Comment by AnthonyMouse
24 days ago
> 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.
There is a pretty decent argument that this was still a result of pseudo-prohibition, which goes like this:
Opioids were easy to get a prescription for, but still required a prescription (and were covered by insurance), and were still highly restricted in who could manufacture them. That made the margins high, and consequently created a perverse incentive for the manufacturers to want patients taking the high margin insurance-funded opioids rather than a cheap commodity out-of-pocket NSAID or acetaminophen.
Because they still required a prescription, getting people taking them meant they had to capture the prescribing physicians, who now get their own perverse incentives. Not only marketing/kickbacks/incentives from the pharma companies, if something over the counter would work and that's what you recommend, the patients buy a bottle at Walmart for $5 whenever they need it and you never see them again, but prescribe something stronger and you get to bill their insurance again and again every time they need another appointment to re-up.
But "ask your doctor" was supposed to be the thing you do to get sound advice. Give the medical establishment a profit incentive to over-recommend the addictive thing and what do you expect?
Meanwhile if they were all available at the convenience store for the same price, nobody would have the incentive to push the addictive one, and then when you ask your doctor (or for that matter anyone else) what they recommend, they would generally tell you not to take opioids unless you really need them.
Surely both manufacturer and convenience store have incentive to push the addictive product in this scenario.
In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves. Have you ever taken an opioid? The idea that unfettered access would result in less addiction and death is a pretty remarkable POV
> Surely both manufacturer and convenience store have incentive to push the addictive product in this scenario.
In this scenario the addictive product has the margins of a generic commodity and 75 competing suppliers. Getting the customer addicted has close to zero returns because the margins are thin and the customer's future purchases are more likely than not going to a random competitor rather than you. Notice how little advertising you see for things like flour or onions. If something is completely fungible and commoditized the incentive to push it on you is minimized.
And retailers have the opposite incentive, because making a $0.05 margin on a bottle of pills once a month is worth far less to them than not having someone who is a repeat customer lose their job to addiction or die of an overdose and then stop buying all of their other products.
> In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves.
If the drug dealers don't need to do any pushing then why do they spend so much time and effort on pushing? It'd have to be because pushing gets results, and therefore blunting the incentive for pushing gets results the other way.
>The idea that unfettered access would result in less addiction and death is a pretty remarkable POV
It's not that crazy, but it has to be coupled with accessible recovery programs. The classic tale (one that people in my life have gone through) is the prescribed opiates -> street heroin when the scrip runs out / when they change the oxy recipe so that it doesn't dissolve in water anymore so you can't shoot it.
This is obviously much more dangerous than getting oxy from your doctor, so the logic of "keep people from seeking heroin on the street" actually does make sense to me from a public health perspective.