Painkillers now kill more Americans than any illegal drug
vox.com
vox.com
In short: I'm the most vanilla, square, anti-drug person you can find. I don't want to use them, and I think other people would be better off if they reduced their usage as well.
Yet I can not for the life of me understand why drugs are illegal. Not just pot, all drugs. I'm totally onboard with making it our public policy that we want to reduce the use of drugs. That makes perfect sense to me. It does not make sense to me why anyone still believes that using the criminal justice system as the mechanism for getting to that goal is the right path. We are spending insane amounts of money on a failed approach while also generating huge negative side effects by creating an enormous group of people with criminal records. It's probably the worst thing this country has done to our own people since segregation and it seems like all of the policy people understand this. Why can't we get political will to do something different?
I think legalisation would be beneficial, as you say, because the criminal justice system does not serve addicts. However, while proceeding with legalisation, we must also establish better social support systems so that people can safely enjoy drugs in moderation.
The libertarian case for legalizing drugs falls apart if society has to take responsibility for providing support systems as a reaction to the actions of individual drug users. Frankly, most people would rather continue to ban drugs than pay for treatment for people who abuse them.
Yes, I know this is shortsighted because we already pay for the costs of incarceration and law enforcement. But that's the status quo, and changing it is going to require convincing people that the alternative is better.
Addiction affects more than just the addict. And addicts are in need of help - while it is easy to think that "they like being high, it's their choice", in fact the addicts hate their habit more than anything, yet they can't stop using without external help.
Would you help a person with a broken leg ? Why ?
Well, that's your answer right there.
Edit: Just a couple of days ago I've watched this documentary and I guess that's how I came to these conclusions: https://www.youtube.com/watch?v=k01VM1f1Akk
Or your children's problem in the case of one of my close relatives. Addicts do stupid stuff, they don't have any money because they spend all of it on drugs. They then aren't able to pay for things like rent, food, diapers, etc. and turn to family or theft (or both) to deal with that problem. They don't take care of themselves or their dependents because they don't care.
Is some of this exacerbated by the Drug War? Yes. But the other side of the coin is that making drugs cheaper/better and then decriminalizing it won't solve the problems (including depression and other mental issues) that cause people to turn to drugs in the first place. And then from there, they get addicted, drop out, and become a useless drain.
The Drug War doesn't really work, and it causes liberty issues. But it's not the recreational users that are the big social problem with drugs. Its generally the people who are already down in life and then turn into addicts and make things even worse for themselves. And legalizing them won't fix that either.
And then there's the whole issue with people who are in a terrible social/economic situation and sell/move drugs to make money but don't care about the product. They're not going to just start becoming model citizens working in the fancy new MJ dispensary because it's legal now. They'll find something else to do that's probably also illegal.
Of course addicts enjoy being high. I'd wager essentially all addicts enjoy the high, even if the joy is just the abatement of withdrawal symptoms.
And while some addicts don't want to "quit", that's true, a vanishingly small percentage enjoy being addicted. In my reading and limited first-hand discussions, even those addicts who don't want to quit still wish they could "cut back", e.g., wish they could just be a social drinker or only shoot heroin on the weekends. They hate the powerlessness they feel, hate the control the substance has over their lives.
Lastly, I don't have hard evidence to back this up, but I've never read/heard an addict cite the high price of their drug being the biggest reason to quit. The biggest reason they want to quit is typically either its impact on their health or its impact on their relationships (or career, which is basically a relationship). I'm not saying you're irrefutably wrong about this; it just doesn't match my anecdotal experiences.
The one thing all addicts share is an expert ability to obtain and use their substance. If it is physically possible to get their fix, they will find a way. Also, illegal drugs are often cheaper than legal ones, because regulatory compliance and taxes add more expense than operating in a black market. At least, that's the evidence coming out of states and countries that have recently legalized certain drugs.
Legal morphine is already extremely affordable, about $1/gram.
On the one hand, I believe an addict will find a way to get their drug if they really want. On the other, a huge part of beating the addiction and maintaining it is to avoid situations where you know you'll be tempted to relapse.
As a personal example, I've struggled with cigarette smoking at times in my life, and it is undeniably harder (for me) to stay on the wagon when I can pick up tobacco on almost any corner, any gas station, convenience store, most pharmacies and grocers, etc. It's just everywhere.
Anyway, I'm just saying that I agree with most of that point – despite my being generally pro-legalization, pro-treatment vs incarceration. Honestly, if we as a society get to the point where an adult can pick up a bump of cocaine at every gas station, I think that will be a bad outcome. Accessibility doesn't necessarily mean prevalent and socially encouraged/acceptable, but it certainly could head us down that road – which is dangerous, at least for opiates/opioids.
And you make a good point about morphine. I guess it's because morphine's considered medicine and not a "decriminalized/legalized recreational drug", which are being subjected to higher "sin taxes".
Implicit in proper pricing is that it'd be legal and easy to use.
Which issues are you thinking about?
>opiates have little side effects outside of respiration depression and constipation
Maybe with proper dosage and medical supervision, maybe. But I think the biggest side effects of regular opiate abuse are addiction and a loss of productivity. I don't think those effects can be discounted. The biggest "waking" factor I have heard ex-junkies state as why they wanted to sober up were "I was killing my family", "I was killing myself", and "it was only a matter of time before it killed me or I killed someone for it".
That said, clean equipment certainly helps solve some of the issues, as infections are extremely common with intravenous users.
I hope people don't argue that drugs should be legalized because it's a personal life choice that doesn't affect anyone else, and then turn around and argue that more support for addicts is needed because their personal issues do affect others.
I know your comment doesn't have this logical contradiction, but I wanted to point this out in case any readers read your comment and silently nod their heads in agreement despite them also holding onto an obviously contradictory opinion.
Myself on the other hand, I believe in my own ability to be fair in judgement, to straddle that difficult line between compassion and personal responsibility. I believe it IS possible to leave someone bleeding in the street because they chose to endanger themself, their family, their community, and the quality of life of everyone on this planet.
That's a position that will strike many as arrogant, entitled, and downright wrong. I can understand that position, and still choose to disagree with it. As an ideal, I hold personal responsibility in the highest regard, while still understanding that life hits you hard sometimes in ways you cant possible predict.
Maybe it's a question of ideology or lack of experience. Possibly you've never seen a friend caught in the web of addiction and so have never understood the deep desire to support someone, to treat someone, to help them overcome addiction.
Having understood the mechanisms by which a person can descend into addiction and criminality, I'll take the legalisation of drugs with an associated support structure over the simple banning and criminalisation of the drug users any day.
I'd also suggest that the status quo you speak of is actually changing before your very eyes.
Suposing that it doesn't, doing nothing would be a hell of lot cheaper and easier than what we are doing now.
Opiodes are derived from cheap agricultural products. A tablet of herion needn't cost more than asprin. The explicit goal of federal enforcment agencies is to raise prices by restrict supply. You and I are spending a fortune on that project, and it's not helping anyone except the sprawling profession of drug-warriors, and the black market gangsters. Ok, maybe it helped HSBC a little. Kind of ironic, isn't it?
This is one of those things that makes me wonder why we even have economists if no one will listen to them.
Go get a cup of coffee, fire up youtube, and listen Milton Friedman's talk "Socialism & The War On Drugs."
https://www.youtube.com/watch?v=fIQ5_4tOx0U
If you don't like that one, pick one from any decade since the Nixon administration. :)
Another vote for Milton. I have watched several of his talks on the subject and it is amazing how clear and rational his thinking is. It is a real pleasure to watch. Amazing how this subject has become dominated by misinformation and hype.
Nobel economist Milton Friedman said, "The proper role of government is exactly what John Stuart Mill Said in the middle of the 19th century in 'On Liberty.' is to prevent other people from harming an individual. Government, he said, never has any right to interfere with an individual for that individual’s own good. The case for prohibiting drugs is exactly as strong and as weak as the case for prohibiting people from overeating. We all know that overeating causes more deaths than drugs do. If it’s in principle OK for the government to say you must not consume drugs because they’ll do you harm, why isn’t it all right to say you must not eat too much because you’ll do harm? Why isn’t it all right to say you must not try to go in for skydiving because you’re likely to die? Why isn’t it all right to say, “Oh, skiing, that’s no good, that’s a very dangerous sport, you’ll hurt yourself”? Where do you draw the line? If you look at the drug war from a purely economic point of view, the role of the government is to protect the drug cartel. That's literally true.”
Milton Friedman interview from 1991 on America’s War on Drugs
Meanwhile, don't look to closely at what has happened with the cartels in Mexico.
It's nothing more than "something must be done; this is something; this must be done." The wave of open drug use in the 1960s was pretty scary to a great many people.
High prices are reducing drug usage. That's basic economics. Food is cheap, so people eat a lot and get fat. Alcohol is cheap, so people drink a lot and destroy themselves. It's not hard to deduce what cheap heroin would do.
OD deaths are up by a factor of three since the feds cracked down on cheap vicodin and oxy. The drug war has also killed huge numbers of people in other countries, harmed civil liberties at home, and cost a lot of actual dollars.
I think it doesn't look like agood deal unless you omit some of those costs.
Friedman addresses this point better than I can. You might enjoy this debate on drug criminalization between Friedman and the former governer Pete Wilson of CA:
I think you have that backwards, and most people go the other direction.
Here's a pretty good documentary in which users describe their experiences: http://www.pbs.org/wgbh/frontline/film/chasing-heroin/
It seems to be quite common to become addicted to legally perscribed opiod analgesics, and move to black market drugs when access is limited.
Also, pills are cheap when you get them from a doctor. Heroin is cheap compared to black market pills. Which comparison are we making?
I think demand for opiods from addicts is somewhat inelastic; this is why so many people start by getting addicted to inexpensive legally perscribed pills, and then end up doing crime to pay for herion, which I believe costs $200/gram or something similar (depending on location, dilution, etc.), where a serious user can easily do a gram a day. If simply making the price go up was going to help that person, we wouldn't have this problem.
If anything, this is an argument for making people who aren't addicts yet pay a huge amount out of pocket for legally perscribed pain killers, which is an interesting, but probably infeasible idea.
Returning to the big picture though, we're making black market opiods expensive as hard as we can, and OD deaths have still trippled in the last few years. It's not working, and even if it were, I don't think the external costs are this are morally acceptable.
People eat or drink to compensate for other things. Happens with heroine, too, sure. But for some the right drug at the right time is medicine, to get their life back in balance. If you have more options than just overeating or overdrinking, then your chances are higher that you find, what you need to get on with your life ...
Well because we don't live an idealized Ayn Randian universe.
Unless someone moved off the grid, cut off all ties with society, and is on a boat in international waters, or some uninhabited island, they are part of a society. They might not like it, but they are.
If they have children, parents, siblings. They are part of the family. If a parent, is using drugs and not providing for their children, I don't think it makes for a healthy society to watch from the sidelines and say "That's ok. Everyone is responsible for themselves. The gospel of Ayn Rand says so. So let the children starve".
That doesn't advocate incarcerating or punishing anyone. But it advocates helping. And it is, and I think should be, a major obligation. At least I would happily spend my tax money on.
> The libertarian case for legalizing drugs falls apart if society has to take ...
It does fall apart. But making sure the liberatrian cause survives and is proven correct, is not a priority. What is a priority though, is making sure children have safety, shelter, are clothed, are not hungry etc. If, as a result, the libertarian cause must falter and be proven to be a joke, I think most people will be ok with that. (Although it seems here on HN quite a few would be rather distraught).
Perhaps if all drugs were legal, people would be able to find less harmful drugs instead of being forced to abuse what's currently legal, and medical costs would go down. I remember reading an anecdote about a guy who stopped drinking by taking occasional painkillers. It scratched the same itch, so he didn't feel the need to drink. Of course the reaction was "this guy is just swapping one addiction for another, and he's going to end up dead with a needle in his arm." But I would much rather have someone dependent on opiates than dependent on alcohol. I can't help but wonder if millions of alcoholics could get sober with, say, a daily dose of Buprenorphine.
Seems like more choice would be a good thing.
In a completely free market, there are no labeling laws, and no way to enforce purity until after someone has died or been harmed by a bad product and has an estate or next-of-kin capable of suing the producer. And that, of course, assumes the producer is both still in business and is going to be dissuaded from making bad product just because it lost one lawsuit, which might only amount to less than one percent of its total income.
I'd rather avoid that.
An interesting related question would be whether people prefer to err on the side of type 1 statistical errors or type 2 errors, and whether the balance of errors would change under a more free-market structure.
Yes, they allow multiple competing agencies, each of which approves a different list of products, none of which is obligated in the slightest to reveal who pays for what.
Libertarians love to rail about regulatory capture, then they propose a system where companies can literally secretly own private regulatory agencies.
> Do not forget that there have been drug and food safety issues under the FDA's watch, and each time, there has been little to no accountability.
You have very little idea how bad it was prior to the FDA, in the snake oil era, and how much the FDA does to ensure safe and effective medications and foods.
Yes, it's imperfect. The solution to imperfection isn't to tear it down and start over. It's to fix what's wrong, to invest the time and mental effort to improve things. Yes, this is harder than just letting the businesses run the whole shop. However, we tried that, during the Gilded Age, and it didn't work, so now we have to improve a system we know works better.
"Agencies" is probably the wrong word. "Companies", maybe. In any event, and organization like that lives and dies on its reputation, so I doubt it would be any less rigorous than the FDA. Probably more.
>You have very little idea how bad it was prior to the FDA...
And you do? You're looking at what the FDA has prevented (thalidomide being probably the biggest win), but how many people have died as the drugs they need remain mired in the FDA's bureaucracy?
Free markets only work if there is good and efficient law. Indeed, David Friedman has written extensively on this very subject. His "Machineries of Freedom" is excellent.
I just said they allowed torts. I also explained why torts alone are insufficient.
It may be that both are required. It may also be that regulation or other public safety standards are necessary for the proper operation of tort law.
And please remember: alcohol is a drug. A very very bad drug.
Replace drug use with something else and you get to the basic question of society. "Why should someone have to support someone else?" - a philosophical question. You have to decide for yourself what the answer is - for me it is simple: Because helping others is what society is all about, without that we are nothing more than individuals in an "everyone for himself!"-scenario, which doesn't strike me as the kind of place I want to live in.
You argue that someone's actions should not create any obligations for support. But that denies the interconnected nature of society. If someone gets injured and is unable to work, and has the misfortune of living in the United States (as opposed to Canada or Australia) then he cost of fixing them may be unbearable, meaning that a potential useful human life has now been subjected to the sidelines, rendering them unable to contribute to society. Thus we have a responsibility to provide safety nets to restore them to health and a functional member of society.
In the same way, addiction and substance abuse damage otherwise useful members of society. Not everyone will fall so far from the tree, but we have a responsibility to provide the institutions necessary to try and get them back on track. When you're talking about illegal drugs, the best way to do this would be through funnelling taxation revenue from sale of previously illegal drugs into rehab and outreach programs (as with THC sales in the Netherlands, where 99% of hard drug users are linked in with social services).
It may turn out to just be quibbling over the meaning of "responsibility", but I don't see how that follows. I can see saying that it would be beneficial / nice / good / useful /etc. to "provide safety nets to restore them to health and a functional member of society". But saying "responsiblity" - to me - suggests a degree of obligation that I don't accept.
This implies a commonly held value structure that prioritizes fuller utilization of human resources. Beyond the in-thread demonstrated non-universality of this particular metric, which raises the question of how and whether to apportion responsibility among ideological dissenters (by force? by opt-out choice? by opt-in choice? casuistic contract negotiations? (only the first scales with low implementation overhead)), "responsibility" does not exist in a vacuum. If one is responsible for something else, one is obligated to affect it. If one is to act to modify with legitimacy, one must have legitimate authority over the modified. Therefore, responsibility for the welfare of others implies authority over the status of others. Mutual responsibility thus creates mutual authority, which is a breeding ground for collisions of contrasting decisions, and thus conflict. Because effective decision-making systems nigh by definition reduce the possibility of conflict, executors of explicitly overlapping authority generally must be trained in the harmonious interaction of their jurisdictions. It is difficult to train nation-state scale populations, thus particularly in harmonious jurisdiction overlap. The rules for interaction must then be so simple as to be (or become) obvious and heuristic.
What simple rules do you propose to effectively avoid mass conflicts of authority between humans with the full distribution of domain competencies displayed in a nation-state population, e.g. that of the United States of America?
Individuals are in society with one another; there is no such thing as "Society," in the collectivist sense.
> Frankly, most people would rather continue to ban drugs than pay for treatment for people who abuse them.
But what happens is that they get both. They ban drugs and pay for treatment. And they pay for the consequences of the criminal activity behind drugs. The property crime and violence and all that.
The consequences of drugs get so out of hand because of the legal status. People who use illegal drugs have to hide and so they don't get the help early enough, if at all. They also have to interacts with criminals, and are exposed to additional risks, like not knowing what the heck they are actually putting in their bodies.
The libertarian argument against prohibition boils down to this: The government can't stop people from doing anything, it can only punish people after they've done it. Substance abuse is something we'd really rather people didn't do, but punishing people after they've done it doesn't help anyone. Therefore, substance abuse shouldn't be punished.
It's also worth noting that most libertarians aren't fiscally conservative capital-L Libertarians. Most of them do not have a problem paying for social services.
I am not a libertarian, but I have worked in drug policy reform advocacy groups, and a number of my colleagues were libertarians. This is not at all an accurate description of the prototypical libertarian argument against prohibition.
If drugs become legalized, the system that gets created will not fit the libertarian vision.
What happens if someone is irresponsible and they drive recklessly, ending up in a rolled over car in a ditch somewhere, trapped. Should society just say "well, they brought that on themselves, fuck 'em"? As a society we've decided that the appropriate thing to do in such situations is to expend collective resources to help them, providing rescue and hospitalization as necessary. Just as when someone recklessly mishandles flammable materials in their home and burns their own house down. Just as when someone decides to commit suicide.
There is a social responsibility to help one another, and we've consistently bought into that responsibility along many fronts, even when individuals get themselves into trouble through their own errors or choices. In the long run it turns out to be a net benefit to society for a lot of reasons, because often times it can put people on the path to turning their behavior around, and often times people make mistakes and learn the error of their ways. Also, addressing social responsibilities earlier (in this case, at the addiction stage) can save money down the road by avoiding the costs of other social responsibilities later (e.g. emergency medical care). But if society doesn't reach out then those people may not get that opportunity to become productive members of society, and they may end up seeing a society that doesn't value them and is adversarial to them, which is an encouragement to reciprocate.
According to a Harvard Medical School study, nearly 35% of Medicare patients were prescribed an opioid from more than one doctor at the time of the study, and 1/3 of this group got opioid prescriptions from four or more doctors. Is this not creating obligations for the rest of us?
You would think that you pay the costs of law enforcement to enforce drug law, but many police forces are underfunded and rely on profits from seized drug money and speeding tickets to fund themselves.
Where did you detect this suggestion?
> The libertarian case for legalizing drugs falls apart if society has to take responsibility for providing support systems as a reaction to the actions of individual drug users.
That's also where the libertarian case falls apart for legalizing cheeseburgers, and motorcycles.
From evincarofautumn's post:
> However, while proceeding with legalisation, we must also establish better social support systems so that people can safely enjoy drugs in moderation.
Those social support systems will cost money. They will have to be funded by taxpayers. Unless they are cheaper than the current system of enforcement and incarceration, people will not support them. Furthermore, it is more politically palatable to punish drug users than to help them. People will be morally opposed to these support systems, and will use them as a reason to oppose drug legalization.
> That's also where the libertarian case falls apart for legalizing cheeseburgers, and motorcycles.
Drug legalization is a political debate. This is about practicality, not pure logical argumentation.
There is no political argument for legalizing cheeseburgers and motorcycles, because they are already legal. Nobody is attempting to change the status quo.
If we want to legalize illegal drugs, we will have to convince people to change the status quo. Changing the status quo, which is the default position, requires evidence that the suggested alternative is superior.
Why couldn't private industry or charities provide such services?
Perhaps this is not so evident to non-drug-users, but harm reduction/prevention is a very important component to using drugs safely. Along the lines of, "always use protection," and "don't drink and drive," drug companies can make helpful use guidelines like "don't mix this cocaine with that amphetamine capsule" and "don't share your needles with your buddies" and then implement services/programs to ensure the success of these guidelines.
Ask anyone who's smoked weed for more than a decade (and outside of California) what it was like to buy weed before legalization and medical marijuana became a thing. They'll tell you that you had usually no idea what kind of weed you were getting, and you had to be happy with whatever the dealer gave you. Today? There's a fucking weed strain review startup called Leafly.com and it's helpful!
The point is that as drugs become part of the mainstream due to our ability to perpetuate good use habits, support the procurement of high-purity substances (thanks to the dark net), and the legalization efforts in many parts of the world, harm reduction and addiction support services will crop up to address the new challenges presented. Whether the government forces this upon us, or if the industry does it itself, it will happen due to the huge number of stakeholders that directly benefit from doing so.
Will they? The illegal drug market currently drives prices far above the cost of production. You could probably tax any drug at 300% and it would still be cheaper than illegal alternatives. Legalizing drugs and providing support may be a net revenue generator.
Now, there are cost-effective ways to solve these issues and they happen to be humane, too: support people with issues they have immense difficulty overcoming themselves, include them in society, do not stigmatise, create support structures. It's effective and carries a short-term cost.
The alternative solution to the problem is not cost-effective, not humane and in fact, not very effective: criminalise a person's problem, push him away into the worst corner of society (prison), stigmatise him (prison), fine him, take away his opportunity, and expect him to resist a drug that has a hold on his brain every waking hour without help. It doesn't work and carries a long-term cost.
And that's just the individual, let's not get into the side-effects of criminalising drugs. (I welcome anyone to look into the Mexican drug war which has taken the lives of more than 100 thousand people in the past decade, and is at least partially rooted in drug policy of various American countries including the US)
Further, I think it's important to stress the limitations of self-control. For example, we don't expect an orphan to take care of himself. We argue, because it's a kid with no level of responsibility or maturity. The libertarian case of self-responsibility does not apply here, based on the biological limitations of a kid's brain. But it's important to consider that people under the effect of drugs or addictions are also to a large extent, not a similar extent but a substantial one, emotionally/biologically limited to take adequate self-responsibility. The solution then isn't to say 'you're an adult, so get over it and take responsibility', when your brain simply has a hard time, not by choice, to act in a way that you know is rational. And in this way an addiction is similar to many other forms of disease. Similarly a depressed person can not 'just' take self-responsibility and get over it. What remains then is the argument 'but before you got addicted, you should've known better'. And that is the worst argument. For one because people don't get addicted by some clear choice, some are ignorant, some are exposed to drugs as very young children, some use it after experiencing extreme trauma. And even if you should've known better, I don't believe the solution is to withhold support as a form of punishment for the sake of punishing a bad action, that makes no sense to me.
I agree. However, I’m talking not only about treating addiction, but preventing abuse in the first place.
The first line of social support is made up of our friends and families. Outreach and education could foster better attitudes toward mental health and addiction, and reduce the systemic effects of stress and loneliness. Rehab is very late in the game, and it’s much more difficult and costly for everyone involved.
You're absolutely correct about social support: when I finally kicked the habit (about 3 years ago), I was only able to do it because I switched jobs and made some new friends. The stress of my previous job combined with the loneliness of being isolated from all my friends were, in retrospect, huge players in my alcoholism. In fact, once I was in that new position, I found it remarkably easy to reduce my drinking to social norms.
Nowadays, I hardly even drink at all. I haven't had a drink since before Thanksgiving, and I don't even think about it anymore.
Hang in there. If there's any way I can help, let me know. I'm a fellow PL enthusiast and designer (I still refer to one of your concatenative programming articles now and then, thanks for that!), so perhaps we can chat sometime :)
Work stress and loneliness were big factors for me as well. I moved across the country with no support network, then went through a difficult breakup. Changing jobs, finding new friends and hobbies, and meeting a new partner who has also dealt with addiction, have all helped enormously.
I am still working on Kitten, and it would be a great help to chat about it, as well as whatever you’re working on. Feel free to email me, or star the repo on GitHub and I’ll include you in the pre-release announcement—soon, hopefully!
But then I begin to think about consequences of car crashes (be it to me or to someone else), about cigars. Some countries already treat that, assuming it's a thing that the society wants. And it easily goes to bed eating habits, and I think that the line goes too much to the other extreme.
Then I conclude that people from each country, each nation, or even each state/city, has a common sense on what is acceptable or not: the society from that circumscription decides when to pay for individual damages (treatment, support, etc), and for which source of damages.
If cars provide more benefits than costs, decide to support it. Drugs? No. Cigars? Yes. Nuclear power plants ? Yes. And so on....
In other words, how do you want a society work where you or a family member might have a strongly prone to addiction? Do you want a society that tries to neutralize such affects so that they can still be functioning members of society? Or do you want only the whim of charity and profit motive of private industry to take care of them? I think the latter very clearly has all the wrong incentives for a stable society. It's classist, and it ignores that everyone has defects of some sort or another.
which just proves once again most people are idiots.
Very few people in society care about the libertarian case.
> Frankly, most people would rather continue to ban drugs than pay for treatment for people who abuse them.
Is that so? I'd estimate that the number of such people is not very high, and is dropping.
Oh, wait...
I typically cut loose a bit over the holidays, as I’m seeing friends and attending parties, but I try to remain mindful that it’s not to be an everyday thing, especially because it interferes so much with things I want to do—work, hobbies, and relationships. A useful strategy for me is to create obligations that preclude me from drinking excessively, such as being DD.
The same is true for alcohol, prescription medication, illegal drugs, and many non-drug products like food and materials goods. Businesses, legal and illegal, have an incentive to promote addiction that caters to customers short term desires but not their long term happiness and satisfaction.
The ultimate manifestation of this is the horrors inflicted on China from opium sales.
So we are stuck with a balancing act. Black markets create violence. Free markets create addiction. Planned markets create poverty. We need laws that try to balance these problems against each other and find the best mix of incentives to minimize violence, addiction, and poverty.
Rates of alcoholism went up after prohibition but alcohol-related crime went way down.
Also, I've always thought this comic about Milton Friedman's predictions about drug prohibition explains the issue very well:
Attach stigma to it, like we have done with cigarettes (though not e-cigs...). The art / film / literary world will still try to make it sexy (rebellious) on occasion, but without full on marketing it's unlikely you'd see widespread use.
Possibly tax it, although I'm not 100% onboard with that, since it would eventually motivate government to lift the marketing restrictions.
For anything that's instantly addictive after one or two uses, perhaps it would be possible and worthwhile to try and create a diluted version that's safe for people to try it out without completely destroying their life.
I think you said it yourself - not to be snarky or anything. But someone has found a way to get rich, and they use their funds to lobby to keep the current system in place.
http://thinkprogress.org/politics/2010/09/16/117661/sb1070-p...
http://ordinary-gentlemen.com/timkowal/2011/06/the-role-of-t...
At my (very highly regarded) university in the UK you'd see this all the time. Pick up bigger bits, resell to friends, keep the "profit" for your own fun.
Instead of lobbying, what you should have is just hearings. The companies could still be free to offer a witness for the hearing, but it's all going to be public, and it's going to look weird if all of your witnesses are corporate people or all are from law enforcement agencies, when debating a new issue/bill.
Open debates in public hearings where multiple politicians participate beat backroom lobbying deals any day.
In reality when you have a country of 300M, a single voice is so tiny as to be not worth speaking up. If you are in a town hall meeting it's completely different.
Which is why democracy doesn't work when you get too big. The top governmental level is too removed from the individuals as to be entirely oblivious to it. Citizens feel powerless and the corporations bypass the elective system by going straight for whoever is in power right now. The special interest power in concentrated and the benefit to them from legislation are obvious while the power of the people is disperse and the disbenefits dilute so nobody 'feels' the pain of a tariff or a corporate tax.
Governments should be kept small and local.
That doesn't change the game theory aspect of everyone chasing their own interest, and a small minority who cares a ton about an issue over-riding a majority who only cares a little. (Prison owners know 100% they'll benefit, while most of the rest of us assume we won't have 3 strikes against us)
In 1994, Bill Clinton passed a crime omnibus bill (with Hillary Clinton advocating for it) which established a federal 3 strikes provision. Separately a number of states passed their own 3 strikes provisions. It is easier to hit 3 strikes under local law than federal so local bills put more in prison. But the Clintons now acknowledge that their bill is responsible for a big chunk of the increase in mass incarceration, particularly for blacks.
Of course Hillary flipped on the issue in the last 2 years when she realized that the Democratic electorate no longer supports "tough on crime" legislation.
For the record, Bernie Sanders voted for the exact same legislation, despite giving lots of speeches denouncing mass incarceration. However his voting record shows that he began voting against increased punishment in 1999. So both flipped, but Sanders did so much earlier.
To add to this, there was actually a huge groundswell of support from black communities in the 90s for toughening enforcement of (and punishment for) crime, including drug-related crime.
In retrospect, the policies were a complete disaster at achieving their original goals, but it's rather frustrating that the 2016 dialogue completely ignores the context in which those laws emerged.
Yes, 90s-era crime laws are largely responsible for mass incarceration of black Americans today. But it's not quite correct to portray the decision in the 90s to support those laws as a political decision against black Americans. At the time, it was perceived by many black advocacy groups to be the necessary response to the devastating effects that crime was having on their communities.
Completely aside from that fact, I do agree that it should be treated as a public health issue. Not a criminal matter.
The 18th amendment was added to the constitution not by some legislative need, but to make a politicized statement where another amendment to the constitution would be required to overturn it (the 21st in this case).
That's not really the case. At the time of the 18th amendment's adoption the prevailing legal interpretation of the Commerce Clause was that Congress lacked the power to regulate intrastate trade. So Congress could have prohibited the sale of alcohol across state lines, but could not prohibit the sale of alcohol within the boundaries of a state, and certainly could not have prohibited its production. It wasn't until 1942, in a reaction to Roosevelt's court packing scheme, when the Supreme Court reversed its interpretation and ruled that Congress does have the power to regulate intrastate economic activity (i.e., the production of a good that is not necessarily sold), giving us the modern legal interpretation of the Commerce Clause.
No. This is all the constitution has to say on the subject of regulating commerce:
"The Congress shall have Power... To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;"
The constitution gives Congress the power to regulate interstate commerce. It does not give Congress the power to regulate anything within a state's borders, which was why alcohol could not have been banned without the 18th amendment.
The reason we have federal drug laws is the courts have been willing to simply ignore the text of the document for political expediency. But this didn't start happening (in the case of the commerce clause, anyway) until 1942 with Wickard v Filburn.
The intent was probably to protect other states from circumstances wherein California could determine the emissions requirements of their cars and Texas could determine the content of their textbooks.
The clause, as intended, would have allowed the Uniform Commercial Code to be federal law instead of identical legislation passed by all 50 states. But it would not have allowed for the aforementioned political expediency.
The 18th was a different sort of action. If I recall correctly, it was reasonably well known that nothing short of an Amendment would suffice. Either that or Wayne Wheeler just wanted to see if it could be done.
Recreational substances have been a favorite moral panic for decades. Even in the 1980s (crack cocaine moral panic) and to a lesser degree the 1990s over MDMA. And this goes back a long way: think reefer madness in the 1930s, the racially tinged moral panic surrounding the Harrison Narcotics Tax Act, etc.
I know some people in the comments below are pinning more blame on the bad laws on lobbyists and entrenched interests, that's certainly partially the case (it's certainly open for debate how much they contributed to creating the moral panic even). But I would tend to put more blame on the moral drive behind many of the laws themselves. Moral panics have a nasty tendency to create harsh legislation that often creates more problems than they solve. And while there are entrenched interests defending the War on Drugs, at one point they were popular entrenched interests. No one is going to overturn legislation when 79% oppose even marijuana legalization, as is the case for this poll in the US in 1988:
http://www.people-press.org/question-search/?qid=195853&pid=...
To get the "political will", I feel that you have to counter the moral panic that has led to these bad laws (as well as the perception in the public mind) with "just the facts" on these compounds (most aren't as bad as the demonization would have it)... combined with demonstrations of the harsh consequences of these laws.
That's already happened to some extent... in 2016, a majority support marijuana legalization. There are more articles then ever on the high cost of our incarceration policy, and there's even greater awareness of how our drug policy has contributed to international violence.
I'm not sure that all Schedule Is will ever be legalized fully (personally I'm on the fence with many of them on to what degree they should, since some might indeed pose more of a risk to public health than it's worth). But if only the incarceration policy was adjusted to more of a treatment based one, that would do a heck of a lot.
Because there's a hugely profitable industry in the policing, prosecution and incarceration of people
Universal basic income just makes too much sense.
1) Racism. In the early part of the 20th Century, various drugs were made-to-be-correlated with "undesirable minorities". This very much in sync with the impulse from William Randolph Hearst ( who owned a huge ranch in the Mexican state of Chihuahua and was partially responsible for an invasion of Mexico to go after Pancho Villa ).
2) Out-of-control heroin use in Vietnam inspired Nixon to first "golden flow" test returning service(wo)men and then declare the War on Drugs.
2a) Doctors in the '60s and '70s prescribed many, many, many pills. See also Betty Ford ( the person, not the clinic ).
3) Drug users are the perfect out group. It's possible to construct all sort a narratives out of this, so it's far too politically useful to do anything pragmatic. And people who don't know anything about drugs are then entitled to feel superior to those who do them.
Criminal laws create self-enforcing social norms to discourage undesirable behavior. Making something illegal is one way of society condemning that activity. Ideally, the social norm itself drives compliance, not enforcement. E.g. it's the social norm that keeps people from stealing, not the threat of getting caught. If people started ignoring the social norm at a large scale, law enforcement would have no hope of stopping them.
As a general principle this is sound. E.g. making eating and drinking on the metro illegal has worked pretty well in creating a self-enforcing social norm. Hasn't worked that way for drugs really.
The first is easy to accept because the limitation is easy to escape. The second is much harder to accept because the law is reaching far into private spaces and private aspects of our lives, all day, every day. And with that comes the purported justification for monstrosities like dynamic entry raids. That purported justification is very circular: Because you could have drugs only in your private space, you might be able to destroy them before they can be seized. And that drives malign legal philosophies that claim that supposedly valid warrants can reach anywhere. Without a Drug War we would not have 90%+ of the SWAT teams, routine dynamic entry raids, police militarization, and super-aggressive plea-bargain driven "justice." Nor might we have questions about whether we should have reliably private communication and data storage.
You are not counting the extent to which drugs have rotted the law from the inside. Never mind the anti-freedom thing, the Hobbesians ought to try and hang the narcs for poisoning Leviathan herself.
You say you don't understand why drugs are illegal. I think this is your core misunderstanding.
You are not the most anti-drug person I can find. I've never used alcohol or cigarettes (I didn't even use painkillers when my four wisdom teeth were taken out), and spent the majority of my life admonishing the use of caffeine.
I am not even anti-drug compared to most Americans. A substantial portion of America believes that using drugs (illegal drugs only, of course) is _morally wrong_. That is why they have favored sending people to prison instead of rehab. Because it is a violation of the social contract they favor to be under the influence of such substances, and that by using them you are no longer able to execute your duties as a citizen. And you aren't. I don't want you high on meth when you vote. I don't want you high on pot when you drive. I don't want you coming down from heroin when you serve on a jury. Those actions have consequences, all actions as a citizen do, because we cannot isolate from each other. Breaking those commitments _could be_ considered morally wrong, and not just from puritans or fundamentalists.
And being under the influence of marijuana while operating a vehicle is illegal everywhere, even where it is a legal substance. DUI is not limited to alcohol.
EDIT: my position, which would typically be described as extremely pro-drug, is largely due to my discomfort in treating medical personnel as de facto agents of the government on drug policy without requiring medical experts judge at trial for drug crimes like they do for malpractice proceedings. Essentially you have the people who decide what drug use is legal and illegal having no competent oversight -- we are in a nation with functionally no drug laws to the influential or wealthy enough to locate a doctor amenable to their suggestions, so why not at least offer everyone the same freedom until a more coherent policy is found?
Some may refer to this as "microdosing" but I think this gets it backwards. If anything, drugs are useful tools that can also be "macrodosed" by those wishing to experience extreme effects.
I would like to live in a world where all drugs are legal and people can use them to enrich their lives, not just escape from them.
But of course, there is a connection, because people tend to force that high so much, that they just do too much ... and also forgetting that you can't be "high" forever. What goes up, usually comes down.
(just being pedantic, in general I agree with you)
... I think OP was using those examples because they're the stereotypical horror story drugs, but their analogues are everywhere.
Heck, you can get drugs even in prison. If the government can't stop that, how can they possibly stop it in the rest of society?
The government legalizing drugs and taxes them heavily. AT some point the cost of the "good stuff" is going to go up and eventually cost more than the street stuff. It's already happening in California and Washington. Street dealers have seen little if any dent in their customer base.
Legalizing drugs is not the answer, it just makes them more readily available. The same people who wonder why pot is illegal and alcohol is illegal because alcohol kills more people every year - are arguing the same thing for legalizing drugs. At some point, there is no long term benefit unless you count the millions in tax money collected.
So then you have to ask yourself, do the tax revenues outweigh the benefits of legalizing all drugs? Surely more people will die if their legalized, just as people argue is the case with alcohol today.
For example if you say legalize X can companies now put X in soft drinks as an ingredient? Can children be served X? X was probably not even illegal in the first place but just restricted.
Restrictions can be good (guns are clear example of what happens with out restrictions).
http://www.opensecrets.org/news/2014/08/money-not-morals-dri...
> Alcohol and Beer Companies.
> Pharmaceutical Corporations
> Police Unions
> Private Prison Corporations
> Prison Guard Unions
http://www.businessinsider.com/police-unions-and-pharmaceuti...
> Pharmaceutical companies that make billions off painkillers and police unions are two big heavy hitters in the fight against marijuana legalization. They throw their monetary support behind groups that fight legislation that would legalize pot — even medical marijuana — and lobby Congress.
http://www.msnbc.com/msnbc/presumed-guilty-how-prisons-profi...
> Yet in documents the company is required to file under securities law, Corrections Corporation of America has told investors that its business may be hurt if new policies advance “leniency in conviction or parole standards and sentencing practices.” And in a 2010 report, CCA declared that “any changes” to harsh drug sentences could stem the flow of new prisoners in the U.S., reducing “demand for correctional facilities to house them.”
https://www.washingtonpost.com/posteverything/wp/2015/04/28/...
> The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction or parole standards and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them. … Legislation has been proposed in numerous jurisdictions that could lower minimum sentences for some non-violent crimes and make more inmates eligible for early release based on good behavior.
Who wants to be the demon that wants to make drugs legal? The opposition would eat him alive! It would be tantamount to suicide.
If I had the choice of releasing a murderer from prison and putting one of those politicians there, I would take it: The chance of a murderer carrying out another murder is extremely low, but such a politician have a history of continuing to cause massive harm to others with these policies.
And yet - there are a vast array of things to do with one's time that many people would probably enjoy and/or benefit from, but we simply don't have enough hours in our lives to investigate them all. If someone believes that my kind of fun is not for them, my inclination is to respect that choice, regardless of the reasons behind it, because we have to decide not to do most of the possible things in life and thus the reasons for rejecting many of them will necessarily be somewhat arbitrary.
Sorry for my dickish attitude. I mean, I completely agree with you, but this is the sentiment held by most HN and Reddit users, and isn't even that directly related to the article.
We know the War on Drugs isn't good. We know it'll take a while to eventually cut back on it and adopt harm reduction over zero tolerance. No need to bring it up every time.
Let it be. We are good as it is. I personally have suffered from an excess of Marijuana and Alcohol and its not pleasant. I've since totally given up smoking for a year (but the Alcohol continues). Why? Because Alcohol is freely available.
I don't see what this has got to do with the topic, namely that a legal drug is killing 19,000 Americans each year while making many more addicted. I was expecting to read some suggestions on how to address this problem.
All the Asian countries I mentioned have more draconian drug laws, less crime and less drug usage rates than the European ones I mentioned (along with the United States).
It's easy to dismiss my argument by calling them corrupt and their statistics misleading. It's another thing to actually refute my argument with facts and figures, which you haven't done.
In addition, there was a recent study showing that harsh penalties and rates of drug use are not correlated. http://www.theguardian.com/society/2014/oct/30/punitive-drug... If you think that particular countries have unusually low rates of use, then you may be just wrong because of misreporting, or it could be to do with other societal factors (eg. children having to live at home longer with parents because of social norms or housing issues).
You should also remember that by far the most widely used illegal drug is cannabis (93% in the UK), and it's almost impossible to die from cannabis. About the only way I can think of is if a block of it drops on you from a smuggler's aircraft. So just looking at deaths from drug use isn't so interesting. There are other ways that drugs are both productive and enjoyable, and can be damaging.
Your argument is like saying that we should make insider trading legal because people still do insider trading. Or that we should abandon financial laws and regulations because the great recession happened in spite of them. This is incorrect. Regulations prevent financial collapses. If harsh punishment were distributed to everyone who engaged in corporate crime then corporate crime would plummet. And I truly believe that if affluent white kids had a real, tangible threat to their short term well-being in response to drug use then we would see a massive decline in their drug use. I know that HN hates this opinion but I'm just being honest. Go ahead and hate me. Downvote away.
"When it comes to boredom users though, it's hard to come up with a solution besides punishment."
Wow. Why should 'bored' people who use drugs need punishment?
You shouldn't mix me up with prohibitionists and Christians. I only want to prevent unnecessary suffering. Heroin and other very hard drugs only cause suffering and death. I have seen this first hand. That's how I know. People seem to hate me personally for having these opinions and I can't imagine why because I only have the welfare of other people in mind.
edit: I have looked through some of your comments. At one point you posed the question: what is the difference between letting someone eat cheeseburgers and use drugs? You practically make my point for me. Regulating the contents of food is extremely effective in reducing health problems. It has been done with success in many places. Saying that hard drugs (not weed and the like) should just be legal is like saying we should let food companies put anything they want into their foods and by extension let people eat whatever they want. Obviously, everything is much better when we regulate our foods.
Look at other countries and you can see that decriminalising it has no positive impact on the actual addicts. Austria for instance will just slap you for drug usage and put you into a rehabilitation program. But there are just way too many people who want to be hooked to them and will continue taking them under doctor's supervision and not succeed in stopping their addiction. This has a terrible impact on the healthcare system and the costs to the country. Not helping them however would not be any better because too many would end up on the streets.
Recently they tried to make "dealing to a friend" possible where the first offence of dealing drugs will not give you a strong punishment and record. The end result was that dealing went up in Vienna and people are now very unhappy with the end result.
I know many Americans like the idea of decriminalising it because the war on drugs is failing, but there is quite a bit of evidence from other countries that there is good reason drugs are not legal.
That's not true though, they're not in prison. Though I've heard prison in Austria isn't as draconian as American prison.
But decriminalization is a half-assed solution. I think it is better than prohibition, because it doesn't result in treating the ill like criminals and doesn't criminalize responsible experimentation, but it only addresses a few of the deficiencies of prohibition.
We need legalization. This will help to combat the illegal distribution chains, which is where most of the real malice is found. It will also give the public a direct means toward helping addicts by regulating the drugs themselves. Regulation can combat overdose by having standard dose sizes so that users know exactly how much they are consuming. It can also guarantee purity — most of the damage to health that a lot of drugs cause, especially meth, are due to toxic impurities.
And instead of shoving addicts into rehab, we should accept that not everyone wants sobriety and you simply can't force it on them because they'll go right back to doing what they want. If you want to address the drug problem you have to accept that. Don't make people do things they don't want, instead, offer them the opportunity to do something they do want. Addicts want to have jobs, or at least some of them do, in order to pay for their drugs. So offer a program to help addicts manage their addiction so that they can be effective employees, and then just give them a job, without the pretense of helping them stop their usage. If you can get addicts back into society, and put them in a healthy environment where they have stability and a purpose, eventually some of them will want to expand on that positive part of their life and might even decide to go to quit completely. Even the ones who don't choose to quit, at least they're being productive, and they're in the care of experts on drug addiction. And the addicts who have no interest in a job will be affected indirectly as well, because addicts associate with other addicts, and if you can get a lot of addicts off the street, it will change the dynamics on the street as well. You can curtail the camaraderie between addicts, who's reciprocity enables them to have a stable source of dope without a stable source of income.
These programs would be expensive, but they can be funded by the money not going into enforcement of ridiculous laws and the taxes from selling drugs.
Also, your last sentence is unsupported. What evidence? What good reasons?
The issue is that many opioids and non opioids gap between the therapeutic dose range and LD50% is often dangerously narrow.
Complication #0: serum bioavailable molecule assay is rarely monitored. People metabolize and clear drugs at vastly differently rates.
Complication #1: Hospital mistakes still happen quite frequently, despite many measures to prevent them, especially with inexperienced and overworked nurses/assistants.
Complication #2: cummulative dosing error or interactions, especially multiple, independent prescriptions for similar opioids with different administration routes (patches, sprays, pills, injections)
Complication #3: overprescription of opioids because they're cheap, especially to veterans, which also leads to prescription and hard drug addictions.
Solution: opiods need to be singularly controlled at home or in the hospital by an integrated, blood/interstitial fluid measuring/dispensing unit to avoid OD and push back on abuse.
Plus, anyone taking opioids should also have narcan or equivalent antidote readily available, and wear a medalert QR code bracelet which lists relevant conditions and medications should they be found unresponsive.
Finally, avoid painkillers as much as possible and take the least dose which reduces stress level.
It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom.
Thankfully, the metamizole they kept filling me up with is not nearly as addictive as opioids and we have free health care, so I didn't have to pay a dime for the repeated blood analyses and CT it took find the cause. Otherwise I'd probably have bigger problems right now.
To be fair, this is related to the symptom you're asking them about. Pain often occurs with no apparent cause.
As an extreme example, it is normal for amputees to experience the sensation of a "phantom hand" where their hand would be if it hadn't been amputated. The phantom hand can feel pain. I'm fairly confident that there is nothing physically wrong with the hand someone doesn't have, even if it is in pain.
His latest work has been investigating body integrity identity disorder which is sort of the opposite of phantom limb: where you feel like a part of you doesn't belong.
I believe this gist of the work is that there is a mapping between our body and our brain (this is what enables one to 'know' where your body is in relation to itself when your eyes are closed) that sometimes is overloaded or malformed and can result in these issues.
http://www.webmd.com/pain-management/tricyclic-antidepressan...
In middle ages, millions dies of plague 'with no apparent cause'. I guess humankind just said 'ah, these things happen, let's not investigate further'. </irony>
If you have pain and you know why, you'll generally volunteer that information to your doctor. If you have pain and you don't know why, they will look at the area that hurts. If there's nothing obvious there, they'll give you painkillers, because all the safe money is on the idea that no matter what they try, they'll never be able to eliminate or even identify the cause of the pain. This is what you want them to do.
Looking at it from the doctor's viewpoint: Does this patient complain a lot? Is this complaint important? Hard to answer, expensive to find out with current technology and discoverability of relevant knowledge, techniques and advances is an everyday battle that hasn't been addressed consistently.
Some patients, like my grandmother, avoided complaining to not seem "fussing" when she dismissed heart disease as indigestion, ultimately had to have a quintuple bypass and coded three times in the OR. Slowly, she came back but it gave her back more energy than the previous decade and she's still alive.
well, we're not, and unless you are billionaire/us president, we won't get there in our lifetimes, nor our children's. fiancee is an internal doctor in one of biggest hospitals in Switzerland (read - you don't get much better public healthcare anywhere in the world), and they are
a) overwhelmed by amount of people, especially old whose bodies are just a massive clusterfuck of issues - welcome to being old. all they try is to keep them somehow alive when today this was failing, tomorrow that etc. there are simply no resources in medicare to treat your non-fatal condition which doesn't stem from something obvious.
b) 50% of people are sometimes in pain. each body is unique. what makes one thrive brings other to its knees.
c) as said here before, doctor's role is not detective investigation, that's research. doctors these days are overwhelmed with patients and must prioritize their incoming queue, even if it's with somebody's pain. Every patient also means hours of bureaucratic hell, same for incoming as for outgoing ones. that's why rich people have private health care - it's not about having best doctor available (same as you don't find brightest IT people in say SAP consulting), it's mainly about having someone dedicating as much time as needed to you.
I wish it would be so too, but that's simply not reality now
So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days, I would still suggest significant pain be checked out and a doctor you are paying should help look into it.
Chronic pain lasts for years, or forever. An incredible amount of effort has gone into understanding it. We can't blame practitioners for knowing that they don't understand pain and aren't likely to in the future, and therefore deciding to treat it with painkillers.
New Metal Gear game?
As I grew into adulthood, I knew the pains I experienced were directly related to my condition, and it was my desire to not really 'cloak' the pain, but avoid it in the first place. Preventive if you will. It helps, but it's clear to me that I wanted to be healthy, and if I have to occasionally take something, so be it. Naproxen sodium has worked quite well of late.
The point of all this rambling is that I simply don't want the hassle of becoming addicted to pain pills. Or sleeping pills. Or nasal spray when it's allergy season. I've lived with pain so long for my life that I'm kind of used to it, and I do say so as a point of pride. It's the body I was born with and it's the one I'll have to use for this gig, take care of it.
I don't fault people for wanting pain treatment. I think the way the system was set up with pills flooding the US was incredibly destructive, and highly indicative of the dangers of for-profit medicine as a system. Toss in the DEA's drug laws and it just turns patients into criminals and that benefits only a very limited group.
When I eventually started seeing commercials on TV for a treatment for opiod induced constipation all I could think about was Trainspotting and that we have a real, genuine problem on our hands in the US.
Now, if 85% of those heart disease deaths were in the 15-28 year old cohort, that might be something quite stunning.
I agree declaring 'war' on addiction is a ridiculous concept, because it's more than likely a statistical constant (with a range) within the human species. A certain amount of people will get addicted, be it drugs, food, or the internet. It's just kinda sorta what we do, and I'd be a big fan if as a society and culture we looked toward methods to save ourselves constructively, rather than use the authority of the state to lock people away, generally speaking.
This is a useful paper: "Imaging the Addicted Human Brain", http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/
Pain is self-report, so all a doctor can do is prescribe based on patient demand. Maybe they can't identify an underlying cause, or maybe the treatment (ex: back surgery) is too risky.
Spine surgery that might not work and can leave you with say, loss of bladder control? I'd take the pill every time, and if my doctor didn't just hand it over, I'd find another doctor.
While unethical prescribers (not all are physicians) contribute significantly to rising misuse of opioids, the vast majority of practitioners want to do what's best for patients. As the article notes, there are few options for managing chronic pain, leaving opioids the only realistic choice in many instances.
None of the providers I know think opioids are preferable, but more like a necessary evil. They prescribe opioids sparingly, reluctantly, diligently. Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic.
Blaming pharmaceutical companies doesn't seem a constructive approach. Probably there's a lot of R&D going on in this domain without much success, meaning it's a very hard problem to solve. I'm certain that a major breakthrough would be eagerly marketed, highly likely the profit margins would be huge. Meanwhile, we're left with the status quo, and manufacturers are meeting market demands. Isn't that how our economy works? Pharma sales are already more highly regulated than nearly all other industries, what more should be done?
Few legal drugs are as controlled in the US as schedule II opioids. If there were no such controls it's likely that the number of overdose-related deaths would be higher than it is. No one knows what solution will work, the need to be being careful about changing "rules" should be obvious.
The article's advocacy of "medical marijuana" as an alternative is IMO inappropriate. Simply enough, research on the uses of cannabis components for pain treatment is in very early stages. Specific indications and side-effect risks are inadequately understood. Recommending use of these components as treatments for pain is premature.
I have experienced this as well. Not only are doctors now reluctant to prescribe opioids, but you as a patient are suspected to be a drug-seeking addict by everyone in the chain: doctors, nurses, and pharmacists. People complaining that it's too easy to get pills clearly haven't had to manage a chronic pain condition in the past couple of years.
I'm still a little steamed to think about it. They received both prescriptions from my doctor and made made a medical decision to withhold based upon the word of the insurance company which should not have been a party to the second purchase. I couldn't get the prescription back either, since it was sent directly to the pharmacy.
I have always had a chuckle thinking about what would happen if the government called the medical marijuana supporters claims out and legalized it. I think it would become a pill with none of the high and turn into something quite boring.
This sort of thing happens all the time where medical decisions are "second guessed" by insurers. It may be in the form of payment restriction, or requiring "pre-authorization", just another way to make it difficult to get treatment that costs more than the absolute minimum. I believe such maneuvers are counterproductive, that is, it will wind up costing more if patients don't get what they need to improve their conditions.
Not quite sure why the pharmacy wouldn't fill the Rx for cash. Maybe afraid of regulatory criticism for the "double fill". Of course there are instances where people are frequently "losing" medication supplies and requesting replacement prescriptions. Then we might rightly suspect medication misuse, but if such requests for extra prescriptions are rare, as in your case, it's wrong not to honor it.
The problem isn't that we don't have solutions. Solutions are a plenty. The problem is that no one in America cares. No one in this country gives a shit that people are dying. Most people want it to happen. They support the fucking drug war. They want people to die. Until this fucking shit changes, people will continue to die and idiots will continue to wonder what can we do? So many fucking things, I don't even have time to write them all down. That's the fucking sad part.
In the first year there were 365 confirmed uses of naloxone, but that is believed to be a significant underestimate of overall use.
The evidence is clear - naloxone works.
Yet the most brilliant colleague I ever worked with had be resuscitated twice from heroin overdoses. A hyper productive individual, capable of incredibly feats of software engineering who yet maintained a great work life balance. And while he was sick, society viewed him as a worthless parasite.
However I've been in decent pain for 1 year+ before so I know what its like & can totally understand why people go for the powerful stuff. Continuous pain like that slowly but surely grinds your psyche to fine dust over the long run. Thats the part that people without chronic pain miss...
While the title mentions heroin, the article at least mentions that deaths are frequently due to more deadly prescription painkillers being mixed in. One thing I wonder that I haven't seen addressed (I'm not sure if there is even data available) is how many overdose deaths are due to use of multiple drugs at the same time (alcohol for example makes many drugs more deadly).
Hopefully there will be more and better reporting on the issue. IIRC (and wikipedia agrees at least), these numbers mean that drug overdoes are now killing non-trivially more people in the US than car accidents.
Right now, a lot of people in the United States are misserable on a lot of levels. It's not just their back pain, or the roaming pain--misery seems to bring. It's the economy. It's finding a place other than a room in your baby boomer's parent's home. It's even finding a shit job--a shit job used to be easy to find. Now--shit jobs are just aweful. Plus, you are competing with very desperate immigrants that happily work for minimum wage, and have no social qualms living like caned Sardines. (I 'm not stereotyping. A lot of immigrants don't see anything weird with a sharing a small room with multiple family members.) In the U.S. it's looked down upon. Especially in the formative years, where you are trying to prove to that perfect person you are a Superman/Superwoman. You are the one. You are the independent winner. You are the one he/she should marry, or just have sex with. It's not your fault you not the big baller. And no it's not just getting the B.S. Degree. It's a whole lot more than that.
Back to the person in pain on opioids. The drugs make them feel better. This is what they think they need to function in this world--some Do! Physical pain is Real?
The big problem is opioids lose their efficy over time. Doctors don't tell the patient in pain up front about tolerance. Why--because in a lot of medicine, a good doctor wants to induce the placebo effect, along with the effect from the drug, and their not idiots. Some actually want you to feel better. They all don't just don't care about the office visit fee. I think?
(While opoids do require more, and more over time in order to get the original effect; there are studies done in Rest Homes, with older subjects where tolerance of opoids did not materialize. The studies are numerious, and many doctors were taught opoids are safe in med school.)
In my case, and the people I know opoids are far from being a non-addictive drug, or tolerance resistant. But the drug has been so vilified, and stereotyped who knows. All those addiction t.v. shows, and even well meaning professionals have told us for years, getting off opoids is very hard. I truly wonder just how difficult getting off opioids is--if we weren't conditions into thinking it's the most difficult drug to kick? I know when I'm told something is going to be a bitch to get off of--it's always worse than the times I didn't know how difficult the withdrawal will be. And the greatest junkie (Burrows) once said something like, 'Geting off opoids is not as hard as they say.'
Now to the opoid deaths. I don't know about the deaths among very ill patients whom are on patches like fentanal. I know about the guy with the bad back who was given opoids. Then the doctor stopped the refills. That patient went to the black market to get their opoid, usually heroin because it's cheaper. At this point, their lives are usually a complete mess. If they are poor, they usually have a record with the authorities. Every day becomes a nightmare. "I'll few drinks along with the heroin--who cares?" A hit of meth--who cares? A sleeping pill with the opoid--who cares? Who cares? I've given up. I can't function like my parents did.
Death from overdose follows.
We have a problem. I think there's a short term solution to a drug problem, and an out of touch society. A society that's still living in the 50's in terms of expectations.
That short term solution is Buoenorpine. It can help a lot of these people whom are addicted to opioids. Don't require the addict to pay a fortune for this drug. Don't make them pay for expensive office visits. Just give them the drug. If they sell it, or abuse it; they go back to herion.
As to people in extreme pain, let Medical doctors treat it. Leave them alone. Let them do their jobs. No government official should be telling them how to alleviate cancer pain, or any physical pain. Hell, they shouldn't have to take a special course in order to prescribe bupenorpine. They shouldn't be limited to 100 patients. Leave MD's alone. Again--leave medial doctors alone. Let them prescribe what they feels works. If the patient abuses the drug--that's not the doctors fault.
If you think the average doctor is willy nilly writing prescriptions for opoids--well just see what happens when you see a doctor, and complain about pain.
Most likely you will be offered 400 mg's of Ibuprofen. Doctors are very leary of writing a script for any opoid. Good luck getting one. The DEA is breathing down their backs.
As a society, the people in real physical pain are being told they can't have opoids. It all seems fine, until you are that person in intense pain in that exam room.
So yes we live in a country that expects a lot from its citizens. We are all suspose to be successful. Even the poor are expected to "make it"--whatever that means anymore. At the same time jobs have gone away. We are in this sharing economy. A economy that just seems to serve the wealthy?
The glow from opoids is enticing in this judgmental society. Bupenorpine might be a quick answer to a complex problem? A real problem. What do we have to lose at this point? I'm tired of hearing about overdose from opioids. Really tired! A least freely provide naloxone over the counter?
Not saying of course that everyone who gets these doesn't need them, I'm sure many do, but we have something like 90% of the worldwide consumption occurring in the States, so something is clearly up.
Does the US just over prescribe painkillers, meaning more flood to the blackmarket?
Is it people are getting it from the Dr and accidentally ODing?
Are the Drs prescribing without care, so those who want the drug for a high and no medical reason can?
I never knew painkillers to be used as party drug / fun drug in the UK (outside of the heroin using demographic) nor ever heard of some one ODing on prescribed painkillers.
Seems strange it is such a big issue in the US
------- Since the 1990s, doctors have been under more and more pressure to treat pain as a serious medical issue. Pharmaceutical companies took advantage of this desire, marketing opioid painkillers like OxyContin and Vicodin as a safe, effective solution to pain. ------
privatised health care and the profit incentive to prescribe high cost pain kills. I believe the Drs get a kickback from the companies for pushing a particular brand (could be wrong on that though).
Also, who put the pressure on the Drs to treat pain as such? Politicians? Why would they? I imagine leant on (or the term is "lobbied" by big pharma. Would be interesting to see the "donations"* paid to politicans from big pharma right around that time and who profited from this.
* I always find this funny who we in the west call this "donations" but when reporting on third world countries it is termed a "bribed". Paying money to get what you want from government so you can make more money....
> I always find this funny who we in the west call this "donations" but when reporting on third world countries it is termed a "bribed".
Well, if resolving the hypocrisy would mean calling our bribes by "donations", please, let it unresolved.
We at third world countries gain a lot from your transparent accounting of what happens here.
(it's probably even useful to speak of legal campaign contributions, because then when illegal bribes happen, they still get attention)
I don't have evidence of this, but I expect the patients. People don't like pain, and they want a silver bullet to make it stop.
no one gets rich from preventing the causes of pain, though of course the country would save money and less people would die
I highly doubt the acetaminophen in vicodin is to limit abuse. Some of the pills I've seen are 750/5mg. Even a moderate addiction of 100mg a could easily kill you at that rate (that's 15g of acetaminophen). Though if you had no choice, a simple cold water extraction will eliminate enough of the acetaminophen to make it safe.
While not quite as evil as all the deaths and stripping of civil liberties the "drug war" has caused, this is a pretty obviously wicked thing to do (while still ineffective).
I would submit to you that deliberate contamination of a drug for the sole purpose of inflicting harm in search of a greater good is an outrageous policy.
Adding risk (whether it's the risk of liver failure or prison time) to addiction behaviors doesn't do a damn thing, because addiction is a disease that fundamentally destroys our ability to make rational cost-benefit decisions when our drug or behavior of choice is concerned.
It has been proven time and time again that systematically removing "common sense" [0] regulations only harms society in the long run.
[0] Please don't start a mundane discussion about what "common sense" means.
Vox, stop with the hyperbola.
If I were being hyperbolic, I'd call that "Over Six 9/11s per year".
The juxta bothers me because Rx drugs are a necessity as judged by physicians, it's not a lark. Illegal drugs on the other hand are not prescribed, for the most part, and are a different issue altogether. They address perhaps other pains, but conflating them in this sense seems dishonest.
I might be completely wrong here so please correct me if I am. Why would a doctor care what a patient demands? Tell them no. There's nothing they can do about it. I can't demand any prescription drugs from my doctor (I'm in the UK) - and I've tried once. Do doctors in the US worry about losing money if they lose a patient or this that not the case?
Edit: Thanks to those who responded. Although I suspected it it still blows my mind that people don't see how and of an idea that is.
Because pain diagnosis is self-report.
"I'm in pain and I know this drug works, please give it to me" is not an unreasonable request.
http://latimesblogs.latimes.com/lanow/2012/03/doctor-murder-...
She made $5 million in 3 years. There are offices like this all over the US.
Marijuana is certainly not the magical silver bullet some make it out to be, but it's incredibly effective for many people whose only other recourse would be opiates.
Whenever I see an article like this, it is frustrating as there is an alternative to opiods for chronic pain management that is just as effective, carries no risk of overdosing, minimizes the the chance for dependence (and in fact is often used by those looking to break opiod dependence) and at scale, could be available for fractions of a penny. As a bonus, it can also serves as an actual replacement to ADD and antidepressant medications as well as serving as an effective tool against other types of addiction (e.g. alchoholism) and has 100s of years of "clinical trials" in the real world to support its safety. http://www.scientificamerican.com/article/should-kratom-be-l...
Unfortunately, the powers that be have no interest in changing the status quo particularly when it would undercut patented money making drugs currently available, so very little research is conducted into this area and those who wish to do so are often actively thwarted to the point one has to conclude that there is not actually a real desire to address this problem.
I mean, ipads do not have a big red button with "rm -r /" listed. I don't see why the drug industry should be exempt from designing constraints that prevent user error.
If the line is between people suffering horrendous incomprehensible pain and people making a choice to abuse drugs. Well I'm pushing that line right up against the people who get the luxury of making a choice.
* patient such as your friend has excruciating pain, requiring the heaviest of the narcotics (say oxycodone/oxymorphone, instead of a "mere" hydrocodone that you'd get for wisdom teeth or something ).
* these narcotics are so incredibly dangerous that they must be taken exactly as prescribed for the following reasons. 1) Patients have a temptation to take an extra one (or snort one) to achieve a euphoric and addicting "high" that can be irresistible once its experienced. 2) In some cases taking even one or two extra pills can kill the patient. 3) Patients have incentive to Not take them because some pills can fetch up to $40 EACH on the black market. 4) not taking them exactly as planned can cause a tolerance buildup or reduction, which can stymie the physician's efforts to find the safest minimal and effective dose for continuous pain management.
* To combat all 4 of these factors, pain management specialists enter into "contracts" with their patients that they will treat their pain, if and only if, they agree to take the pills EXACTLY according to plan. To affirm compliance to this plan, the patients are subjected to random drug testing. Not just to see if they are getting high (over using them ), but also to see if they are using them at all, (i.e. not selling the pills for a massive profit ). IIRC, if you show up to your test and they find no painkillers in your urine, you can be taken OFF the plan, i.e. no pills for you.
tl;dr they drug test patients to make sure a precise plan is being followed because there are at least 4 separate "failure modes" to chronic pain management.
I learned most of this from news articles and reading junkie's tales on /r/opiates. I'm not an expert, nor user, but I just find the whole topic very interesting. Please correct me if I've said anything wrong.
People have agency. And should be allowed to make their choices. Especially in cases where not allowing them to make their own choice starts hurting innocent people. And by hurting, I mean that very very literally in this case. The type of pain that causes people to end their lives. Caused by a system more afraid of a bad decision than of leaving people alternating between howling and sobbing in pain for days.
It's a fucked up way of dealing with people we suspect have a health problem to take an action we know makes the problem substantially worse for a large proportion of them.
The irony is that medical grade heroin in predictable doses is one of the safer alternatives, and far cheaper again. But of course these people do not get medical grade heroin - they get street heroin cut with anything from cheaper drugs to brick dust.
I posted this yesterday if it helps: https://matt.sh/heroin
For opiods...few. For paracetamol...lots.
Fortunately I don't appear to find them addictive - I stopped taking the tramadol after about a year's usage (my consultant raised similar concerns to you - restarted them about three months later as it had been shown they weren't worsening the headaches) cold turkey (I was told it would be worse than stopping heroin), and suffering absolutely no ill effects or withdrawal.
[1] Multiple others have been tried (ibuprofen/diclofenac/amitriptyline/sodium valproate/naproxen/gabapentin and a few others I can't remember), and made no difference to the headaches. The amitriptyline is helping with pain in my hands though.
If your dentist is unsure if it's worth it and you don't want to spend the money on a custom mould on a long shot I suggest asking for a recommendation for a cheap and crappy generic biteguard to try for a few days. It won't be comfortable and may very well affect your sleep, but it'll be enough to verify it there's any point without the cost.
Another long shot that you've probably discounted already: Make sure you're not compressing your neck at night e.g. by pushing your head up against the top of your bed. I was doing that too, and fixing that helped a lot as well.
But when it's oxy or hydromorphone I'd agree, also I don't even want to think about having morphine or fentanyl patches in my possession.
Or is that straight statement supposed to distort some watered down, meaningless figure factoid like 100 million people have lingering pain due to some cause at some point in their entire?
http://www.firsthand.com/portfolio/pain.html
https://www.hitl.washington.edu/projects/vrpain/
I've heard of Mindfulness Meditation being used to change the experience of pain from an act of suffering to an act of simple awareness. I don't know how widespread that technique is deployed though...
And read comments (search for Todd Hargrove comment). Looks like there is more pain management science without drugs than many know.
Granted, I use them somewhat occasionally (as needed) for pain, but they don't really cause in me the compulsive, addictive behavior I've read about. My internet addiction (HN included) is far worse than any chemical substance I've ever used.
Drugs have effects. Usage doesn't cross some threshold dose and instantly become abuse.
It's not euphoria from a high that blocks the pain, the medication really does work as intended.
It's just also incredibly habit forming and dangerous.
These chemicals stimulate receptors in the brain which are part of natural feedback cycles in which part of our brain synthesizes similar chemicals and feeds them to other parts of our brain to nudge conscious thought in a beneficial direction (learning, eating, running, fighting, mating). The broad class of opioid receptors appears to be central to how the vertebrate brain works.
Natural behavioral reinforcement, pain relief, intense euphoric highs: Same receptors, same effect, same mechanism, somewhat different quantity. Injured people given vicodin often describe "Not caring about the pain". Because they're high - at least, a little bit.
Opium having the reputation to make people amorph losing their will to rebel.
The new trend is opioid are now cheap and not prescribed to the rich but the poor.
Religion used to the opium of the people they said, and now that opium is cheap, religion is not needed anymore to make people servile.
I love this new era of progress.
Tomorrow we make an application to help parents poor sell their kids body part on the internet for the cure of richer people?
I mean, let's try to make even more dystopic. We can do better. That is what progress is. Making system more efficient.
If illegal drugs were all made legal tomorrow, we would see something similar.