utterly predictable outcome:
> The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases.
> The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases.
Enforcement just needs to be consistently intense enough to create an incentive for traffickers to opt for less bulky alternatives over bulkier alternatives.
I assume this is because everything is being diluted with cheap fentanyl.
But for drugs I do know and sometimes purchase, dollar prices have barely budged while the value of the dollar has declined (compared to the 90's). It's still $60-$120 for a gram of cocaine. It's still $3-$5 for a hit of acid. It's still $20-$30 for an eighth of shrooms. Ecstasy pills sometimes go for $30 now, but you can still find them for $20 just like in the 90's.
This is a myth. Nobody is cutting non-opiate drugs (like cocaine) with fentanyl. Fentanyl overdoses from non-opiate drugs are the result of accidental contamination, not intentional adulteration.
Drugs like cocaine are cut with other substances intentionally, but not fentanyl.
Obviously, we need some legislation, otherwise we'll revert to the world of patent medicines. (Basically, cure-all patent medicines had opioids in them, and people didn't realize what they were taking.)
Also, obviously, we shouldn't criminalize addiction to opioids.
Perhaps we merely need to change how opioids are prescribed so that someone can legally maintain an addiction without an otherwise "medical" need? IE, a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?
Is legislation the primary problem with these addicts? Or are there other social factors involved? If so, then perhaps the legislation itself is the least important part of the puzzle.
> Also, obviously, we shouldn't criminalize addiction to opioids.
We don't.. it's just possession and sales that are criminalized.
> can legally maintain an addiction
What social interest is there in promoting that?
> a recreational heroin user can get a prescription, and if someone accidentally becomes addicted to painkillers that were prescribed for medical reasons, they can legally continue that addiction as long as they want to?
There's a real fantasy on Hacker News about what the debonair lifestyles of heroin addicts actually are and zero apparent understanding of the long term consequences of the same.
> What social interest is there in promoting that?
Because the whole reason why we have the opioid crisis is because consuming any opioid without a medical reason is illegal.
IE, if you have an injury, and are prescribed opioids, and then accidentally get addicted, your only legal option is to go through withdrawal.
If you or I found ourselves in that situation, we'd probably go through withdrawal. Other people won't, and choose to violate drug laws in order to maintain their addiction.
Edit: I just want to point out that plenty of people willingly do stupid things: They get addicted to cigarettes, become alcoholics, drive too fast, write mean comments on the internet... We don't force them to quit their vices. The same should apply to opioids too.
> If you or I found ourselves in that situation, we'd probably go through withdrawal.
I wouldn't be so quick to make that assumption if I were you. Most people who become opiate addicts involuntarily would have assumed they would never resort to illegal opiate use.
That's a crucial piece of the puzzle: opiate users aren't a different class of person than you or any of the other users on this site. They're not cut from a different cloth. In all likelihood, most people on this site would respond the same way if put in the same situation. The only difference is that most are lucky enough that they haven't been put in that situation.
I could hardly function on the opioids (Lortab?) that I was prescribed after major surgery. I was relieved when my surgeon told me to stop taking them. Likewise, and I really hate the other opioids (Percoset?) I've been prescribed for minor dental surgery.
One person I know really enjoyed them and ended up dying from the addiction.
Clearly my head and body react differently than other people. I assume that akira2501 would be ultra-careful if he was in my situation.
Threw away the rest of the capsules. If my physiology reacts in such a way, it means I was beginning to develop a physical addiction to it. To Kratom, of all things.
It kind of opened my eyes to how quickly it can happen to people as well as how the desire to feel better and reduce suffering can easily lead us to ruin if we aren't careful and attentive.
Fair enough, but I am simply unwilling to call "just letting them be addicted" a _solution_ of any sort whatsoever. I'm entirely disappointed with this level of social response. You can be saddened by the apparent hopelessness of their situation, but beckoning further destruction and squalor for lack of willingness to truly care about the problem genuinely upsets me.
I understand that part of the concern is these people acquiring a "record" that will make their life difficult in the future. A simple mechanism that expunges these charges entirely upon proof of sobriety is all that's needed to solve this.
Basically, the problems that arose from alcohol prohibition are the biggest proof that keeping a substance illegal leads to crime and squalor; not the substance itself.
(Assuming you're in the US or similarly governed countries:) The law isn't about forcing people to make the right decisions for themselves, it's about helping society function. IE, "freedom" only works when other people can do dumb things.
Clearly, our current situation (opioid consumption is illegal unless actively being used for pain management) isn't working; and doubling down on that situation isn't a solution either.
There's a clear difference between "you shouldn't do this" and "doing this is illegal." Having the maturity to understand the difference is why we ended alcohol prohibition, and also what's needed to contain (and hopefully end) the opioid epidemic.
Watching first hand how opioids impact people in SF. I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.
Getting police involved in trying to solve social problems has its own inevitable tragic consequences. This is not a problem you can arrest people out of.
This is counterfactual. There is zero basis for claiming that tolerances are increasing at a population level. The increase in potency of street drugs is due to the basic economics of the black market on the supply side, not a response to demand.
> I think forced treatments have to start becoming an option. It isn't humane to let people rot on the streets.
Forced treatment is itself inhumane. It's a "solution" proposed only by people who have little idea of what it looks like in practice, of how substance abuse works, or of what successful treatment actually entails. In reality, "forced treatment" dramatically increases the death rates of people subjected to it.
If your problem is with people living "on the street", there are lots of simpler ways to address that problem than to subject them to a costly, expensive government response that will statistically end up killing them.
I think he is just saying even if you legalize it and allow addicts to get drugs easily, it’s not viable long term as the addicts will develop tolerance to the drugs and will need ever increasing doses.
Right, and that's not true, because that's not how addiction actually works.
Can tolerance result in withdrawal when dependence is present? Probably not? No one has mentioned it anyway. If so a person who has developed tolerance and dependence on a drug will just not feel any of the effects when they take it but will feel withdrawal effects when they stop.
Addiction is a different can of worms though. If addicts crave the effects of the drug and won’t be satisfied otherwise, then tolerance is a problem for them and they will require ever higher doses to stop the cravings.
This is exactly what I'm afraid of. Especially when it is very easy to overdose on fentanyl.
The main reason why overdoses occur is because street drug potency is unknown, and because street drug potency can be inconsistent within the same batch.
(IE, if my black market "heroin" is really powdered fentanyl mixed in a gel, if I don't mix it well the fentanyl will clump, and the clumps could kill someone.)
Just to be clear here, I'm speaking from a position of much more domain knowledge than "a quick reading of a few health websites".
> If addicts crave the effects of the drug and won’t be satisfied otherwise, then tolerance is a problem for them and they will require ever higher doses to stop the cravings.
This, along with the entire trichotomy you've presented, is incorrect. It may surprise you to know that this is a topic that has been quite extensively researched, and there are mountains of clinical data on the topic. Maintenance doses aren't "ever-increasing" - they're fixed.
Pardon me. It’s hard to tell since your original post was pretty low on content. “No you are wrong” isn’t very insightful.
> Maintenance doses aren't "ever-increasing" - they're fixed.
Does this work for addiction or just dependence? Can we see some of the “mountains of clinical data on the topic”?
Canada ran a safe injection site with (cough) free heroin of guaranteed quality and potency, and free access to addiction counseling.
Turns out most people (in the program) quit using eventually.
I personally don't remember the details, and if you want to do the research to confirm (or dispute) my facts, that's on you.
The bigger problem is that government anti-drug propaganda (like DARE in the US,) biases people to assume that legal access to drugs will increase addiction, when the facts generally disprove this assumption.
You are describing maintenance programs. While methadone has been the maintenance drug of choice for programs in the US due to legal barriers, it turns out that heroin maintenance programs are even more effective than maintenance programs based on substitution.
With a maintenance program, members come to the site to receive a legally-obtained, pharmaceutical-quality[0] supply of the drug. Depending on the program, they may either use it on-site (e.g. supervised injection) or bring it home. Crucially, the drug is provided free of charge, so members don't have to worry about how to come up with the money to pay for it.
It turns out that these programs reduce crime rates among the members, because most crime that they are committing was in pursuit of the money for their basic needs[1]. Without having to worry about obtaining their drug, or the safety issues associated with the illegal drug market, many are able to find stable jobs, return to stable housing, and lead otherwise normal lives.
This isn't new science - one of the first studied attempts was in the 1990s[2], and there have been many more papers published since, documenting the extraordinary benefits. The science behind it is rock-solid. The challenge, as always, is a political one.
[0] Zero adulterants, no contaminants - just like the supply of morphine or fentanyl that is used in hospitals for inpatient treatment.
[1] Yes, for someone addicted to opiates, the drug is a basic need: involuntary withdrawal is extremely dangerous even under medically supervised conditions, let alone in the conditions most people are forced to experience it.
I used to be sympathetic with that Bill Holiday song "Ain't nobody's business if I do." I'm doubtful about that now but I don't think anyone will stand for a half measure when there's a full measure available - and the last full measure is throwing someone in jail to protect them but that's dumb.
No, legal access to opioids to maintain an addiction also comes with addiction treatment options.