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Interesting question: The replacing opioid addiction with maintenance drugs... I could understand that drug being an okay interim solution, but in the end the person still needs to go through withdrawal, the drug just replaces withdrawal with another drug.

Withdrawal is hard. Yes. But at least the person is in the right mindset to go through it once they are off the compulsory addiction, even if it takes a year to get to that point.

As kchoudhu points out and many have pointed out to me before this article, certainly once a bunch of white kids have this problem, suddenly they are "victims" not "criminals". Yet we have destroyed so many lives between the 80s and now, especially with the mandatory minimums and such.

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Maintenance drugs are usually legal and tend to have less side-effects. This allows the addicted to focus on the underlying issue and then, once that is solved go through withdrawal. There has been a fairly interesting experiment in northern Germany a few years ago that handed out medical grade heroin to heavily addicted people. The results were pretty good, people were highly functional. Often the side effects of the addiction- having to organize drugs (and money for drugs), infections from used needles, additives in the drugs, breakdown of the social support network etc. are much worse than the actual drug. Giving substitutes, even allowing legal access to drugs helps removing those hindrances. Drug policy is just weird.

Why? The problems with addiction - specifically opioid addiction - is that it causes negative, destructive behavior. This isn't a consequence of having a physical dependence we are all physically dependent on things after all.

No, it does not cause negative, destructive behavior. It causes you to lie down and feel good. And it also causes constipation. And, if your supply is interrupted, withdrawal symptoms. The rest is caused primarily by the laws and social environment. Having to interact with criminals? Getting uncertain doses? Overdosing? Those things are because it is illegal, not because it's an opiate.

The withdrawals do lead to destructive behavior.

Addiction by definition does cause negative destructive behavior. That's part of the definition. What you're describing is a combination of the psychoactive effects of it and its withdrawal symptoms.

I do agree with you, however. People become addicts due to how our society has criminalized and deregulated drug manufacture and sale and made it extremely hard to teach people how to do properly.

"Negative distractive behavior" can also include things like "spending so much money on drugs you can't afford basic living expenses," "destroying relationships with your friends/family," "being unable to take care of your children," "getting fired from your job," "not being able to take care of your basic commitment," "'lying down' while driving," etc., etc.

> Withdrawal is hard.

Just to emphasize that:

Before my SO started working in a hospital, I had no idea that people going through alcohol withdrawal can end up in the ICU. They're ending up in an ICU because of the withdrawal, not the alcohol... That was really surprising to me.

Alcohol is one of the only substances on the planet that can cause you to straight up die from withdrawal alone. Deaths from opiate withdrawal are secondary, usually from falling during a seizure. But with alcohol, your heart can simply stop or your brain have a massive stroke from the withdrawal. We think it harmless because its legal, but alcohol is radically dangerous from an addiction standpoint.

That's interesting and makes alcohol sound pretty menacing. I should read more about it. It definitely sounds like seizures and heart issues come up the most. Plus their livers are shot, so toxicity of normally benign treatments is a concern.

Also interesting that, in the very wealthy area we're in, outside of infants and the elderly, middle-aged white men going through alcohol withdrawal are the most common ICU patients.

(sorry for derailing discussion away from opioid addiction)

FWIW, you can die from alcohol withdrawal well before your liver is shot. Also, you don't need to have been drinking for decades; you can get yourself in that pickle in months, not years.

Alcohol and benzodiazepines are the only ones, IIRC. In 2014, Xanax killed more people than fentanyl, morphine, and meth (https://www.usnews.com/news/articles/2016-12-20/heroin-cocai...)

My cousin is a pharmacist... During her training she found out "sometimes if you have an old drunk, you prescribe him alcohol, because the withdrawal will likely kill him"

Withdrawal is stupid and unnecessary. You don't go through withdrawal if your doctor were to say 'ok, you are no longer injured, but your medication is one which has dependence as a side effect. Here is your 12 month schedule for reducing your dosage very gradually.'

I'm physically dependent on caffeine. Why bother fixing that when it is cheap legal and available?

In case you're looking for a sincere answer: being physically dependent on any otherwise unnecessary drug is a drag. You constantly have to seek it out to feel better. Even though caffeine is easily obtainable, I still have found it to be inconvenient when I've been at high levels of consumption. Plus, it does have health effects. It may not be so, but you'll likely feel a lot better without it.

I've gone cold turkey on caffeine a couple of times (takes me about a week of headaches, I'm not an especially heavy user), mainly because I was making hot drinks to avoid work out of boredom, so switched to ginger teas and such like.

Anyway, there doesn't appear to be consensus on whether coffee/tea drinking in moderate amounts is good or bad, but I've seen more suggestions that it's beneficial than otherwise. Any input to that?

No you aren't. Caffeine "withdrawals" are trivial and not life threatening at all.

Opiate withdrawal is generally not life threatening either.

    > but in the end the person still
    > needs to go through withdrawal

Why?

I'm not sure it is a race issue. Times were different. People are now accepting that drug consumption doesn't make you a criminal.

At some point Britain thought that wealthy highly-educated people were incapable of being criminals, until time proved them wrong. Science is always evolving.

I would agree with this perspective. Over the last few decades there has definitely been a change in how people view addiction and more importantly how to address it. Harm reduction has much more traction then 20 years ago.

In a fair system, black and white defendants who score the same number of points under this formula would spend the same time beyond bars. But The Herald-Tribune found that judges disregard the guidelines, sentencing black defendants to longer prison terms in 60 percent of felony cases, 68 percent of serious, first-degree crimes and 45 percent of burglaries. In third-degree felony cases — the least serious and broadest class of felonies — white Florida judges sentenced black defendants to 20 percent more prison time than white defendants.

The war on drugs weighs particularly heavily on black defendants. The police target their neighborhoods, herding people into a court system where judges are demonstrably harder on black offenders. The report found that nearly half of the counties in Florida sentenced African-Americans convicted of felony drug possession to more than double the jail time of whites — even when their backgrounds were the same.

This may just be a Florida problem, but I doubt it.

https://www.nytimes.com/2016/12/17/opinion/sunday/unequal-se...

Male vs Women rape statistics seem to denote the same thing, 10% difference, 18% difference, -5% difference. How many cases did the study cover? Looks to be about 300 given the dataset from the website.

300 is a small statistic.

10% of 300 is even smaller.

Science is hard.

I'd like to see a control for the amount of money spent on legal defense. The anecdote in that report itself suggests that it's the skill level of the defense attorney which is most likely a dominant factor.

From someone I know with personal experience, after they were charged with possession with intent to distribute due to growing pot, they had 3 choices. Go to jail, spend $X on an attorney who would get them probation, or spend 10 * $X on an attorney who would get them off. Both attorneys had perfect records, n>100, at their respective objective.

I'd like to see a control for the amount of money spent on legal defense.

So, then, why would black people spend less money on legal defense?

People spend as much money on legal defense as they can possibly afford, obviously. But that doesn't make the system racist.

So, black people have less money to spend on legal defense, because . . . ? And, do you think that the people in charge of the system don't know that black people have less money to spend on legal defense? Do you think they're unaware of the history of slavery -> convict leasing -> our modern prison system?

1. I haven't read the article. Why--because for myself, all the talk makes the problem worse.

2. For myself, going on generic bupenorpine, and tapering off was not that bad. I took a year to taper off. I probally could have tapeed off the opioids if I was given a chance. The problem is most Doctors just cut you off. Completely ridiculous, especially if the patient is a serious individual. (I got lucky to find a doctor to prescribe bupenorpine without driving me crazy with endless office visits. I also just happened to be given the drug for another disorder.)

3. The generic bupenopine is still pricey. I don't quite get it, other than most Dr's don't trust their patients to not abuse opioids, so there isn't a huge demand for generic Subutex? There are still some sensible people who just want to stop the original addiction. On the other hand, I wouldn't be schocked if the price of generic Subutex is the result of some shenanigans.

4. Most people will be given Suboxone, that has Naloxone in it. It makes doctors feel safe, and that's what was taught in the course they had to take in order to prescribe/treat. Crazy again. (I felt Nalaxone just raised the price of the drug, but some of you will need an opoid antagonist in your treatment, especially if street drugs are easily available, or you don't have not much self control.)

4. My point is if you Taper off, all the drama is spared. My story will never be on Lifetime.

5. It's still a pain in the ass with the Dr. visits, and getting scripts though.

6. I can offer this, if you want to stop, Taper off. Yes--I know it's just not that easy. The system we currently have makes getting off difficult. Again crazy?

7. Stay away from all the support group sites. They just scared the hell out of me, especially the ones on the internet.

8. If you are addicted to anything, most of you can successfully taper off yourself. Very few of you need the drama, and expense of a rehab. Again--the system is so rediculious, we are forced into going to the rehabs, just to get the opportunity to taper off. Again crazy.

9. We have a crisis. It's not giving addicted people the easy/cheap way to Taper off the most controlled substances. It's no wonder people turn to the streets to feed their cravings.

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