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Comment by 6gvONxR4sf7o | Hacker News Reader

I think legalization is good. I also think universal healthcare is good. Unfortunately healthcare is super expensive and enabling certain behaviors increases costs a lot. Different estimates seem to suggest that (back in 2015) the opioid epidemic had had an economic cost somewhere between a half a trillion and a trillion dollars, and it's increasing [0, 1]. Full-on prohibition is bad, but maybe there's still lots of societal value in having some controlled substances.

[0] https://www.whitehouse.gov/sites/whitehouse.gov/files/images...

[1]https://altarum.org/news/economic-toll-opioid-crisis-us-exce....

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I think you are confusing several matters.

If I understand your comment right, you are saying that the opiod crisis shows that people do choose drugs if they can and if there was univ. healthcare, then the system would go down under the costs.

The problem with this, as I see it: A good chunk of people addicted in this opiod crisis didn't choose to get addicted. They were all too readily prescribed hard painkillers for ailments that did by no means require such a treatment (e.g. backpain of various degrees). This is fentanyl as a gateway drug, so to speak. Those people would not have been addicts otherwise. But they got hooked on the medication and when their prescriptions comes to an end, then they would seek a replacement.

That is why doctors and pharmaceutical companies are getting sued - and are losing.

Further: If psychedelic drugs are indeed this helpful with issues like smoking and depression, like recent research suggests, then controlled administration would surely be a great relief to an overwhelmed healthcare system: saving e.g. on expensive anti-depression drugs or on cancer treatments, where the cancer was caused by smoking.

I was taking issue with this statement:

>I’m an adult, I can either make those decisions for myself or hire experts for consultation to help me make the decision.

The opioid crisis is evidence that this can lead to trouble. There's an easy counter argument that it only causes trouble for the people who choose to start using those substances, and so it's still the right thing to allow someone to do. I tried to present an externality imposed to counter that counter, and healthcare is an easy example.

that's chump change compared to sugar (=> diabetes at $225bil per YEAR) and alcohol (destruction upon others via accidents as well as chronic health problems).

so what is your take on those? should they be controlled substances? because it certainly seems we need to have a discussion at the level of the nation about how we're going to pay for universal health care consumed by those taking part in these behaviors going forward if this is going to realistically work.

The best thing I've ever read on the subject of decriminalization:

Legalize This!: The Case for Decriminalizing Drugs by Doug Husak

The argument is simple and comes from the legal perspective: every person who is put in jail should have a satisfactory answer to the question "Why am I being put in jail?". As the author (philosopher) points out, no satisfactory answer has been (or likely can be) given in the case of non-violent drug users.

All currently-known drugs should be decriminalized.

The damages from the opioid epidemic are almost entirely due to the unpredictable quality of street drugs and, especially, the resulting fentanyl overdoses. Opioids have some toxic effects even without those overdoses, but the resulting deaths are more than an order of magnitude smaller. (People rarely die from constipation and hearing loss.) If you want to reduce the human cost of the opioid epidemic, you will favor legalization so that opioid addicts can safely obtain their drugs with known purity, and people who taint the drug supply with unpredictable poisons can be found and brought to justice.

On the other hand, if you want to reduce the economic cost of healthcare by killing opioid addicts with accidental overdoses, you may not be persuaded. But I am not on your side.

>The damages from the opioid epidemic are almost entirely due to the unpredictable quality of street drugs and, especially, the resulting fentanyl overdoses.

Wow. I knew the unpredictable quality was bad, but didn't know that the damages were almost entirely due to them. Any chance you have a source there?

I dug around trying to find the link to the study I'd seen, but I haven't been able to. I'd be much obliged if you could share whatever links you dig up.

It's not exactly on point but this comment[1] from HN user UglyToad links to a Guardian article[2] that mentions several studies. The article is specific to Heroin, not Fentanyl, but (admittedly knowing nothing about street drugs) I think they're quite similar, chemically.

[1] https://news.ycombinator.com/item?id=21270553

[2] https://www.theguardian.com/politics/2001/jun/14/drugsandalc...

The issue with fentanyl is that it's much more powerful than heroin, in the sense that the dose to reach a given effect is much smaller. This makes it much harder to prevent the smuggling of, but also means that insufficient mixing can give you a fatal overdose much more easily.

I don't know if heroin has a safer therapeutic index than fentanyl. Possibly. The Grauniad article is correct about the relatively low risks of properly prepared heroin and the dangers of adulteration. I wouldn't be confident that fentanyl in properly prepared doses is equally safe; it might be safer or less safe, but the major difference is in ease of smuggling, which is associated with lack of accountability.

The article mentions amphetamine briefly in an unjustified aside: "It is the same with black-market amphetamines: speed alone may not kill, but speed with a blindfold is highly likely to finish you off." The truth is that amphetamine is fairly safe at therapeutic doses—safer than many common psychiatric drugs, anyway—but at the much higher recreational doses, it reliably generates progressive damage to multiple organs, including the brain. This is not a problem shared by the opiates, aside from the much milder constipation problem.

I had seen somewhere an empirical study comparing deaths from prescription opiates and black-market opiates. I'd like to find it again.

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