Comment by bheadmaster

To be honest I would prefer addicts could get heroin prescribed. The primary danger of street drugs is the inconsistent purity and chemicals it’s cut with. If it was pharmaceutical grade and everyone prescribed was on a list, we would have fewer overdoses and a better understanding of who to put in treatment

Sr-17018 is making rounds now (ok was a year ago) among people using opiates too much. On forums, it is pushed as the miracle stuff which allows lowering dosage without major withdrawal.

That's because the reasoning does go in circles.

0) Zero tolerance! We still remember how it ended last time!

1) But ... pain medication helps against anything. From headaches to hernia to bone cancer (of course in some cases it's in a "die somewhat dignified" sense). And in quite a few cases it's the only thing that helps ... In the medical sense of "helping", after all medicine can't make people live forever so that can't be the goal. The goal is better quality of life, ie. mostly longer life, including the ability to live (think "sing, dance and play tennis") ... and not life at any cost.

The problem here is that this is an entirely correct argument. Some diseases are either incredibly painful or long-term painful. Bone cancer or hernia can serve as examples. We cannot really help such people (by that I mean: not in a way that the pain stops). So can we at least make their life livable?

2) This pain medication sure helps these very seriously ill people well. But X suffering is at least as bad as bone cancer! X then is everything from still serious diseases, psychological suffering, and of course this then goes down and down until someone points out pain medication also helps existential dread and lackluster parties.

Again, all of that ... is true. That's not the problem.

3) The medication becomes the problem. Mostly because of what people do to get money for their fix (and the crime, prostitution, ... that it leads to). But this is not the only problem. It makes people who broke a bone last week go skiing again. And ... I'm almost afraid to say it but you can increase the effect of morphine ... by damaging yourself. You can guess how that ends.

The problem is that pain medication, irrespective of whether it's physically ("biologically") addictive is addictive. Anybody who's had a serious pain for a week, say kidney stones, knows that they would have sacrificed their favorite cat for it to stop. The problem is not just that morphine is addictive. The problem is the pain, and the fact that pain medication is a temporary non-fix.

4) The medication becomes the problem, but doesn't just affect patients. It goes from "you know this funny thing happened to my niece ... and she did it to herself ..." to it destroys families, neighborhoods, childhoods ...

Result: ONLY ONE SOLUTION! ZERO TOLERANCE!

GOTO 1.

I agree. I would say that I am addicted to caffeine. I definitely get withdrawal symptoms if I don't have a coffee. But since it is so accessible and there are no health risks, it does not affect me negatively to "feed" the addiction.

By definition addiction involves pursuing substances or engaging in behavior repeatedly despite negative consequences in one’s life.

Any behavior or substance that causes serious addiction is still bad regardless of whether it causes death or other negative health effects. The addiction itself inherently causes suffering because the addict is engaging in something despite the negative consequences in the rest of their lives. The negative consequences cause suffering and the psychological pain of wanting to stop and not being able to stop also causes suffering.

I know some other commenters mentioned caffeine addiction but nicotine and opioids (and also behavioral addictions like gambling) are vastly more addictive than caffeine.

Negative consequences from addiction can involve more than loss of money (although loss of money is still a significant thing of course.) They can cause damage to one’s career, family relationships, friend relationships and so on. Even if the addictive behavior or substance has no other inherent negative health effects.

In high school I had a really bright and motivated friend. He went to an Ivy League school. He became horribly addicted to World of Warcraft as a freshman. He spent so much time playing the game that he damaged his grades and GPA. He almost failed out of school. He had to make serious effort to stay in school. And he had to spend tremendous mental effort to avoid playing additive games anymore. That’s just one example.

> .. if addiction is the only remaining problem with them, should we care that much?

I think we should because it’s undignified to have people who want to stop taking them but are unable to resist the compulsion. I feel the same way about basically every addictive substance. Even if it was freely available and risk-free I still think that being trapped in a cycle of use and withdrawal is such an affront to someone’s dignity that we should still try to prevent that.

There's already buprenorphine and methadone. But, using either means some degree of responsibility, punctuality, etc. So unless you mean freely distributing it with very little process, it wouldn't change much.

> if addiction is the only remaining problem with them, should we care that much?

Have you _seen_ what the streets of major cities look like these days? Ever heard of "fent zombies"?

I mean I guess it depends on the level of use? Do you need to be nodding off, drooling on the verge of respiratory collapse to cope with the dread of your situation? (I feel like people are mostly only considering the physical reasons for starting opiates in this post btw). Or is it a more reasonable dose that allows you to participate in society unencumbered by your pains? (Which in any case is a slippery slope with long term use)

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