The war on drugs has failed: doctors should lead calls for drug policy reform

However, don't get it confused with over-prescribing opiates to people with chronic but not life-ending pain, then suddenly restricting them again, which many point to as creating a ready market for illegal drugs.

Ideally they'd get less dangerous pain medication, and/or in a controlled manner that prevent accidental or intentional abuse, resale etc.

And thanks to Church, some would say "because it is a sin".

Doctors are already fighting the good fight every day -- carrying the fire (the vast majority, at least). I have always mostly lived in a liberal bubble and over my life I'd say 90% of the people I have interacted with often over a long period were liberal, and this extends to 90% of my extended family too. Bubbled in all the way. All of these physicians in my bubbles throughout life have mostly fit the liberal label (except maybe fiscally) and would be more than happy with treating drug addiction like a health problem. And lots already do! Depends on the city, of course.

Things like "ending the war on drugs" are simply not on your average doctors' mind in the day to day (in my experience). They have other stuff to do, like maybe save a life or two, finish that big paper on immortality or w/e, and they simply go right ahead being doctors, knowing in the back of their mind they are largely "above" the drug war anyway, since they can and do dole out narcotics constantly.

To my dad, an 80mg oxycontin (the old ones, the holy grail of opiate pill abuse) lost its status as a "ooooh, awwww, look at this neat pill" thing probably within 60 seconds of becoming a doctor (that's a guess). My mom was/is a psychologist (retired) and doled out narcotic tranquilizers left and right as well (though at the VA, so she got left alone). It happens to pharmacists too, even a pharmacy tech friend of mine would go "meh" at a 1500 count bottle of perc 30s.

The drugs just become part of the day to day like, for lots of HN readers and myself at least, working on tens of millions of dollars with of computing infrastructure is business as usual.

I think the access to narcotics and constant distribution and "above it" feeling is relevant to why I think doctors won't be leading the anti-war on drugs movement. I don't know for sure about many other than my parents and a few others, but I'm guessing they would all end the war on drugs tomorrow and treat it as a health issue if they knew how to do it without making things infinitely worse. And I'd venture to say most doctors I've known over my (liberal-bubbled) life would agree without much thought put into it -- if they aren't already in some small (or big) way.

I'm not sure how true that is. The amount of knowledge of (bio)chemistry required by most doctors in their day-to-day work is actually quite limited. A few years out of medical school, and many of them have already forgotten most of what they were taught in medical school, and the medical school curriculum really only gives a high-level overview of the topic.

I'm not a doctor, but my mother and brother are. My mother despite being a doctor will admit her chemistry knowledge is quite limited, but to be fair to her she doesn't need to know much chemistry at all to do her job–you don't need any detailed knowledge of biochemistry to prescribe an antidepressant or perform a caesarian section. My brother by contrast knows a lot about chemistry, but that's not due to medical school, that's due to majoring in chemistry as an undergrad.

From a medical standpoint, I believe there has been some research into salvia's potential use as a anti-depressant, but that might just be anecdotal, I can't recall right now.. [1] points to some clues how this might be the case. Now I remember some research into depression and how it is related to the pain centres in the brain in some fashion - "Tylenol appears to reduce activity in a region of the brain called the “dorsal anterior cingulate cortex,” which research has tied to physical pain and social rejection and ostracism, Randles explains. It’s likely that dampening activity in this brain region accounts for the study participants’ weakened sense of anxiety, though Randles says it’s too early to prescribe Tylenol as a cure for existential distress."

From a psycho-spiritual viewpoint, oh boy. I could go on forever about that and the need to really start getting a handle on this topic (re: transpersonal psychology). But my own experiences (i.e. kundalini, reliably) and what that is like... what is going on, from a scientific standpoint, even if it's all in my head, is very interesting. The brain/mind connection is a lot more complex than we can even think of...

I haven't read the article yet, so I don't know if it promotes the medicalization of psychoactive substances, which is a concern of mine. Lumping everything under "drugs" (but leaving out alcohol) is really idiotic. There are all these facets, along with sociological aspects, that each substance needs to be considered individually when figuring out a rational way to deal with the problems while utilizing them in some fashion to improve society.

So, no, salvia does have some relation to western medicine.

[1] https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor#Conscio...

I worry that physician groups are trying to shape this narrative in a way that just shifts government-sanctioned power from one group to another. Physicians are not disinterested parties in this, because they have huge financial benefits to gain from official policy being that drugs are a "medical" issue. Once this happens, if nothing changes about the way that the medical system is organized, you'll just have a different group sucking up money and controlling individuals wholesale without sufficient justification.

I agree with you up until a very critical point. Doctors are better equipped to understand the neurochemical reactions being caused by drugs than criminal justice professionals. However, they are not necessarily better equipped to understand the neurochemical reactions than other scientific professionals, nor are they better equipped to understand the economic, social, or legal consequences than criminal justice and other professionals.

This is what is happening with the medical rhetoric: you have a group of experts in area X, who are currently legally designated as either the only people truly qualified, or in control of those qualified, arguing "drugs are an issue of X." In doing so, they put themselves in control of decision-making in this area, with all the financial benefits that accrue to them, and, more dangerously, simultaneously take control of discourse away from others, because then they become the ones who are only, or who are most qualified to make decisions about whether or not it is an issue of X. Once society deems drug use a "medical disease," then physicians become the people who are only truly legally qualified to make decisions about drug use, and also the only people truly qualified to make decisions about drug use policy. It's an entirely self-serving vicious circle.

This line of reasoning is also dangerous, because there is no end to its logic. Given that humans are fundamentally biological beings, any state of human suffering can ultimately be seen as "medical" in nature.

Reading this sounds conspiratorial, and I don't mean it to be, but it's frustrating to me that society doesn't recognize the ethical conflict of interest created by current medical certification and licensing systems.

Don't get me wrong: the current system for handling drugs is woefully broken. But I worry that labeling drug use as a "disease" will only shift the problems from one area to another, unless that system is also reformed to foster a more competitive, less hierarchical health care community. Drug use problems are a complex, social, biological, psychological, legal, economic problem set that is outside the purview of any particular professional community. The best approach is to just deregulate it, and treat it as a form of human suffering that requires a multifactorial approach.

I'm deeply skeptical this will happen, though, given our recurrent need to oversimplify everything.

He may have the knowledge, but I'd question his understanding.

For your assertion however, I can only yell "NO". I can't emphasise that strongly enough. Just gives supremely high chance of poor opinions heavily biased by the over confidence effect.

This is probably controversial, so bear with me, while I try and explain as it'll probably take some space. I'll apologise for length and poor explanation before I even start!

Let's look at a different neurotransmitter a moment - dopamine. Amphetamines markedly affect dopamine receptors. If most people take recreational doses they'll be stimulated, motivated, and sociable. If I take it I get no effect on motivation, and chill out. I'll probably sit and binge watch TV, work or read a book for eight hours straight. I won't be bothered to be sociable as I'd be delighting in the chilled calm. You may not be surprised to learn I have ADHD.

I fought for years with doctors "knowing" drugs and how they act on the brain in trying to get diagnosed with ADHD. Took years to not be dismissed out of hand. I don't find most doctors any more aware than the general public much of the time. That's not a function of where I live - time hanging around the assorted ADHD forums that have come and gone show all countries have had similar issues and hundreds of people struggling to get a diagnosis or referral because of horribly poor doctor, psychiatric or specialist awareness. Often those doctors are responding as though the patient is a normal brain merely seeking recreational drugs (which of course happens too), but it's entirely opinion. It's not uncommon to get misdiagnosed something else, perhaps with lasting and damaging consequences. (You don't typically ever get "undiagnosed" of mental disorders).

For many only when learning the field extensively themselves is real progress made. It's quite sobering to realise just how many have had to start studying and reading research themselves prior to being able to get diagnosis.

Minds are more difficult as we tend not to be able to diagnose anything like as easily as a broken bone, germ or viral illness. There's a need to rely solely on self reporting as we can't, yet, throw someone in a scanner and identify them as having depression, ADHD, Asperger's or LSD addiction. In the case of recreational drugs and use there's going to be little in the way of studies of their effects on healthy minds. I seem to remember quite recently LSD had the first study in 50 years. Anti depressants often seem to have suicide and suicidal ideation as side effects - the same medicine can have dramatically different mental effects in ways not often seen with say paracetamol.

The main difference then is a doctor is more likely to be believed and have opinions acted upon without any real understanding. They may have better understanding, if and only if the correct studies are there. For the most part they won't be. Yet.

Doctors are well placed to advise on studies and contraints as health impacts arise from legalisation however.

...WTF? Is it even possible to write a more egotistical comment? Most doctors (especially surgeons, etc.), along with firefighters, police, etc. derive their respect in "educated circles" not from their pay (that's some of the worst nonsense I've heard this week) but from the kind of work that they do: saving other people's lives, especially in situations where one small mistake on their end can prove fatal for one or more parties involved. That's quite sufficient to deserve a ton of respect just by itself....

>>They derive most of their status from their pay.

No, they derive it from the insane amounts of education, training and hard work they have to put in to get to where they are at. It's basically "crunch time times two" all the time from the moment they start med school until they complete their residency, and only slightly lessens afterwards.

We can discuss transfer, sale and other forms of distribution on a case by case basis, depending on how harmful the drug in question is. And we can say that possession of significant quantities, clearly beyond personal consumption, should be considered evidence of intent to distribute (although it should really be rebuttable - i.e. the person should get a chance to present counter-evidence to prove that there was no intent to distribute, and the judge or jury should decide on the balance of probabilities).

But there's no rational reason whatsoever to punish consumption of anything.

Your personal opinion.

>secondly, you can do it indoors without everything smelling like weed,

Vaporizers diminish the smell to a point where it's almost unnoticeable, and edibles don't smell at all.

>thirdly, the mild depressant effect of one alcoholic beverage is way more pleasant than getting high

Again, your personal opinion.

>Not to mention the cost.

"The average price per gram, they found, was $6.81; the average joint was $3.50."

http://www.nytimes.com/2016/07/15/science/how-much-weed-is-i...

I think for most people an entire joint by themselves is going to take care of them for the entire night (or longer if it's snuffed out and re-lit). How many beers or mixed drinks are you getting for $3.50?

Vaporisors and edibles are odorless, and the price would surely come down if it was grown in commercial quantities.

While I am also opposed to the war on drugs, let's not make overbroad claims. There is evidence that alcohol prohibition actually reduced demand. Not 100%, but significantly. From Wikipedia:

> The Prohibition was effective in reducing per-capita consumption, and consumption remained lower for a quarter-century after Prohibition had been repealed.[34]

34: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470475/

From that article:

> Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. They rose after that, but generally did not reach the peaks recorded during the period 1900 to 1915. After Repeal, when tax data permit better-founded consumption estimates than we have for the Prohibition Era, per capita annual consumption stood at 1.2 US gallons (4.5 liters), less than half the level of the pre-Prohibition period.32

32. Miron Jeffrey A. and Jeffrey Zwiebel, “Alcohol Consumption During Prohibition,” American Economic Review 81 (1991): 242–247; Dills and Miron, “Alcohol Prohibition and Cirrhosis”; NIAAA, “Apparent per Capita Ethanol Consumption.” The figure is for 1935.

I for one is happy that it is started to be treated as public health issue, it is a long overdue approach, yet one can't not to see the race based disparity mentioned above.

And your point about "doctors come out en masse and state that drug addiction is a health issue" may be a double-edged sword for them since we all know that the opiate epidemic and subsequent heroin use increase are issues created, by a large part, by doctors.

Drug money is used to rig elections and train brutal corporate sponsored dictators around the world

- Serj Tankian

(on another note, I am happy this is the second time I have quoted System of a Down on HN and it was 100% pertinent to the discussion)

Isn't it amazing that you think that? Seems to say something about the schools... If physicians can finally, at this late date, consider doing the right thing politically, it makes one wonder... will public schoolteachers ever kick the DARE officers out?

Seems unlikely, doesn't it?

I don't disagree in any way that policy reform is badly needed and the war on drugs has failed: My point was more that the messaging seems to be very conflicted these days for physicians in the United State. To me - as a layman - there appears to be no "middle ground" for both policy reform and bringing the opioid addiction under wraps. That is the disparity I am trying to point out and what I find to be conflicting / frustrating.

If there is a middle ground I'd love to hear it.

Yes, for sure. Here in MA we did pioneer state support for marriage equality, and we also pioneered individual-mandate health insurance (now known as Obamacare).

I'm saying this because I have seen close relatives turn into alcoholics. The mental illness/disease angle doesn't do the addiction dynamics justice, and you know that when you have seen other relatives develop genuine mental illness. There's a difference between drinking too much for several evenings in a row without a real reason and not getting worried about it the following morning and losing touch with reality due to developing schizophrenia.

There are living conditions that make it understandable why someone would like to choose not to be sober but leaving personal responsibility out of the picture, saying it's the doctors fault or it's all in your genes, is infantilizing.

Question mental issues -- nothing we can do.

It's a bad joke.