people die in large numbers from overdoses from prescription opiates too - easing access to prescription opiates is a terrible solution
In an ideal world, yes. But realistically patients will often be prescribed both.
> What we need is to start prescribing opiates for recreational use and eliminate the black market.
I strongly disagree with this concept. Opiates for recreational use is basically legalising heroin. The addictive potential is simply too great. I don't know what you are basing this argument on but my first-hand experience working with patients with opiate addictions, as well as a close friend and colleague who started using (pharmacological grade) opiates and rapidly had his life spiral into a shambles. The fact is that these debates have been had in the past. They are the basis of the harm minimisation strategies already in place by governments all over the world - Methadone, Suboxone and Buprenorphine programs, which bind opiate receptors with a long half-life meaning that users are not constantly bouncing from a crazy high to the physical sensation of pain which results from withdrawal of opioid agonism in the context of dependence.
> Opiates cause no harm (the worst side effect is constipation) so there is no reason that we should be trying to stop people from using them recreationally other than knee jerk moral panic and conservatism.
Again, I strongly disagree. Opiates cannot be used recreationally by the masses in a way which is consistent with normal societal functioning. This would be a disaster of epic proportions.
For instance, heroin injecting rooms are government or health-service funded clinics which provide a safe place to shoot, needle exchange, medical supervision should patients have reactions or overdoses, and the ability to seek out further harm minimisation through enabling access to treatment programs, should the addict wish.
The united states scores poorly on access to these services anyway, the rest of the world does substantially better, including my home (Australia)
again, the answer to harm minimisation is not legal recreational opiates
Right but be careful: "the answer... is not legal recreational opiates" does not necessarily imply that the answer is illegal recreational opiates.
If that's what you are suggesting: I am unconvinced. Has a war on drugs ever actually worked for us? Is it clear that legal opiates would mean more overdoses? Even if they would, has someone done a cost-benefit analysis of a) enforcing the illegality of the drug and b) efforts to reduce the negative effects of the drug through education about the risks of using and how to use responsibly. I'd be curious to see the results.
Edit: According to http://www.drugwarfacts.org/cms/Economics (pardon the biased domain but it was the first search result with the answer), only 5% of the money the US spends on drugs is allocated toward prevention and 37% goes to treatment. The remaining 58% goes to enforcing the illegality of drugs. Clearly the enforcement is not very effective because as you mentioned elsewhere 16k people are dying a year from heroin. So the question is: would that money be better spent otherwise?
What's your evidence for this?
[0] - CDC report describing epidemic in prescription opiate deaths
[1] - NIH report showing overdose deaths. the relevant stats: Since 2001, prescription opiate deaths have risen from 6000 to around 16,000. Over the same period, heroin overdoses went from 2,000 to 8,000. This data is to 2013. So there is a clear problem, and in fact prescription opiates cause significantly more deaths than heroin.
[2] - a report from closer to (my) home and region of practice detailing increases in prescription drug use in Australia and increase in opiate-related deaths secondary to this
[0] http://www.cdc.gov/drugoverdose/data/overdose.html
[1] http://www.drugabuse.gov/related-topics/trends-statistics/ov...
[2] https://www.mja.com.au/journal/2011/195/5/prescription-opioi...
https://www.psychologytoday.com/blog/wicked-deeds/201404/pre...
Also, these data include things like acetaminophen overdoses (estimates run from 100 to 1000 deaths per year).
The answer to heroin abuse is not prescription fast acting opiates, which themselves have significant abuse potential, but treatment programs such as suboxone, bup or methadone. The pattern of use needs to change from the epic highs and withdrawal cycles which generate the behaviour of an addict (and is still there with oxycodone due to the pharmacology of the drug) to a substance that maintains opioid receptor agonism for longer periods
They're not going to throw their hands up and go 'whelp, can't get any more legal oxy, time to quit drugs'.
The answer is to get them onto treatment programs, not further their addiction with access to drugs they are abusing
Treatment programs should be available and encouraged, of course, but if the guy really wants to continue abusing his prescription medication, that's his choice and I don't see the issue in supplying him.
Doctors encourage their patients to quit smoking, they don't jack up their cost of cigarettes 1000% and then shake their heads and absolve themselves of all responsibility when the patient isn't ready to quit and goes broke buying cigs instead.
But if someone wants to abuse drugs, then they shouldn't be given access to them. I really don't think you have any conception of how destructive opiate addictions are over the medium to long term. I don't accept your arguments that it is simply a factor of choice, and if someone wants to abuse a serious drug, then they should be enabled by providing them with access to a restricted drug , that is being used for the purpose of abuse. It's not acceptable in civilised society.
As to your supporting argument, yes doctors do encourage their patients to quit smoking. But in Australia we have jacked up the price of cigarettes to act as a disincentive as well. And, guess what - it works. The idea that we should make it easy for patients to access drugs of abuse, for the purpose of abuse, is severely flawed and your argument is bunk. An opiate is a drug of abuse and a restricted drug for a reason, and that reason should never be the recreational consumption.
The destruction is a direct result of prohibition, it is not inherent in the drug. People can and do take opiates long-term with little harm.
> But in Australia we have jacked up the price of cigarettes to act as a disincentive as well.
Yes, but not to the level that people have to prostitute themselves or rob others to get their fix. I didn't say it had to be dirt cheap, just cheap enough to sustain an addiction without turning to crime or selling one's house.
> An opiate is a drug of abuse and a restricted drug for a reason, and that reason should never be the recreational consumption.
I also didn't say it should be sold like candy to anybody at the corner store. But cutting somebody off who is already addicted like they do in the US is what ruins lives, not the pills.