on drugs?

Both sides. Plus many other countries.

Furthermore, it's only been recently that the public has finally supported legalizing even marijuana[1]. So legislative action hasn't been in the cards until as of late, and sadly there still doesn't seem to be much of a push or actual policies aside from a few exceptions (Yang).

1. https://www.pewresearch.org/fact-tank/2019/11/14/americans-s...


> considering that decades of administrations beyond Nixon continued the war on drugs?

There were unrelated reasons that lead to Urban decay and increase in crimes at the same time. The War on Drugs was a convenient distraction and an explanation for the ills that faced American society at the time. Only later did we realize the root causes of those instabilities were unrelated to drug use, and that the war on drugs actually made the problem worse.

This isn't all that surprising. Consider: the current POTUS and administration vilifies immigrants and blames them for all American societies ills.

This is such a common strategy of distraction, and the American public seem to fall for it repeatedly.


Don't forget, once the public came to associate marijuana with "bad things" then it was easy to get cheap votes by being "tough on crime" and correspondingly tough on drugs.


The point is Nixon was not outlier. His thinking was not exceptional, he just happen to be on tape and on charge.


No, your Portugal-model belief isn't that "out there." In my (subjective) opinion, once you do your homework on the issue you come away assuming that the continued scheduling of drugs with low addictive potential and high potential for therapeutic use is due to:

1. The healthcare and pharmaceutical profits at stake if people needed less care and fewer prescription pharmaceuticals

2. Cultural momentum excluding Alcohol from being considered a drug (LOL) and approving of drugs that support the protestant work ethic and existing labor system (caffeine, nicotine, and prescription amphetamines to stay alert on the job and alcohol to wind down in the evening), plus the cultural momentum of billions of dollars and decades spent on a pointless and damaging "War on Drugs"

3. The threat that psychedelics in particular pose to existing authority structures: high self-respect, beliefs that each human is as worthy as the next, and the ability to imagine less authoritarian systems are all threatening to the existing system. Tim Leary wasn't wrong when he said that (users) "won't fight your wars, won't join your corporations"

~~~~~

    There are five different schedules of controlled substances, numbered I–V. The CSA describes the different schedules based on three factors:

    Potential for abuse: How likely is this drug to be abused?
    Accepted medical use: Is this drug used as a treatment in the United States?
    Safety and potential for addiction: Is this drug safe? How likely is this drug to cause addiction? What kinds of addiction?


Please don’t use code blocks for quotes, they’re impossible to read on mobile.


If people are going to complain about this, why isn't it in the posting instructions? In fact I don't see any posting instructions.


They're not all that easy to read on desktop either.

The real issue is that code isn't intended to wrap naturally, while prose is. Prose doesn't belong in code blocks.


The real issue is no one knows this and being informed of weird UI quirks by sporadic user messaging seems the wrong approach. Eg if you care so much should you not instead be requesting a software fix?


There is no software fix other than simple removal of functionality. You still want code blocks to not wrap(scroll) and you still want prose blocks to wrap. We already have solutions for both cases. For prose quote with "> ". Making posting guidelines won't stop people from using the wrong thing. "Sporadic user messaging" is all there's left.


You can put a posting guide on the message submission form with these hueristics.

You can detect very long lines in code blocks and issue a warning / suggest prose. Or automatically toggle.


You're welcome to bring these suggestions to the moderators. Email: hn@ycombinator.com


So are you and you're the one who cares about layout. I can't because a) I can't represent what would work well or know all the solutions <code>2: I don't care about formatting so I'm not going to spend the effort. You do, why don't you explain the problem to them and let the devs invent a solution.


Again, we already have solutions. You just don't like them.


> There are five different schedules of controlled substances, numbered I–V. The CSA describes the different schedules based on three factors:

> Potential for abuse: How likely is this drug to be abused?

> Accepted medical use: Is this drug used as a treatment in the United States?

> Safety and potential for addiction: Is this drug safe? How likely is this drug to cause addiction? What kinds of addiction?


> I don’t understand why federal legalization has been so difficult.

Drug laws are enforced unequally across different racial groups. Those who benefit from oppressing racial minorities, especially via voter suppression through felony disenfranchisement, are understandably reluctant to relinquish their tools.



For what it's worth, I used "those" rather than naming names because that way it is easier to keep to the specific issue and avoid descending into partisan warfare — which is more in the spirit of the HN guidelines.


Haha, well, when it starts with "oppressing racial minorities, especially via voter suppression through felony disenfranchisement" ...just follow the data ;)


While I respect the guidelines, we shouldn't be suppressing awareness and dirty tactics


IIRC this quote has been discredited.


Why is this your about? It makes you seem confrontational. I read abouts for all types of reasons. I clicked on your username to see the likelihood that you're a bot ;-)

> If you're reading this odds are it's because you're incapable of having a well reasoned debate with someone who doesn't share your point of view.


Please provide proof


Best I can do right now: https://www.vox.com/2016/3/29/11325750/nixon-war-on-drugs and https://skeptics.stackexchange.com/questions/32247/did-ehrli...

Someone wrote a well done article (I wanna say it was Medium) which appears to be what the stackexchange answer is summarizing that actually tracked down all the who said what and laid a pretty darn good case for why the quote wasn't legit. It basically boiled down to the guy who alleges the quote having several past opportunities to drop that bomb but instead waited until everyone who could disagree was dead. A cursory Google search didn't turn it up for me and I'm not letting a stranger on the internet suck up any more of my time.


Except the Portuguese model, which I’m in favour of, does not ‘decriminalise drugs’. It decriminalises drug use, while still keeping hard drugs illegal to sell or exchange for a profit. What this does is keep users out if prisons and protects medical and social services professionals that help them with e.g. clean needles.

I do think the decriminalisation of the sale of marijuana is a reasonable step, but it’s fundamentally got nothing to do with the Portuguese model.

Norway seems to be taking the same route, so hopefully we’ll see more data to back up the success of this model in future.


If I understand correctly about Portugal, I believe people can obtain drugs legally at government locations where they distribute the drug, but also have the ability to receive treatment for addiction. I don't know if there are some drugs like marijuana they can buy legally, or if even marijuana is illegal. Surely there aren't a bunch of people obtaining marijuana for free at the government office? Or are they?


I think Portugal prescribes some substitute drugs like methodone to some addicts as part of rehabilitation therapy, but this isn’t unique to Portugal and isn’t really a significant part of the overall strategy except to treat addiction as primarily a health issue.

Of course that’s a lot easier to do in countries with universal health care. I wish we took this approach more here in the UK.


> I wish we took this approach more here in the UK

As do I, but given UK politics, it's unlikely to happen.

Both Labour and the Conservatives jump on drug control as a political points scoring mechanism, fueled (as always) by the tabloid press. As usual, it's "politics before people".

The fairly recent Psychoactive Substances Act, which makes just about everything illegal (except alcohol, caffeine, nicotine), shows just how progressive drug policy is in the UK.


Lobbying by the pharma and alcohol industries has been one of largest impediments to progress on cannabis.

There’s a tremendous amount of money that does not want legalization to happen.


Nonsense. Pharma will greatly benefit from the increase in number of schizophrenia patients.

Cannabis is a well established trigger among people whose genes are latent for schizophrenia or other psychosis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604190/


> Nonsense.

Pharmaceutical companies have donated millions to preventing legalization[0], and yet you’re invoking a rare genetic condition as evidence that pharma supports legalization? They’re literally some of the largest donors to anti-legalization efforts.

0: https://www.theguardian.com/sustainable-business/2016/oct/22...


They are donating to anti-legalization for the positive PR so that when people say “you make an addictive drug”, they can say they are trying to stop abuse.


If that's genuinely their motivation it's incredibly stupid, given that it's easy to accuse them of trying to keep home remedies out of reach of the public.


Pharma does not make marijuana


But they do make opioids, benzos and other abuseable drugs.


And how is that relevant?


For the reason I said, giving money to anti-legalization efforts helps improve their public image despite selling addictive drugs.

Perdue gave a lot of money to anti-legalization efforts to deflect the criticism of selling OxyContin.


That may be true but it doesn't rule out the possibility (more like 'virtually certain likelihood') that they have other motivations as well.


Nonsense. The number of potential marijuana users that would stand to benefit vastly outnumbers the number of potential users who have a psychotic break in their future that could be accelerated by marijuana or another psychotropic drug. Which, yes, is an acknowledged risk of many of these substances.


The idea that any drug is capable of permanently transforming a sane individual into a psychotic lunatic is pure bullshit. If there was a substance capable of such magic it would have been weaponized long ago and political dissidents would all wind up insane as opposed to dead in places like modern day Russia, China, etc.


I won't argue for or against marijuana, but I disagree with your argument.

Some drugs are capable of permanently transforming a "sane" individual into one with psychosis or other permanent mental disorders. Even alcohol has been shown to have this effect in some heavy long term users. It's even more common in meth users. It is not "pure bullshit."


As long as a drug's success rate in making someone psychotic is low enough, it will not be able to be weaponized.

Per https://www.health.harvard.edu/blog/teens-who-smoke-pot-at-r... if you have marijuana while young and no other particular risk factors, your chances of becoming psychotic increase by 7/1000. The combination of you had to take it while young and this low rate make it a poor choice of a way to abuse dissident adults.


Sounds like bs to me. People with early psychiatric symptoms are probably more likely to self medicate with weed. In other words the arrow of causality is probably backwards.


> political dissidents would all wind up insane as opposed to dead in places like modern day Russia, China, etc.

I don't think it's safe to assume these regimes would favor chemically induced insanity over murder/assassination/execution. For starters, induced insanity wouldn't provide a supply of organs. For another, those in power might fear that the procedure could become reversible, or may have efficacy that wears off over time (these fears may well be ungrounded but still sufficient motivation.) This is to say, there is a finality to death that's hard to match. Furthermore, if it only works "naturally" on a small segment of the population then it's not a forgone conclusion that Putin could snap his fingers and have it weaponized such that it's effective on everybody.

Also keep in mind that inducing insanity reliably can already be done today using very primitive technology. Prolonged sensory deprivation, or even just social isolation, takes a hard toll on people. That's a pretty reliable mechanism from what I understand, and is considered a heinous form torture by many, yet these governments still choose kill people. They could also give people lobotomies or fry their brains [ab]using electroconvulsive therapy, but they still choose to kill people.


...if anything they would benefit more by making marijuana and other drugs legal and cheap, in order to suppress dissent. Surprised no one ever looks at it that way; people sitting around smoking a bowl are not likely to do much political protest


Anticholinergic OTCs like Benadryl can cause both acute and chronic psychosis when abused.


It's no joke, Benadryl gave me horrifying hallucinations when I was a kid. It happened because a careless caretaker gave me the adult dose rather than the children's dose.


Just to make sure I understand you correctly: you don't believe there exist any drugs which can permanently alter the psyche of an individual, up to and including psychosis?


I think a lot of the time, it is a side effect of lifestyle decisions (and/or misuse) that the drug in question can induce, not necessarily the drug itself. For example, amphetamine is prescribed to millions of Americans for ADHD (see, Adderall/Vynanse). However, if one were to for example, have poor sleep hygenine as a result of miuse, the chance of psychosis is high from not getting enough sleep.

There are definitely neurotoxic substances that can induce psychosis or other problems (such as parkinsonianism) but these tend not to be very usable either clinically or recreationally. I think overall, the chance of cardiotoxic or repository depression is more of a common problem with most common recreatioal drugs at common doses.


Define greatly. The amount they stand to lose from just chronic pain medication vastly out strips any potential profit from treatment of maybe slightly increased cases of schizophrenia.


> As a former marijuana user this seems obvious to me

That's a key point, you've used it and have actual experience with it.

Marijuana has long been misunderstood and misinformation abound, but as more people use it or know those who do, that's been quickly changing. Add to that increasing medical evidence and more doctors coming onboard. It's just a matter of time now.

Indeed it seems we've already hit the tipping point. Public opinion flipped in recent years on whether it should be legalized, most are now in support: https://www.pewresearch.org/fact-tank/2019/11/14/americans-s...


There are a few presidential candidates that are for it, including mushrooms:

https://www.yang2020.com/policies/decriminalizeopioids/


There is a fundamental truth society and lawmakers refuse to ignore. People that want to consume drugs will do so regardless of the legality of it.

It would be much healthier for everyone (drug users and non drugs users) to simply acknowledge this truth.


>I don’t understand why federal legalization has been so difficult.

Alcohol and opioid manufacturing buying off politicians. Mass incarceration as a policy to preserve slavery in the US economy and to serve as a jobs program for police and guard forces.


Not only that, but the Prison-Industrial complex is a real thing. Private prisons are an outrage.


Private prisons only account for ~8% (and falling) of US prisoners[0]. Their incentives are bad, but public prisons have just as many self-interested groups with even more political power[1].

[0]: https://www.sentencingproject.org/publications/private-priso...

[1]: e.g. https://www.motherjones.com/politics/2013/02/biggest-obstacl...


So sad that this is the right answer.


I think it's because the people in charge just don't understand or care about the culture. They see the few problems that stem from marijuana and write off the entire idea. Only slowly has marijuana crept into the mainstream for who we might consider "adults."


"Good people don't smoke marijuana" https://www.youtube.com/watch?v=QGx72wL4gx4


I don't feel like there is much that unites the left and right in American politics these days, except for perhaps anything said by Jeff Sessions is a pretty strong argument that the opposite opinion is the correct answer.


Billionaire Sheldon Adelson contributes a lot of money to "conservative" politicians as long as they're anti drug. His son died of an overdose. https://theintercept.com/2016/11/02/sheldon-adelson-fights-m...


Just to clear a common misunderstanding.

Portugal decriminalized drug use. Meanings that drugs are still illegal, it is just that you won't face a court of law and you won't go to jail, but you can still get punished, for example with a fine.

Also, if you have more than a small amount of drugs, it is considered trafficking and it is still a crime in Portugal. With jail time.

And there is no exception for cannabis, it is illegal just like crack and heroin.


There's a small percentage of the population for which marijuana triggers psychosis.

I support legalization of all drugs regardless of their safety, but it's important not to generalize too widely based on personal experience. Marijuana presents a different but important risk set when compared to alcohol or tobacco.


For those who are susceptible any strong or traumatic experience can trigger psychosis, including leaving home for college. I don’t think that’s a good argument against going to college though.


There's a decision of the German high court finding there's no inalienable right to get high. However, the right to an education is a fundamental human right.

I'm not saying I understand or agree with the fundamental arguments. In fact, I don't think there aren't any arguments that were not subjective.

I'd say moderate intoxication is not a necessary evil. School is, though. Well, mild intoxication, for lack of a better word, is inavoidable. School is avoidable though.

Speaking from personal experience I find drug use and learning can be at odds very much. The topics are interrelated. And your comparison is backwards. If you are really saying: There can be good reasons not to go to college, but these don't generalize--whatever reasons those may be; Then we can prohibit drug use, if we can make school compulsory. There's no equivalence.

I mean how ridiculuous would it sound that, we must get these people high!? We must let them have relieve at the cost of a few failed existences--sounds not much better. It's OK in case of college, because we need that to reduce the need for it--something like that, if not to cure alzheimer. At this point I note that my idea of drug use chiefly to get high might strike someone as odd and in need of regulation.

That's what they call for, after all, control, information, responsibility. What would that look like in practice? Only one way to find out, you have to inform yourself.

The message that it's bad and hence illegal is therefore the simplest. It does not incur any further responsibility for the emitter, but leaves it completely with the user: It incures duty in prisons--that's the users fault, they didn't have to. Prohibition is a reasonable form of control, too. Because, first those who must participate will find a way any way, whether to their own detriment or not. And then, getting caught should always follow a prior fuck up. Import a substance that sells at the price of, I don't know, alluminum, although it's literally peanuts--hell yeah you are morally corrupt. And I don't see the price coming down after legilization. Whereas getting imprisoned for possession is rather difficult where I'm from, so it's a proxy for worse offenses that get one in the spotlight, often enough.

Perhaps price is a measure of control. If time is money, then an economist sees a lot of time going to waste; perhaps even in colleges and business schools. Thereby I've achieved reduction ad absurdum, commiting to the same falacious comparison as you.

If there's anything else I wanted to say, could have or should've said, the I forgot. My memory is very bad, sorry. I blame information technology, and a sped up aging process.


I think you're bumping up against the difference between positive and negative human rights. Positive human rights requires someone to do something for you. Negative human rights only requires others to not interfere with you.

Negative human rights are the only kind that make sense in my opinion. I don't owe you my labor, my time, or even my existence. It's only when you start thinking you are owed a part of me that you start thinking you should get to control what I do with my body.

This is why the right to free speech is about the government not inhibiting your ability to speak and why the right to bear arms doesn't imply the state must provide you with a gun. Some positive human rights like right to an attorney squeak in because we're about to take away one or more of your other negative rights through the judicial process.


> negative human rights

did you make that up? I know positive and negative discrimination is a thing, and there was even a fourfold distinction something I don't quite recall about positive/negative punishment/encouragement, sometging about how we learn. So, thanks for the downvotes, I mean, the attention.

"Negative right" is a paradox. You cannot at the fundamental level forbid to forbid.


Not the parent poster, but no, they didn’t make it up. It’s a well-established conceptual classification: https://en.wikipedia.org/wiki/Negative_and_positive_rights


[flagged]


.


Brown people historically refer to blacks and Latinos in the US.


Depends on the context.


A friend of mine served in Iraq and has a lot of health problems related to his time there. He has a shoebox full of medications for various ailments but, when he can use marijuana, he only needs like 5 of them.

So every few months he drives three states over to the closest legal state, stays for a few days and buys enough to last him until his next visit. From what I understand, this experience is not uncommon at all. There are even AirBnB's that cater specifically to these "medical refugees" coming in to buy there because they cannot get the medication they need in their home states.

It is really insane to me that prohibition of a plant continues despite all the evidence of its positive benefits. Especially when drugs that are far more dangerous to you than marijuana can be purchased at your corner drug store without even showing an ID.


Imagine being pulled over while traveling.

So insanely risky, especially considering speed traps are not illegal and cops practically camp where speed limit drops by bits.


A few years ago, a friend of mine here in Seattle went to visit his friend in Ohio, who wanted him to bring some legal pot. He took a train to Chicago, then rented a car to drive the rest of the way. He got stopped in Indiana, consented to a search where the officer found the pot in the car. My friend was lucky, he only got a warning with the pot seized, he was carrying a bit more than what would be considered a personal stash.

The cop told him that a quarter of the rental cars he stopped on the highway were carrying some form of contraband. Apparently, out of state rental cars on the highway attract police attention.


And they were most likely looking for large amounts of cash, Cops love the Seize cash, anyone carrying more than 10K in cash will likely never see it again, perfectly legal under Civil Asset Forfeiture


why did he consent to the search when he knew he had contraband in the vehicle?


We’ve talked about it this a lot. He takes precautions, such as vacuum sealing his cargo and keeping it in a locked bag, leaving at a reasonable time, not driving erratically, no evidence in the car, getting rid of all the receipts, etc.

But even he acknowledges it’s a risk; just for him I think it is a worthwhile risk to not have to deal with that shoebox of medications.


Progress is slow, but happening. I'd expect the pace of change to be governed by voter turnover.

https://en.wikipedia.org/wiki/Legality_of_cannabis_by_U.S._j...



And they're trying the same thing with kratom: https://www.kratomutopia.org/real-reason-fda-targeting-krato...


The FDA/DEA war on Kratom is truly heinous. The worst part is certain media outlets (like USA Today) are happy to regurgitate FDA propaganda without even mentioning the counter arguments. There are a few articles I see in other outlets that are fair, but more often than not it's the government-approved line.


Kratom is addictive and you can overdose on it, neither of which is generally considered true for cannabis. It seems odd to mention both in the same breath.


You can not over dose on kratom. You'll become nauseous and throw up long before reaching a toxic level. It is addictive tho. But so is caffeine, and even sugar, but nobody wants to ban those.


This is also similar to marijuana IIRC. You pass out long before you're ever able to reach toxic levels of THC. I'm not sure how true this is though, only something I heard from someone in HS who was a massive stoner.


I don't see how you could possibly overdose on kratom - large doses make you sick (and when I say "large dose", I mean relative to a typical dose of 3-10g - which is nowhere near to an overdose). I don't have a source (on mobile), but I seem to recall reading that you'd need to eat something like a kg if kratom to overdose.

Both cannabis and kratom can be psychologically addictive, in the same way as anything "rewarding" can be.

As kratom contains opioids, it might also cause physical dependence. I say might, as mitragynine is not a typical opioid, in that it doesn't recruit beta-arresting - which is thought to be responsible for the build up of tolerance and dependence by opioids, as well as for some of the negative side effects, such as respiratory depression.

There are many conflicting anecdotal reports claiming that kratom does cause withdrawal on abstinence, or does not. Personally, I have previously been able to stop kratom multiple times with no withdrawal at all (which has certainly not been the case with my prescribed opioid meds). My guess is there may be genetic factors at play here, and of course as a natural product there are bound to be variations in chemical composition of kratom from different sources.


Meh. Show me credible data on actual overdoses. The addictive potential is definitely there but is present elsewhere and otherwise accepted.

And for when it is in an addictive context, is it merely replacing an unhealthier habit with a more benign one?


A close friend of mine who suffered from a severe autoimmune disorder was unable to receive proper care from literally dozens of different doctors over the course of fifteen years of suffering. No experts could provide a useful diagnosis or safe drugs to treat symptoms. It was either tramadol and other potent narcotics or immunosuppressants, which have severe side effects.

Kratom was one of the only medicines that allowed him to function and it was getting more difficult to reliably source due to regulatory pressure.

He died abruptly 3 months ago due to rapidly progressing infection secondary to immunosuppressant / chemotherapy drugs prescribed to help him control symptoms.

He was 34.

Pay attention to the FDA's leadership. It's a revolving door with industry. Access to safe, effective medicine is not the FDA's goal in practice.

I'm torn between the need for effective regulation and the often dysfunctional real-world implementation of those controls.

Culturally, scientifically sanctioned pharmaceuticals are usually the only option provided to patients who are left to either seek alternative therapies or become dependent on treatments that often do not improve their well-being. "Non-traditional" medicine is often demonized as anti-science and lumped together with nonsense like homeopathy despite long successful histories in folk medicine.

This is unfortunate, because I believe that by treating medicines outside the mainstream -- medicines that are widely accessible, sometimes illegal, but primarily are not commercially viable (and thus are excluded from much scientific research) -- as akin to snake-oil means that a large and growing body of people are susceptible to things like anti-vaccination silliness. "Correct think" -- a culture of fetishism of scientific expertise that isn't actually scientifically motivated -- is responsible, in my opinion, for reactionary movements that are harmful to everyone. We live an an age of a narrow definition of scientific and off-load our critical thinking to experts who, in the best case, do not have the resources or data to look beyond the recommendations they learn in medical school, or in the worst case, produce phony medical trial results that exaggerate benefits and overlook harm. I would call it scientific myopia, but it's a cultural illness and not a problem particular to science.

It's possible to approach non-mainstream medicine rationally and not be casting bones in search of omens. But not according to our current cultural outlook.


Personal anecdote warning

Marijuana is a reasonably effective pain treatment which is readily available without prescription. Even without the really scary stuff surrounding Opiates, I'm far more likely to use the pain meds I can pick up at the corner dispensary. The cost of weed is far less and more important, availability and bullshit hoops I have to go through are far less.

About the only downside to weed is you gotta smoke it unless you process it first and making edibles or an infusion with a sous vide is not very difficult at all.

https://www.sousweed.com/blog/2015/6/13/sous-vide-cannabis-b... https://medium.com/sous-vide/sous-vide-thc-infused-cocktails...


> About the only downside to weed is you gotta smoke it unless you process it first and making edibles or an infusion with a sous vide is not very difficult at all.

Yep -- I don't even consider this an issue since it's very easy to get edibles as a consumer. For example, you can get marijuana-infused candies and tongue drops from pretty much any big dispensary for a pretty reasonable (sometimes better) THC+CDB/cost ratio.

Smoking and vaping marijuana (flower, dabs, oil, etc.) is known to be pretty bad for you, but edibles bypass that negative altogether.


Sousweed eds are also more potent than store bought ones [1], and deliver more effect that smoking the source. Given I live in a legal state and enjoy cooking, especially experimental cooking, I'm considering very small-scale distributing in 2020.

[1]: IMO, I use top-shelf for my eds; generic ones are probably a lot of shwag, and the "mg THC" ratings are incredibly inconsistent.


Largely matches my experience. I make infusions and usually have to cut it quite a bit before sharing, otherwise people get entirely too baked too quickly.

I enjoy crafting more than consuming so I tend to have way more than I can consume and give most of it away.


i had shoulder surgery in April of this year. I react poorly to opiates - primarily digestive problems ("heroin makes you constipated", as Trainspotting said) but also it just makes me feel awful. Shoulder surgery is pretty painful to recover from; without weed I'd have been in a much worse place. But also, I leave near a decriminalized state, so obtaining edibles is easy.


Vaporization (heating the flowers to ~200C) is also effective and less harmful than burning.


I do prefer vaping to burning, but still enters your lungs to questionable effect and also makes me cough, though not as much. I'd far rather just have a shot of infused tequila.


Anecdotally, I just got out of the hospital after some serious surgery on Christmas (maybe not “emergency”, but if they did it on 12/25 it obviously couldn’t wait). I’ve got a Vicodin subscription, my wife filled it, but I don’t plan on using it unless I have to. I live in WA, which legalized weed, and I plan to just smoke (well, vape) up. OTC meds aren’t quite enough, but yeesh, the next step is Vicodin? Nah, way too much, I think the weed will tide me over.

But if cannabis weren’t legal in WA, I’d probably just take the Vicodin because OTC isn’t enough. So for my current situation, cannabis falls right in that happy middle I need, and to bring it back on topic, keeps me off the hard stuff.


I highly recommend against smoking or vaping marijuana and instead choosing edible oils[0]. These sublingual oils are the safest way to ingest marijuana, and they are just as effective (if not more) as other forms of edibles. Not only that, but you can administer surgically precise doses very easily, since you control exactly how many drops you take.

[0] https://www.leafly.com/products/edibles/tinctures-sublingual


Thanks for the pointer. Looks like the store down the road has a wide selection. I’ve also been reading the other comments on making butter and the like, which I might give a whirl since I’m not leaving the house for a while. :-)


If you have never had edibles I'd proceed with caution. Weed is much more psychoactive when ingested and lasts way longer. If you take too much, you'll be in a bad place for hours instead of 45 min with smoking.


Uh, no. This is simply not true with sublingual tinctures where the concentration is very well-defined per drop. This only holds true for brownies and other food-based edibles where you don't know the concentration...


I can also recommend tinctures over edibles, but be sure to use a highly concentrated one, so you don't swallow any (this is actually quite difficult if you hold any more than a tiny amount of liquid under you tongue or between your gums and teeth!

For at least the first few times using edibles, I'd also advise the GP to be extremely cautious, and especially so if you don't have a precise source; the effects of vaping/smoking are 1-2 hours, but can be 5-7 with edibles - if you have too much, you're in for something akin to a bad trip (it's not the same, but the closest I can describe it), feeling nauseous, anxious and paranoid. It really is absolutely horrible


Curious why you are recommending against swallowing tincture drops. I typically swish the drops around in my mouth for 30s-2min depending on how quickly I want the high to onset, then I swallow. There are also times where I only swallow and I still get high.

Sure, drops will last longer than smoking/vaping, but the high is much milder and less intense (holding the amount of THC/CBDs constant). As someone who used to get anxiety and paranoia from weed, I can say that drops are much more benign in that manner.


"This only holds true for brownies and other food-based edibles where you don't know the concentration..."

I've upvoted both of your comments. Since a lot of people won't draw the distinction between the different types of edibles, the previous warning is warranted.


Thanks, apologies if my comment was slightly dismissive. I don't think the replier caught the distinction I was making.


Could also be because it's getting to be a huge pain in the ass to get prescribed opioids. You have to go to the doctor, often several times, and then you get to pay a pretty penny to fill the prescription. Much easier to smoke a doobie or eat a brownie. Convenience wins every time.

IMO the best strategy for the drug war is to make MJ and other drugs with very low addiction potential (shrooms, LSD) available nationwide, and continue to harshly prosecute the sale (but not possession) of crack, heroin and fentanyl.

That way people who feel like they need drugs to deal with their life situation will choose MJ out of convenience alone.


Not surprising that marijuana is a sort of strange attractor that prevents people from using harder drugs. Also not surprising that the federal government doesn't just execute faster and legalize it nation-wide already. I find it mind-boggling that you can be dying from opioids in one state and not another just because the state you're in happens to have banned a benign plant that can help save you and wean you off of opioids.


Let’s be real, the government was at best complicit in the opioid crisis. The Sacklers did a lot of lobbying; meanwhile “big marijuana” didn’t exist until very recently.


To a first approximation, the federal government is currently incapable of passing any laws whatsoever.


If you're against drug legalization, this is like hearing "allowing people to steal whatever they want is causing less murder". Allowing everyone to do bad things, in order to slightly reduce the number of really bad things is not a basis for legalizing something.

Now I'm personally for the recreational legalization of all drugs in general, but this is a poor argument, just like increased tax revenue is a poor argument. Proponents of legalization should be arguing that anyone should be able to do whatever they want to their own body as long as they're not hurting anyone else.


I don't know. Seems if someone were on the fence for supporting Marijuana legalization, the fact that it also helps reduce opioid use seems to be a reason to support legalization. The picture you paint is of someone who is unlikely to support legalization, I find evidence based arguments (relative dangers of marijuiana vs alcohol/other drugs, potential benefits, incarceration rates, etc) to also be compelling.

>Proponents of legalization should be arguing that anyone should be able to do whatever they want to their own body as long as they're not hurting anyone else.

Sure. That's one possible argument. The evidence in this paper is another.


> If you're against drug legalization, this is like hearing "allowing people to steal whatever they want is causing less murder".

The problem with that analogy is that taking a drug is a victimless crime while stealing something is not. The quality of “bad things” is entirely different. Stealing means I am deprived of my property due to your actions. Smoking weed means I am offended by your actions, and I just happen to have a dumb law to cudgel you with.

The sentiment behind keeping most drugs illegal looks a lot more like racism or homophobia or bigotry in general than anything else.


What do opponents of marijuana legalization actually believe?

The only coherent opposition to it I've ever heard is that it's difficult to test for marijuana intoxication on the side of the road. Which still doesn't really make sense when you consider that people are clearly doing it anyway (and now can easily cross state lines with no marijuana in their possession but quite a bit of THC in their blood).


They believe that it is a bad thing that bad people do. And that because they're bad people they deserve bad things to happen. Because drugs are bad, m'kay?

Seriously, I can only guess because none of it makes sense to begin with.


I think there are in general 2 arguments.

Firstly, there have been multiple studies linking cannabis use to schizophrenia, and opponents like to point to them.

But most of these studies are of poor quality (e.g. small sample size, short duration, poorly controlled for confounding factors), or/and have skullduggerous sources of funding.

Secondly, decades of anti-drug propaganda have much of the population convinced that all drugs (except of course alcohol, caffeine and nicotine) are essentially evil, and that cannabis in particular is a "gateway drug" to things like heroin (personally I find this to be ludicrous, but it's been said enough times by tabloids, politicians and schools that enough people believe it).

This second one is deeply entrenched, and it will take much time to change opinions.


Proponents of legalisation should use any argument that is likely to persuade, as long as it’s honest. For a person who believes that drug use is inherently bad, “anyone should be able to do whatever they want to their own body” isn’t an argument. It’s just the opposite of their opinion.


"Proponents of legalization should be arguing . . ."

. . . in a way that convinces me, not other people.

That's not how changing minds works.


There are parallels to the prohibition of alcohol here. During prohibition you were more likely to find liquor. Even after prohibition for some time liquor was more popular - my grandparents were more likely to have a cocktail than a beer or wine. Today people drink more beer and wine than liquor, there are more options, we don't have to go straight for the hard stuff.


It's difficult to buy their causality thesis.

Opioid addiction rates across states (and nations) already varies quite wildly, totally independent of weed laws, which were all quite similar some time ago. And the variation is large, far beyond the 5-10% supposed relationship in the paper.

Organisational, legal, social attitudes towards opioids change quite frequently as well - these would be very hard to normalise for.

If someone can validate how they crack the normalisation to achieve causality I'd love to hear about it.


The statistical methods are explained in detail and the article was published in what appears to be a reputable peer-reviewed journal. What kind of validation are you looking for?


It seems to me there's a huge range of factors they didn't and can't possibly control for. Particularly availability of black market opioids. And if I'm not misreading - the changing policies of opioid scrips over time, a lot of which is 'trendy' i.e. socially driven as much as policy driven (i.e. individual doctors making changes in their practice because they read something).

More specifically, I'm always wary of 'top down' science that doesn't consider the myriad of real world considerations regarding their thesis; specifically they don't actually talk to people (or even take surveys) to get a feel for what is actually happening.

What if they had a lot of conversations and did a few surveys and found that people tended to not medicate 'en masse' for specific interventions?

I honestly don't understand how researchers can look at such an intensively social and behavioural subject without getting a personal feel for the prevalent behaviours.

I'll bet doctors, social workers on the front line have pretty good insight into what's going on.

So my question was pointed to anyone who understood this paper or issue in detail who could articulate in so many words 'why the correlation is valid'.


I agree that reviewing the statistical methods before judging the soundness of the conclusions is a good idea, I disagree that being published in a reputable peer-reviewed journal is sufficient validation for many well-known reasons and others that may be less-known.


Thank you for your opinion. Great point.


Always seemed insane to me that pharmaceutical drugs based on Marijuana are bad but drugs that share a base with heroin are okay.


Don’t have access to the paper, but would love to see how they controlled for dropping opioid use.

The roll out of marijuana legislation overlaps quite nicely with an overall effort to reduce opioid prescriptions.

I imagine it would be difficult to control for that effect.


The link is to the full text of the article. The method (difference in differences) is well-known from the famous study on minimum wage laws (Card and Krueger, 1994).

> To examine the effect of cannabis access laws on opioid prescriptions, we estimate a series of difference-in-differences models, exploiting the staggered adoption of cannabis access laws over time ... Following Bradford et al. (2018); Buchmueller and Carey (2018) and Patrick et al. (2016), we include controls for [several] different legal changes that may impact opioid prescriptions in a series of robustness checks ... As described in detail in the appendix, we test our data for parallel trends between providers in states that adopted cannabis access laws and those in states that did not. We are unable to reject the null hypothesis of parallel trends, which supports the use of difference-in-differences models.


They could compare states that have legalized with those that haven’t. I don’t know if that’s what they did in this study.


while opioids are clearly awful when abused, they are at least a controlled substance and a bit expensive. There are MANY more people who manage pain with alcohol due to it's price point and availability.. I'm very interested to see the effects there. a quick search turns up some papers, but nothing recent or with any significant data.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700545/


I recall seeing a study recently looking at using GHB for chronic pain management (which has similar effects to alcohol, but without the hangover).

IIRC, it did work somewhat, but of course the participants felt "drunk".

I suffer from chronic pain caused by small fiber neuropathy in my arms and legs, and can add a single data point: alcohol does help a bit - but the way it does so is more by "distraction", whereas opioids really seem to reduce the pain. It's also completely impractical if you want to drive, work, look after children etc (normal life, basically). But I can certainly see why people would use alcohol if they were unable to obtain prescription medicines that helped them.


It is 2020. Just legalize it already. And legalize DMT and mushrooms while you're at it. So many can benefit from these natural and relatively safe remedies.


Anecdotally, DMT made me black out and go crazy for 20 minutes. I would not make it easily available.


But you got ahold of it despite its legality. Ironic, no?

These drugs should be treated as seriously as any other (know your drug!). Some will fail to do that, but that is how it goes.

The moment I hear "drug X caused this bad thing to happen" I think of how much suffering alcohol consumption does globally on a daily basis. That tempers all associated concerns.


There is also the issue of QA in the supply chain (to be clear, by making this comment I'm not necessarily saying that the GP in particular didn't have pure DMT).

I've seen multiple studies, mostly looking at pills sold as MDMA, which examined the actual content of samples of street drugs, and the findings were not exactly surprising - almost all samples were not pure (I mean, aside from cutting agents!) MDMA, often containing significant amounts of amphetamine.

In a legal, regulated marketplace, there are guarantees of quality, which would represent a huge increase in safety for drug users.

With a legal marketplace, production would also shift from global cartels to local businesses - improving lives, creating local jobs and increasing tax revenues.

The fact is that there will always be a market for drugs - people have afterall used drugs for millennia - so why not accept that and try to make something better of it?

There are of course risks to taking any drugs, just as there are with alcohol - but the potential for good by legalising is staggering.


Fair - my suggestion would be to legalize it, but similarly to cannabis where consumer needs to be an adult and it needs to be sold with warnings.


"That tempers all associated concerns."

Until you compare the number of sufferers as a percentage of users, there is no tempering of concerns here.


One might say the same thing about building a significant degree concern based upon random anecdotes.


I do not have first hand experience with it as it is illegal. But I've done a lot of research and it seems that under controlled conditions it can help people a lot.


Sometimes its ok to be recreational :-)

The most profound thing about DMT was learning that what I saw decades ago is a shared experience: https://en.wikipedia.org/wiki/N,N-Dimethyltryptamine

For actual learning, LSD/Psilocybin is a much gentler teacher.


One day MDMA legalization will significantly reduce both alcohol consumption and DUIs.


If you want it to remain effective and to avoid serious complications (depression, anxiety, loss of verbal fluency) MDMA can't be taken anywhere near frequently enough to replace alcohol for the average individual.


That was supposed to be GHB.


> Information on opioid prescriptions comes from Symphony Health’s IDV® (Integrated Dataverse) dataset ... The dataset includes approximately 90% of all prescriptions filled at outpatient pharmacies in the United States between 2011 and 2018 ... Each observation includes the year the prescription was filled, the eleven-digit national drug code (NDC) for the prescription, the total days’ supply for the prescription, the quantity of drugs, an encrypted patient identifier, and an encrypted healthcare provider identifier.

Given what we’ve learned about data re-identification [1], this sounds like a pretty scary dataset. Does anybody know more about it? Do you need to pay for access? Is access restricted to researchers who can be trusted not to attempt re-identification?

[1] https://en.wikipedia.org/wiki/Data_re-identification


When I see these types of research, I wonder if it is a short-term or a mid-term effect of marijuana legalization. There was a time when Heroin was a legal trade-mark that was available over-the-counter... It was thought that only weak could get addicted to it while short-term effects were recognized.


Marijuana legal states are rich or have been gentrified so they use less opioid.


"Marijuana laws" are what caused this mess in the first place. The title of this post makes it sound like government is doing something rather than getting out of the way.


Recreational Marijuana Laws has generally meant regulating it in a manner very similar to Alcohol. Given what we've seen with black market products being cut with dangerous chemicals that have sent people to the hospital, I'm happy to know my state performs quality control tests on the marijuana products I'm buying.


Do you really believe that people would "cut" legal marijuana with "dangerous chemicals" and sell it from their dispensary? This barely ever happens with illegal marijuana. The reason drugs like heroin and cocaine are cut is to increase profit margin, either through dilution with a relatively harmless substance, or (more dangerously) a cheaper, more potent alternative like fentanyl in the case of heroin. Marijuana cannot be "cut" in this way, and it is the black market that incentivizes it with other drugs. I should be able to grow it for myself and my friends and family but that's still illegal most places that have rec laws. These laws are preferable to prohibition but it is not the laws that are helping people. It's the plant itself that is doing so.


It's not so much someone cutting pot with dangerous drugs. In the past when you bought from someone, even regularly, there'd be that infrequent time where the guy's supplier didn't come through so the quality or amount was less than the time before.

With pot shops, they print out the THC content on every label so you can buy a consistent product at a regular price every time.


You don't need a government agency to test for THC potency. Businesses can and do already solve that problem. That doesn't seem to be what the parent commenter was getting at, regardless.

As an experienced grower I would trust myself and others I know who have expertise. I wouldn't need a lab test before consuming their product. As a frequent user, exact THC content is not really that relevant. Not nearly as much as knowing the strain and growing process, which as the grower, or the customer of a reputable grower or dispensary, I would know.

We're talking about a plant. The worst that can happen to you is a Peggy Noonan style freak out. Yet we're setting up a system where rent seekers will squat on grow and distribution licenses and the price will inevitably go up.


Cannabis is less likely to be adulterated than other drugs, but it does still happen and legalising and regulating it makes this less likely.

Page 36: https://www.researchgate.net/publication/235912814_CUT_A_Gui...


Vape juice is huge, and is being cut with stuff like vitamin e acetate in illegal markets.

There's also fake terpenes you can spray on bud.


"Do you really believe that people would "cut" legal marijuana with "dangerous chemicals" and sell it from their dispensary?"

He specifically said, "black market products".

"This barely ever happens with illegal marijuana."

While it isn't the result of "cutting", the poisons applied to illegal pot kills animals (inluding bears) within minutes of ingestion, is destroying ecosystems, and will undoubtedly be impacting the health of innumerable users in the decades to come, destroying lives, and impacting the cost of healthcare. https://www.usda.gov/media/blog/2017/08/21/cleaning-illegal-...


This is not good news for big pharma, they dont want people using less drugs. They want you using more. Its morally bad.




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