Comment by hash872
4 hours ago
>The government should just regulate it, control purity and production and let people access small amounts for recreation/performance
Famously, the US spent about 15-20 years attempting this with opioids. They were widely available to people via a pseudo-medical process, or via secondhand dealing. Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. The result? A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War.
(For people saying 'no, that was illegal heroin or fentanyl that did all that damage'- the Wiki page for the opioid crisis is quite clear that at least 50% of all deaths were due to perfectly legal, regulated opioids).
When you make drugs legal & easy to get, lots & lots of people do them- who develop life-shattering addictions and OD en masse. They also build tolerance and then move on to even harder stuff. AFAIK out of the 300ish countries on the globe, there is not 1 that has decriminalized hard drugs in the modern era. And no don't say Portugal, contrary to widespread myth they forced people under threat of jail to attend drug rehab, and anyways they've recently curtailed even that.
I realize this is not going to get a lot of upvotes on HN, but yes making it difficult to do hard drugs is a reasonable public policy goal. (Which again, is why literally every country on the planet does it). There's room to argue about the exact tactics, but the broad goal is perfectly legitimate
"the Wiki page for the opioid crisis is quite clear that at least 50% of all deaths were due to perfectly legal, regulated opioids"
Are you talking about this page?
https://en.wikipedia.org/wiki/Opioid_epidemic
Could you then be more clear where exactly your claim came from? I did not find it, but rather this:
"According to medical professionals, supervised injection sites are effective in reducing overdose deaths and the transmission of infectious diseases."
I think a astronomically better example would be programs in the Netherlands, Denmark or Switzerland, where people heavily addicted to heroine can get into programs that will provide them with pharmaceutical heroine. Still prescribed by doctors (although specialized ones), but not just for pulling a wisdom tooth with huge margins for the Sacklers...
A problem LAR programs have had since the start is that although methadone is less attractive as a drug than heroin, it's still attractive, and basically the only way to figure out how much a heroin addict needs is to ask them. Leading to users asking for extra, selling the excess (to users who were not in the LAR program) and buying other drugs with the profits. For some years, more people died from methadone overdose in Norway than heroin.
Sure, you could demand injection on site to reduce this problem. But that just makes the program less appealing. You could also just hand out the users' drug of choice directly (heroin) rather than the less harmful substitute, but at some point that starts counting as physician-assisted suicide, really.
Are you referring to the massive opiate abuse crisis that followed World War One?
I believe the gp meant the last few decades and the crisis that culminated with the Purdue trial.
Your opioid comparison is wildly apples to oranges. They were marketed and sold to consumers as safe, much more effective, and dramatically less addictive than it actually was. An industrial addiction machine ignored regulatory safeguards, built a 'pay for play' rewards structure to incentivize prescriptions, and a zillion other cartoonishly evil things .
There is a world of difference between something like that and government dosed methadone, meth, etc.
The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too.
If the drug is socially stigmatized only true addicts will use it. Those are exactly the people you want to have access to it because they can be gradually tapered off on a controlled dosage, they can be targeted for interventions, and it keeps them from stabbing you and stealing your wallet to get more meth.
Its incredibly counterproductive to just outlaw a thing that people need on a level that they will do almost anything to get it.
I think another under-discussed factor in the opioid crisis is that opioids are cheap, but (American) healthcare to treat underlying pain is not. You might not be able to afford six weeks of physical therapy, surgery, etc., but you can probably afford $11.23 a month for a generic prescription.
My view of a lot of the opioid crisis stuff aside from physical pain is psychological trauma - people self medicating as an alternative to doing the work.
That’s why I think the psychoactive legislation that’s introduced recently about psychedelics is so important because those things can rapidly accelerate processing and healing psychological trauma.
My view, is if this was done 20 - 30 years ago there wouldn’t be such a large demand for opiates. I take it further and say that probably some in the drug companies understand this already and were lobbying against the introduction of more curative psychedelic treatments so that they could sell subscriptions to painkillers.
7 replies →
>Those are exactly the people you want to have access to it
Yes but that's different from 'every random person can buy some meth at 7-11 or the government store' though. I'm fine with a controlled program for registered, hardcore addicts- the 2% who do 50% of the drugs or what have you.
>The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too
I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though? If 'removing the profit structure' worked magically, more countries would do it. AFAIK rates of alcoholism aren't even different between state-run and private sector models
> I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though
They have less of it. Reducing access and increasing price reduces consumption, as any economist would expect.
The main problem with government monopolies of this sort is that they usually lack democratic legitimacy (i.e. would be voted away in a single issue vote) are under constant PR attack from people who profit from the regulated product. Leading to concessions such as the Norwegian monopoly being run as a for-profit corporation.
> If 'removing the profit structure' worked magically, more countries would do it.
No they wouldn't, for the obvious reason: those who profit from it have a voice, and are better organized than the ones who suffer from it (many who are addicts and want easy access anyway).
That's a bit of an apples and oranges comparison. The thing about for-profit prescriptions is that they incentivize doctors to prescribe opiates for people who don't need them, people who may not have even been interested in them. A for-profit retailer selling alcohol doesn't have that aspect at play at all; at most the for-profit aspect encourages flashy advertising and displaying alcohol more prominently, but nothing to the level of having a trusted expert in a one-on-one setting personally pushing for you to consume.
Instead the pressure to consume alcohol comes at a grassroots level. Social alcohol consumption is deeply rooted in human culture, and it's generally the people around you who will push you to consume. This pressure is independent of any profit motive, so removing the profit motive does nothing to affect it.
> AFAIK rates of alcoholism aren't even different between state-run and private sector models
Looking at some 2016 WHO statistics, the US seems to have ~3x the rate of alcholism as Iceland, but I recognise these are cherrypicked examples and I'm not interested enough to do a deep dive aggregating countries. Still, it seems plausible that government intervention can reduce alcholism rates. The fact that it's not 0% means nothing; nothing in the world is 0%, outlawing murder doesn't mean murder doesn't happen, but you can strive to reduce it as much as reasonably possible.
State run liquor stores in the US don’t prevent companies advertising alcohol on TV. The US is really bad at allowing drugs without then also allowing drug promotion.
A better comparison is probably countries where prescription drugs can’t be advertised to the general public. But, then you’re dealing with a lot of differences in other government policies.
All Scandinavian countries except Denmark have some form of state-run monopoly on the sale of harder alcohol, and of these countries, Denmark is the country where people drink the most, in particular among the youth.
It is disingenuous to claim that something doesn't work if it doesn't eliminate it completely. It is pretty well recognized that tight regulation of alcohol sales and marketing together with taxation helps reduce overall consumption. Alcohol consumption was also not eliminated during the prohibition in the US.
It's also important to recognize that making a drug legal is not the same as regulating it properly, and just making it legal can very well bring more harms than keeping it prohibited if no regulation of its sale and marketing is introduced.
2 replies →
There are 193 countries, plus the Holy See.
How many died because they were cut of from the supply that they had been told by doctors did not cause addiction?
> A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War.
Except that you're wrong. The war-on-drugs kept drugs under control. It did not _eliminate_ them, but they also were not available on every street corner.
Once we stopped the war-on-drugs, the abuse rates skyrocketed. Not just opiods, but also meth. You can see it on the graphs in this article, the general wind-down of drug abuse policies started around 2008-2010.
I personally consider the war on drugs to be a colossal failure and there tends to be widespread agreement that the War on Drugs was somewhat effective at enabling enforcement, but ineffective or counterproductive at eliminating drugs or reducing long-term harm.
What America continues to ignore, intentionally or not, is the root cause of drug addiction which tends to be a more complicated and nuanced
Well, now the war on drug is over and we see that the harms from _not_ doing it are worse. In 2023, overdoses overtook gun and traffic deaths _combined_.
Surrendering to the drugs was a mistake.
Yeah, we should have changed tactics. Zero-tolerance policies were terrible nonsense, long prison terms were not helpful, and we should have clamped on prescription pills way sooner.
> but ineffective or counterproductive at eliminating drugs
It was effective in _controlling_ their level. And alternative approaches are just not working.
I think we're agreeing with each other?