The impact of cannabis access laws on opioid prescribing
doi.org
doi.org
As a former marijuana user this seems obvious to me. I don’t understand why federal legalization has been so difficult. There are many benefits despite the potential of unknown risk.
Maybe my beliefs are a little out there. I wish for all drugs to be decriminalized. Portugal’s model seems to be working quite well.
https://time.com/longform/portugal-drug-use-decriminalizatio...
Alcohol and opioid manufacturing buying off politicians. Mass incarceration as a policy to preserve slavery in the US economy and to serve as a jobs program for police and guard forces.
[0]: https://www.sentencingproject.org/publications/private-priso...
[1]: e.g. https://www.motherjones.com/politics/2013/02/biggest-obstacl...
Drug laws are enforced unequally across different racial groups. Those who benefit from oppressing racial minorities, especially via voter suppression through felony disenfranchisement, are understandably reluctant to relinquish their tools.
https://qz.com/645990/nixon-advisor-we-created-the-war-on-dr...
> If you're reading this odds are it's because you're incapable of having a well reasoned debate with someone who doesn't share your point of view.
Someone wrote a well done article (I wanna say it was Medium) which appears to be what the stackexchange answer is summarizing that actually tracked down all the who said what and laid a pretty darn good case for why the quote wasn't legit. It basically boiled down to the guy who alleges the quote having several past opportunities to drop that bomb but instead waited until everyone who could disagree was dead. A cursory Google search didn't turn it up for me and I'm not letting a stranger on the internet suck up any more of my time.
There’s a tremendous amount of money that does not want legalization to happen.
Cannabis is a well established trigger among people whose genes are latent for schizophrenia or other psychosis.
I don't think it's safe to assume these regimes would favor chemically induced insanity over murder/assassination/execution. For starters, induced insanity wouldn't provide a supply of organs. For another, those in power might fear that the procedure could become reversible, or may have efficacy that wears off over time (these fears may well be ungrounded but still sufficient motivation.) This is to say, there is a finality to death that's hard to match. Furthermore, if it only works "naturally" on a small segment of the population then it's not a forgone conclusion that Putin could snap his fingers and have it weaponized such that it's effective on everybody.
Also keep in mind that inducing insanity reliably can already be done today using very primitive technology. Prolonged sensory deprivation, or even just social isolation, takes a hard toll on people. That's a pretty reliable mechanism from what I understand, and is considered a heinous form torture by many, yet these governments still choose kill people. They could also give people lobotomies or fry their brains [ab]using electroconvulsive therapy, but they still choose to kill people.
Some drugs are capable of permanently transforming a "sane" individual into one with psychosis or other permanent mental disorders. Even alcohol has been shown to have this effect in some heavy long term users. It's even more common in meth users. It is not "pure bullshit."
There are definitely neurotoxic substances that can induce psychosis or other problems (such as parkinsonianism) but these tend not to be very usable either clinically or recreationally. I think overall, the chance of cardiotoxic or repository depression is more of a common problem with most common recreatioal drugs at common doses.
Per https://www.health.harvard.edu/blog/teens-who-smoke-pot-at-r... if you have marijuana while young and no other particular risk factors, your chances of becoming psychotic increase by 7/1000. The combination of you had to take it while young and this low rate make it a poor choice of a way to abuse dissident adults.
Pharmaceutical companies have donated millions to preventing legalization[0], and yet you’re invoking a rare genetic condition as evidence that pharma supports legalization? They’re literally some of the largest donors to anti-legalization efforts.
0: https://www.theguardian.com/sustainable-business/2016/oct/22...
Perdue gave a lot of money to anti-legalization efforts to deflect the criticism of selling OxyContin.
That's a key point, you've used it and have actual experience with it.
Marijuana has long been misunderstood and misinformation abound, but as more people use it or know those who do, that's been quickly changing. Add to that increasing medical evidence and more doctors coming onboard. It's just a matter of time now.
Indeed it seems we've already hit the tipping point. Public opinion flipped in recent years on whether it should be legalized, most are now in support: https://www.pewresearch.org/fact-tank/2019/11/14/americans-s...
1. The healthcare and pharmaceutical profits at stake if people needed less care and fewer prescription pharmaceuticals
2. Cultural momentum excluding Alcohol from being considered a drug (LOL) and approving of drugs that support the protestant work ethic and existing labor system (caffeine, nicotine, and prescription amphetamines to stay alert on the job and alcohol to wind down in the evening), plus the cultural momentum of billions of dollars and decades spent on a pointless and damaging "War on Drugs"
3. The threat that psychedelics in particular pose to existing authority structures: high self-respect, beliefs that each human is as worthy as the next, and the ability to imagine less authoritarian systems are all threatening to the existing system. Tim Leary wasn't wrong when he said that (users) "won't fight your wars, won't join your corporations"
~~~~~
There are five different schedules of controlled substances, numbered I–V. The CSA describes the different schedules based on three factors:
Potential for abuse: How likely is this drug to be abused?
Accepted medical use: Is this drug used as a treatment in the United States?
Safety and potential for addiction: Is this drug safe? How likely is this drug to cause addiction? What kinds of addiction?The real issue is that code isn't intended to wrap naturally, while prose is. Prose doesn't belong in code blocks.
You can detect very long lines in code blocks and issue a warning / suggest prose. Or automatically toggle.
> Potential for abuse: How likely is this drug to be abused?
> Accepted medical use: Is this drug used as a treatment in the United States?
> Safety and potential for addiction: Is this drug safe? How likely is this drug to cause addiction? What kinds of addiction?
Look into the history of laws surrounding marijuana in the United States and you'll start to understand the politics behind it.
For example, here's a statement from John Ehrlichman[1], Assistant of Domestic Affairs to former president Richard Nixon.
> “You want to know what this was really all about?” he asked with the bluntness of a man who, after public disgrace and a stretch in federal prison, had little left to protect. “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”
By whom? (Citation?) This is the first time I'm hearing that.
0: https://qz.com/645990/nixon-advisor-we-created-the-war-on-dr...
>Nixon advisor: We created the war on drugs to “criminalize” black people and the anti-war left
so it was more their political enemies in general rather than a race. Not to say it wasn't part racist.
e.g. https://www.newyorker.com/news/q-and-a/how-a-historian-uncov..., https://www.cnn.com/2016/03/23/politics/john-ehrlichman-rich...
My take is that both narratives are simultaneously true. That different people involved had different motivations, some people having multiple motivations. The dimensional of the true series of the events is too high for any human to comprehend, so we instead study lower dimension projections of the truth. Like flatlanders looking at a cylinder; some think it looks like a rectangle and some thinks it looks like a circle. There can be underlying truth to multiple perspectives that may seem mutually contradictory at lower dimensions.
Organized crime in China has long been closely associated with mysticism and minority religions. Hashish, associated as it was with foreign traders and genuinely scary secret societies like the Hashashin*, may have set off alarm bells back in the day that are still taken seriously today.
"What’s often overlooked, however, is that these legal victories would probably not have been possible without the ability to break the law." - Moxie Marlinspike
[1] https://moxie.org/blog/we-should-all-have-something-to-hide/
It still happens today. I spoke to some Canadians who served in Afghanistan. They initially liked having some Americans on patrol with them. The Americans could call in better air power. But the Americans started burning all the marijuana plants, which the locals had only started growing growing because they knew the Americans had been burning poppy fields.
Both sides. Plus many other countries.
Furthermore, it's only been recently that the public has finally supported legalizing even marijuana[1]. So legislative action hasn't been in the cards until as of late, and sadly there still doesn't seem to be much of a push or actual policies aside from a few exceptions (Yang).
1. https://www.pewresearch.org/fact-tank/2019/11/14/americans-s...
There were unrelated reasons that lead to Urban decay and increase in crimes at the same time. The War on Drugs was a convenient distraction and an explanation for the ills that faced American society at the time. Only later did we realize the root causes of those instabilities were unrelated to drug use, and that the war on drugs actually made the problem worse.
This isn't all that surprising. Consider: the current POTUS and administration vilifies immigrants and blames them for all American societies ills.
This is such a common strategy of distraction, and the American public seem to fall for it repeatedly.
I do think the decriminalisation of the sale of marijuana is a reasonable step, but it’s fundamentally got nothing to do with the Portuguese model.
Norway seems to be taking the same route, so hopefully we’ll see more data to back up the success of this model in future.
Of course that’s a lot easier to do in countries with universal health care. I wish we took this approach more here in the UK.
As do I, but given UK politics, it's unlikely to happen.
Both Labour and the Conservatives jump on drug control as a political points scoring mechanism, fueled (as always) by the tabloid press. As usual, it's "politics before people".
The fairly recent Psychoactive Substances Act, which makes just about everything illegal (except alcohol, caffeine, nicotine), shows just how progressive drug policy is in the UK.
I support legalization of all drugs regardless of their safety, but it's important not to generalize too widely based on personal experience. Marijuana presents a different but important risk set when compared to alcohol or tobacco.
I'm not saying I understand or agree with the fundamental arguments. In fact, I don't think there aren't any arguments that were not subjective.
I'd say moderate intoxication is not a necessary evil. School is, though. Well, mild intoxication, for lack of a better word, is inavoidable. School is avoidable though.
Speaking from personal experience I find drug use and learning can be at odds very much. The topics are interrelated. And your comparison is backwards. If you are really saying: There can be good reasons not to go to college, but these don't generalize--whatever reasons those may be; Then we can prohibit drug use, if we can make school compulsory. There's no equivalence.
I mean how ridiculuous would it sound that, we must get these people high!? We must let them have relieve at the cost of a few failed existences--sounds not much better. It's OK in case of college, because we need that to reduce the need for it--something like that, if not to cure alzheimer. At this point I note that my idea of drug use chiefly to get high might strike someone as odd and in need of regulation.
That's what they call for, after all, control, information, responsibility. What would that look like in practice? Only one way to find out, you have to inform yourself.
The message that it's bad and hence illegal is therefore the simplest. It does not incur any further responsibility for the emitter, but leaves it completely with the user: It incures duty in prisons--that's the users fault, they didn't have to. Prohibition is a reasonable form of control, too. Because, first those who must participate will find a way any way, whether to their own detriment or not. And then, getting caught should always follow a prior fuck up. Import a substance that sells at the price of, I don't know, alluminum, although it's literally peanuts--hell yeah you are morally corrupt. And I don't see the price coming down after legilization. Whereas getting imprisoned for possession is rather difficult where I'm from, so it's a proxy for worse offenses that get one in the spotlight, often enough.
Perhaps price is a measure of control. If time is money, then an economist sees a lot of time going to waste; perhaps even in colleges and business schools. Thereby I've achieved reduction ad absurdum, commiting to the same falacious comparison as you.
If there's anything else I wanted to say, could have or should've said, the I forgot. My memory is very bad, sorry. I blame information technology, and a sped up aging process.
Negative human rights are the only kind that make sense in my opinion. I don't owe you my labor, my time, or even my existence. It's only when you start thinking you are owed a part of me that you start thinking you should get to control what I do with my body.
This is why the right to free speech is about the government not inhibiting your ability to speak and why the right to bear arms doesn't imply the state must provide you with a gun. Some positive human rights like right to an attorney squeak in because we're about to take away one or more of your other negative rights through the judicial process.
did you make that up? I know positive and negative discrimination is a thing, and there was even a fourfold distinction something I don't quite recall about positive/negative punishment/encouragement, sometging about how we learn. So, thanks for the downvotes, I mean, the attention.
"Negative right" is a paradox. You cannot at the fundamental level forbid to forbid.
It would be much healthier for everyone (drug users and non drugs users) to simply acknowledge this truth.
Portugal decriminalized drug use. Meanings that drugs are still illegal, it is just that you won't face a court of law and you won't go to jail, but you can still get punished, for example with a fine.
Also, if you have more than a small amount of drugs, it is considered trafficking and it is still a crime in Portugal. With jail time.
And there is no exception for cannabis, it is illegal just like crack and heroin.
So every few months he drives three states over to the closest legal state, stays for a few days and buys enough to last him until his next visit. From what I understand, this experience is not uncommon at all. There are even AirBnB's that cater specifically to these "medical refugees" coming in to buy there because they cannot get the medication they need in their home states.
It is really insane to me that prohibition of a plant continues despite all the evidence of its positive benefits. Especially when drugs that are far more dangerous to you than marijuana can be purchased at your corner drug store without even showing an ID.
https://en.wikipedia.org/wiki/Legality_of_cannabis_by_U.S._j...
So insanely risky, especially considering speed traps are not illegal and cops practically camp where speed limit drops by bits.
The cop told him that a quarter of the rental cars he stopped on the highway were carrying some form of contraband. Apparently, out of state rental cars on the highway attract police attention.
But even he acknowledges it’s a risk; just for him I think it is a worthwhile risk to not have to deal with that shoebox of medications.
https://www.theguardian.com/sustainable-business/2016/oct/22...
https://www.zerohedge.com/news/2019-08-12/big-pharma-takeove...
And for when it is in an addictive context, is it merely replacing an unhealthier habit with a more benign one?
Both cannabis and kratom can be psychologically addictive, in the same way as anything "rewarding" can be.
As kratom contains opioids, it might also cause physical dependence. I say might, as mitragynine is not a typical opioid, in that it doesn't recruit beta-arresting - which is thought to be responsible for the build up of tolerance and dependence by opioids, as well as for some of the negative side effects, such as respiratory depression.
There are many conflicting anecdotal reports claiming that kratom does cause withdrawal on abstinence, or does not. Personally, I have previously been able to stop kratom multiple times with no withdrawal at all (which has certainly not been the case with my prescribed opioid meds). My guess is there may be genetic factors at play here, and of course as a natural product there are bound to be variations in chemical composition of kratom from different sources.
Kratom was one of the only medicines that allowed him to function and it was getting more difficult to reliably source due to regulatory pressure.
He died abruptly 3 months ago due to rapidly progressing infection secondary to immunosuppressant / chemotherapy drugs prescribed to help him control symptoms.
He was 34.
Pay attention to the FDA's leadership. It's a revolving door with industry. Access to safe, effective medicine is not the FDA's goal in practice.
I'm torn between the need for effective regulation and the often dysfunctional real-world implementation of those controls.
Culturally, scientifically sanctioned pharmaceuticals are usually the only option provided to patients who are left to either seek alternative therapies or become dependent on treatments that often do not improve their well-being. "Non-traditional" medicine is often demonized as anti-science and lumped together with nonsense like homeopathy despite long successful histories in folk medicine.
This is unfortunate, because I believe that by treating medicines outside the mainstream -- medicines that are widely accessible, sometimes illegal, but primarily are not commercially viable (and thus are excluded from much scientific research) -- as akin to snake-oil means that a large and growing body of people are susceptible to things like anti-vaccination silliness. "Correct think" -- a culture of fetishism of scientific expertise that isn't actually scientifically motivated -- is responsible, in my opinion, for reactionary movements that are harmful to everyone. We live an an age of a narrow definition of scientific and off-load our critical thinking to experts who, in the best case, do not have the resources or data to look beyond the recommendations they learn in medical school, or in the worst case, produce phony medical trial results that exaggerate benefits and overlook harm. I would call it scientific myopia, but it's a cultural illness and not a problem particular to science.
It's possible to approach non-mainstream medicine rationally and not be casting bones in search of omens. But not according to our current cultural outlook.
Marijuana is a reasonably effective pain treatment which is readily available without prescription. Even without the really scary stuff surrounding Opiates, I'm far more likely to use the pain meds I can pick up at the corner dispensary. The cost of weed is far less and more important, availability and bullshit hoops I have to go through are far less.
About the only downside to weed is you gotta smoke it unless you process it first and making edibles or an infusion with a sous vide is not very difficult at all.
https://www.sousweed.com/blog/2015/6/13/sous-vide-cannabis-b... https://medium.com/sous-vide/sous-vide-thc-infused-cocktails...
[1]: IMO, I use top-shelf for my eds; generic ones are probably a lot of shwag, and the "mg THC" ratings are incredibly inconsistent.
I enjoy crafting more than consuming so I tend to have way more than I can consume and give most of it away.
Yep -- I don't even consider this an issue since it's very easy to get edibles as a consumer. For example, you can get marijuana-infused candies and tongue drops from pretty much any big dispensary for a pretty reasonable (sometimes better) THC+CDB/cost ratio.
Smoking and vaping marijuana (flower, dabs, oil, etc.) is known to be pretty bad for you, but edibles bypass that negative altogether.
But if cannabis weren’t legal in WA, I’d probably just take the Vicodin because OTC isn’t enough. So for my current situation, cannabis falls right in that happy middle I need, and to bring it back on topic, keeps me off the hard stuff.
[0] https://www.leafly.com/products/edibles/tinctures-sublingual
I've upvoted both of your comments. Since a lot of people won't draw the distinction between the different types of edibles, the previous warning is warranted.
For at least the first few times using edibles, I'd also advise the GP to be extremely cautious, and especially so if you don't have a precise source; the effects of vaping/smoking are 1-2 hours, but can be 5-7 with edibles - if you have too much, you're in for something akin to a bad trip (it's not the same, but the closest I can describe it), feeling nauseous, anxious and paranoid. It really is absolutely horrible
Sure, drops will last longer than smoking/vaping, but the high is much milder and less intense (holding the amount of THC/CBDs constant). As someone who used to get anxiety and paranoia from weed, I can say that drops are much more benign in that manner.
IMO the best strategy for the drug war is to make MJ and other drugs with very low addiction potential (shrooms, LSD) available nationwide, and continue to harshly prosecute the sale (but not possession) of crack, heroin and fentanyl.
That way people who feel like they need drugs to deal with their life situation will choose MJ out of convenience alone.
Now I'm personally for the recreational legalization of all drugs in general, but this is a poor argument, just like increased tax revenue is a poor argument. Proponents of legalization should be arguing that anyone should be able to do whatever they want to their own body as long as they're not hurting anyone else.
>Proponents of legalization should be arguing that anyone should be able to do whatever they want to their own body as long as they're not hurting anyone else.
Sure. That's one possible argument. The evidence in this paper is another.
The only coherent opposition to it I've ever heard is that it's difficult to test for marijuana intoxication on the side of the road. Which still doesn't really make sense when you consider that people are clearly doing it anyway (and now can easily cross state lines with no marijuana in their possession but quite a bit of THC in their blood).
Seriously, I can only guess because none of it makes sense to begin with.
Firstly, there have been multiple studies linking cannabis use to schizophrenia, and opponents like to point to them.
But most of these studies are of poor quality (e.g. small sample size, short duration, poorly controlled for confounding factors), or/and have skullduggerous sources of funding.
Secondly, decades of anti-drug propaganda have much of the population convinced that all drugs (except of course alcohol, caffeine and nicotine) are essentially evil, and that cannabis in particular is a "gateway drug" to things like heroin (personally I find this to be ludicrous, but it's been said enough times by tabloids, politicians and schools that enough people believe it).
This second one is deeply entrenched, and it will take much time to change opinions.
. . . in a way that convinces me, not other people.
That's not how changing minds works.
The problem with that analogy is that taking a drug is a victimless crime while stealing something is not. The quality of “bad things” is entirely different. Stealing means I am deprived of my property due to your actions. Smoking weed means I am offended by your actions, and I just happen to have a dumb law to cudgel you with.
The sentiment behind keeping most drugs illegal looks a lot more like racism or homophobia or bigotry in general than anything else.
Opioid addiction rates across states (and nations) already varies quite wildly, totally independent of weed laws, which were all quite similar some time ago. And the variation is large, far beyond the 5-10% supposed relationship in the paper.
Organisational, legal, social attitudes towards opioids change quite frequently as well - these would be very hard to normalise for.
If someone can validate how they crack the normalisation to achieve causality I'd love to hear about it.
More specifically, I'm always wary of 'top down' science that doesn't consider the myriad of real world considerations regarding their thesis; specifically they don't actually talk to people (or even take surveys) to get a feel for what is actually happening.
What if they had a lot of conversations and did a few surveys and found that people tended to not medicate 'en masse' for specific interventions?
I honestly don't understand how researchers can look at such an intensively social and behavioural subject without getting a personal feel for the prevalent behaviours.
I'll bet doctors, social workers on the front line have pretty good insight into what's going on.
So my question was pointed to anyone who understood this paper or issue in detail who could articulate in so many words 'why the correlation is valid'.
The roll out of marijuana legislation overlaps quite nicely with an overall effort to reduce opioid prescriptions.
I imagine it would be difficult to control for that effect.
> To examine the effect of cannabis access laws on opioid prescriptions, we estimate a series of difference-in-differences models, exploiting the staggered adoption of cannabis access laws over time ... Following Bradford et al. (2018); Buchmueller and Carey (2018) and Patrick et al. (2016), we include controls for [several] different legal changes that may impact opioid prescriptions in a series of robustness checks ... As described in detail in the appendix, we test our data for parallel trends between providers in states that adopted cannabis access laws and those in states that did not. We are unable to reject the null hypothesis of parallel trends, which supports the use of difference-in-differences models.
IIRC, it did work somewhat, but of course the participants felt "drunk".
I suffer from chronic pain caused by small fiber neuropathy in my arms and legs, and can add a single data point: alcohol does help a bit - but the way it does so is more by "distraction", whereas opioids really seem to reduce the pain. It's also completely impractical if you want to drive, work, look after children etc (normal life, basically). But I can certainly see why people would use alcohol if they were unable to obtain prescription medicines that helped them.
The most profound thing about DMT was learning that what I saw decades ago is a shared experience: https://en.wikipedia.org/wiki/N,N-Dimethyltryptamine
For actual learning, LSD/Psilocybin is a much gentler teacher.
These drugs should be treated as seriously as any other (know your drug!). Some will fail to do that, but that is how it goes.
The moment I hear "drug X caused this bad thing to happen" I think of how much suffering alcohol consumption does globally on a daily basis. That tempers all associated concerns.
Until you compare the number of sufferers as a percentage of users, there is no tempering of concerns here.
I've seen multiple studies, mostly looking at pills sold as MDMA, which examined the actual content of samples of street drugs, and the findings were not exactly surprising - almost all samples were not pure (I mean, aside from cutting agents!) MDMA, often containing significant amounts of amphetamine.
In a legal, regulated marketplace, there are guarantees of quality, which would represent a huge increase in safety for drug users.
With a legal marketplace, production would also shift from global cartels to local businesses - improving lives, creating local jobs and increasing tax revenues.
The fact is that there will always be a market for drugs - people have afterall used drugs for millennia - so why not accept that and try to make something better of it?
There are of course risks to taking any drugs, just as there are with alcohol - but the potential for good by legalising is staggering.
Given what we’ve learned about data re-identification [1], this sounds like a pretty scary dataset. Does anybody know more about it? Do you need to pay for access? Is access restricted to researchers who can be trusted not to attempt re-identification?
With pot shops, they print out the THC content on every label so you can buy a consistent product at a regular price every time.
As an experienced grower I would trust myself and others I know who have expertise. I wouldn't need a lab test before consuming their product. As a frequent user, exact THC content is not really that relevant. Not nearly as much as knowing the strain and growing process, which as the grower, or the customer of a reputable grower or dispensary, I would know.
We're talking about a plant. The worst that can happen to you is a Peggy Noonan style freak out. Yet we're setting up a system where rent seekers will squat on grow and distribution licenses and the price will inevitably go up.
Page 36: https://www.researchgate.net/publication/235912814_CUT_A_Gui...
There's also fake terpenes you can spray on bud.
He specifically said, "black market products".
"This barely ever happens with illegal marijuana."
While it isn't the result of "cutting", the poisons applied to illegal pot kills animals (inluding bears) within minutes of ingestion, is destroying ecosystems, and will undoubtedly be impacting the health of innumerable users in the decades to come, destroying lives, and impacting the cost of healthcare. https://www.usda.gov/media/blog/2017/08/21/cleaning-illegal-...