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Comment by anon987 | Hacker News Reader

Here's to hoping people realize and deal with the real gateway drug: Prescription opiates

Here's to hoping people realize and deal with the real gateway drug: Alcohol, that great destroyer of worlds, marriages, cultures, physical health and particularly the brain, time (hangovers, boredom), coping strategies (emotional pain), real pain (coping strategies), poor decision making (you know it), and so on. Start here, and come into it with a few entrenched problems, and sure enough you'll find yourself elsewhere should time and circumstance align.

To all the magical, healing drugs that are currenly illegal: may you one day be free. http://www.economist.com/blogs/dailychart/2010/11/drugs_caus...

Alcohol, in small doses (0.5–2 drinks) is a pretty good anxiolytic.

This. Problem is some people sober up fast after that little, so a continual low-level intake can be required.

That said, I've found I'm more productive with whiskey than without lately.

That's a dangerous slope you are sliding down there..

To qualify the previous statement, I've been using low amounts of alcohol to break anxiety related to lack of productivity. It helps with actually getting things done, as opposed to being stuck in a nervous loop overthinking things.

Once I've built momentum again I just cut out the alcohol entirely. It's kind of like a bootstrapping process, or perhaps boozestrapping..

I can't recommend anyone actually does this though, especially if you're prone to problems with alcohol. Personally, I've far more to fear from RTS games as far as addictions are concerned.

>It's kind of like a bootstrapping process, or perhaps boozestrapping..

You are describing the ballmer peak (https://xkcd.com/323/). It's a joke, but some truth rings to it. Developing while dealing with anxiety can be crippling so a small amount of booze helps lubricate things.

That said it's easy to get into the habit of drinking very slowly, so never getting intoxicated, but the drinks still add up over the hours. You end up putting down a lot of excess calories not to mention the negative impact on your overall health if you drink 5-6 drinks over the course of a 10 hour coding session over and over again.

I've since found exercise works just as well and is much more sustainable. Something for you to keep in mind perhaps.

Gotta hit that Ballmer peak[0]!

[0] https://xkcd.com/323/

Alcohol has costs, but it also has benefits.

Looking at only one side of the equation doesn't make for fair analysis.

What would happen to those rankings of meth and heroin were sold at every grocery store?

Alcohol takes a lot of blame because it is the most accessible and cheapest drug.

Methamphetamine is sold at grocery stores (Safeway, Target, several others), at least according to a quick search:

http://www.goodrx.com/desoxyn?drug-name=desoxyn

Wow its not even masked under a different name, just straight methamphetamine for sale

This is misleading; it's sold at grocery store pharmacies, but only with a prescription. As a Schedule II drug the controls are much tighter than normal drugs, including strict regulations on who can prescribe such drugs and secondary verification for new prescriptions. In NY (and soon more states), they can only be prescribed electronically using approved security measures.

> Here's to hoping people realize and deal with the real gateway drug

I think they already tried a certain approach, about hundred years ago

Point isn't to ban it, just to be honest about what we're dealing with so as to better understand the dangers and / or benefits of other drugs and approaches.

Opioids are actually much less harmful than other stuff, even alcohol. Alcohol is a neurotoxin, i.e. it literally kills brain cells. On the other hand, everyone's bodies produces opioids naturally. Endorphins are opioids, and the rush you get when you work out at a gym, is you getting mildly high on the natural opioid, endorphin (whose name is short for "endogenous morphine").

Synthetic and natural opioids have the same mode of operation on your brain as endorphins. They bind to these things called "opioid receptors"[1] in your brain. There is a biological purpose for the existence of these receptors. Quoted from Wikipedia: "The endogenous opioid system is thought to be important in mediating complex social behaviors involved in the formation of stable, emotionally committed relationships."

Opiates actually seem to have a significant benefit to people suffering from severe and refractory major depression, where all other legal anti-depression medication has not helped them.[2] Now compare this with alcohol (ethanol) -- a substance that recklessly goes around destroying cells in your brain and your liver, which people take just to get rid of some social anxiety. Huh.

[1] https://en.wikipedia.org/wiki/Opioid_receptor

[2] http://www.opioids.com/antidepressant/opiate.html

> everyone's bodies produces opioids naturally

That's one of the dangers of opioids - once external opioids get into the system, it adjusts for them and if they are withdrawn, everything breaks down. Of course, if you are seriously ill, then your other choice - e.g. suffering severe debilitating pain or depression - is worse, so you choose lesser of evils. But that doesn't make opioids something nice and safe.

With alcohol, for most people usage in typical recreational doses is completely safe. I've been using alcohol recreationally for decades without any problems, and so did many people I know. I suspect doing the same with opioids would end very badly (and I'm not inclined to test that hypothesis and don't recommend to anyone).

Why so you insinuate that stuff your body produces is good to consume? That's a naturalistic fallacy.

Alcohol does not kill brain cells. This is a common myth.

Well, I sort of agree. I work with several fibromyalgia groups, and it's a simple fact that pain management in america is abysmal. The regulation of prescription opiates so onerus, it makes it extremely difficult for patients to get, and doctors to prescribe, the medication that would have a massive difference in their quality of life.

It is because of this that they find alternatives/substitutes, which range from alcohol to heroin to suicide. Two people I know have killed themselves because they could not deal with the pain and the medical system failed them.

I find the attitude of doctors to chronic pain for which they cannot provide a solution to be very frustrating.

Why is it that opiate addiction is seen as far far worse than debilitating chronic pain? Why can't the patient make that choice?

For most people with long term pain an opiate prescription is the wrong choice.

The patient ends up with an addiction of opiates; while taking dangerously large quantities of opiates; while still being in pain.

They've still got the pain; they now have two additional problems.

Most people with long term pain need access to pain management services which include other stuff (exercise, physiotherapy, weight loss, psychological therapies) as well as (if needed) opiates.

Except that the primary focus of pain management services seems to be overwhelmingly about reducing opiate intake, rather than helping the patient deal with pain.

Maybe there are no good choices for some long term pain.

I don't know where you are, but in England most pain control clinics are mostly about helping the patient deal with pain, and using appropriate medication to do so.

Here's the English guidance for managing pain in non-specialist settings, so this is what people should be getting from a regular doctor. (For neuropathic pain).

http://www.nice.org.uk/guidance/cg173/chapter/1-recommendati...

None of those are alternatives that make sense with fibromyalgia. I could see them for lower back pain.

The thing with fibro is that pain causes reactions that make fibro worse, such as sleep deprivation.

Opiates can break this cycle through a short term course.

They're not just gateway drugs, but also a huge problem in and of themselves. I have a friend who went to rehab for heroin and he said most of the people there were addicted to oxycodone, not heroin. Opiates are not to be trifled with, yet some doctors are more than willing to throw them at people. My other friend was prescribed Norco for a sore throat >:(

I've heard that Heroin was invented in first place to be a "phasing out" drug of sorts, to fix Morphine addiction...

It was. Then suboxone, methadone, etc. I can't wait to see the latest fad.

Suboxone helped me kick a 6 year heroin addiction. For an actual addict, there is effectively no high from it (aside from the relief of getting rid of withdrawal symptoms, which is very different from an actual high). So, you can dismiss it as much as you like, but it (coupled with excellent support from the government-run clinic) saved my life.

I recently burned my hands with bacon grease while cooking which was a painful experience and was prescribed Norco. The pain was pretty much gone in the morning ~12 hours later and I had only taken one dose (which made me feel terrible, btw) and didn't take any more. I imagine many people just take the dosage until the prescription is gone.

> I imagine many people just take the dosage until the prescription is gone.

Or more than the dose and then buy it on the street after they run out. After that gets too expensive they figure out heroin is the same rush.

Here's to hoping people realize that the whole concept of "gateway drug" is horseshit. Human beings exhibit a wide range of behaviors following the use of any substance, that usually have much more to do with the humans and with their environment than with the substance.

These days it's hard to get a handful of Vicodin to get you through a few days of pain after hurting your back.

It's being "dealt with" for sure. I'm not sure the amount of inconvenience and needless suffering imposed is an improvement on anything. I've never abused drugs. Opiates after back pain, minor surgery or a root canal aren't a "gateway" to anything for the vast vast majority of people.

I don't know about recreational heroin, cocaine or meth. I'm going to err on the side of caution and suggest that they're probably something I don't want to see legalized.

OTOH it'd be nice if marijuana advocates would stop treating alcohol as if it's the worst substance known to man. Current DWI laws are not justified with science. Legalizing marijuana and criminalizing responsible consumption of alcohol is not progress. If everyone you know would probably be in jail were it not for the fact they haven't been caught, it's probably not a good law.

Sane pain management should be between you and your Dr. Ethical patient treatment should not be disincentivized because someone has a political agenda.

"I'm going to err on the side of caution and suggest that they're probably something I don't want to see legalized."

Beware of status quo bias. Why do you think restrictions are the cautious choice, as opposed to the daring choice?

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