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by hash872 37 days 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

21 comments

I don’t think it’s fair to say we tried letting people access it for recreational or performance use. The insurance companies and doctors became drug pushers without an explicit acknowledgment of what was happening. Easy access to drugs without being able to discuss what was really happening is worse than prohibition sure, but that’s not informed consent. Informed consent is the patient tells the supplier what they’re doing and the supplier is trained to handle that. Our doctors are not drug shamen or addiction specialists, but we could imagine a situation where these are the people providing drugs, safe drug sites, and free counseling. Otherwise the solution is men with guns and weird geopolitical shit. Also the government gets to decide what drugs people can take which I disagree with in general. There has to be a better way.
Doctors prescribed drugs and everyone became addicted, do you seriously think Nestle is going to pull their punches when they can sell people crack?

They’ll be outside funeral homes, outside schools, offering free graduation crack. Ads on every bus, hot women handing it out in the street.

Selling it in adults-only dispensaries, along with banning advertising seems like the best idea. I'd ban tobacco, liquor, and gambling advertising too while we are at it.
This doesn’t happen with regulated cannabis. This is just wild fantasy.
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...
The last time I looked up the Swiss program it was only servicing a small number of people. Around 1500 in a country if 9 million. It also wasn’t prescribed like a typical medication but part of a program where they received other treatment as well. There was some exception where some people could get 2 days of it at a time to take home, but it wasn’t a free for all prescription where they could just talk to a doctor and get their monthly desired supply from a pharmacy.

Many countries, including the US, use methadone for maintenance. As I understand it it’s not as enjoyable as some people’s opioids of choice but it’s still an extremely powerful opioid depending on the dose (easily fatal).

So it’s not only the countries you mentioned that provide pharmaceutical opioids as maintenance treatment. The US does too, though the form is different.

> a small number of people. Around 1500 in a country of 9 million.

What is this supposed to mean?

That’s a completely nonsense statement to make because you’ve provided no data on problem opioid use in Switzerland.

Is 1500 a lot? Not many? Average? Should all nine million be on the program?

I'd say it is about what you expect for a country with voluntary programs. In the Netherlands the original program like the Swiss, resulted in heroïne becoming a medication for heavily addicted people usable under supervision. In the Netherlands there are about 4000 people with medical prescriptions for heroine on a 18M population.

Note that it is free, supervised and voluntary so ymmv in other countries. The conclusions of the original program with methadone in the 80s was that it resulted in hardly any reduction amongst heavy and problematic users and they were likely to go back to using heroine with all the associated problems, the heroine distribution program worked but needed some tweaking, thus the program was fully legalised and put into law resulting in supervised consumption (at the distribution point) with dosage control and medical checkups and far less issues.

I’ve used heroin maybe 80 times.

I can understand why methadone is ineffective as a treatment.

Wow. Can you speak more about this experience?
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.

methadone is not a less harmful substitute, it's just the one that makes official people money. the withdrawals are worse.
Don't Spain and Portugal also have fairly progressive policies/programs for drug harm reduction? I remember reading about it a while back, but it was a US source and they were trying really, really hard not to have to say "you know, this might actually be a good way to handle it".
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.

Cocaine and Heroin (and LSD...) were widely available 20-30-40-50 years ago. Maybe this is a "It's the economy, stupid" thing?
Pretty much. Most Americans live awful miserable lives regardless of being addicted to drugs or not
Sorry what? What does ego death have to do with healing a back injury?
Nothing and everything: https://www.frontiersin.org/journals/immunology/articles/10....

(This is a serious article by a serious researcher. There exists good work on Frontiers in….)

The 5-HT2A receptor is profoundly immunomodulatory. (Acid is arguably a more potent immunomodulator – an antiinflammatory one – than it is psychoactive.) Local inflammation is a thing in injury, "global" inflammation as well – there is strong interplay between cytokines and metabolic/anabolic/catabolic process; Interleukin-6 stimulates osteoclasts which actively break down joint tissue – and neuroinflammation also affects physiology. Muscle tone, blood flow, pulmonary function, and so on.

Ego death happens to be a phenomenon or qualia when you boop that receptor hard. I'm not sure ego death necessary for anything. It might be. Ego death is very intimately related to the individual neuronal state and memory, and inflammation is quite enmeshed with that. (Cf. cortisol.)

huh. glad I asked.
I did say aside from physical ailments
Chronic Back pain is correlated with emotional trauma. The physical body is a mere projection of the energetic and spiritual being. This is wahy meditative spiritual practices such as yoga and taiji are good for chronic pain, as the physical pain is a mere projection of a deeper trauma that needs released.
how does my spiritual wellness affect the mechanical structure of my lower back?
Relieved to learn that my small peen is merely a projection of my energetic spiritual being.
I feel like you missed a turn somewhere.
>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

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.

> 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.

Alcoholics (the really bad ones that we're presumably talking about here) don't consume because of social pressure. It's addiction and all the associated psychological and sociological complexity that implies.

I expect any comparison of alcoholism rates will need to account for social (particularly religion) and socioeconomic factors. An awful lot of addicts are engaging in escapism.

Addiction doesn't start until you've first started consuming a substance. The means by which you first start consuming alcohol vs. opioids are completely different, and the former is virtually always the result of social environment.
Sure, recreational social interactions tend to be the introduction since it's legal and a common pastime. But such interactions are almost never the primary driver of alcoholism except perhaps in specific college environments where you might reasonably describe the pastime as competitive drinking. That's far from the norm though.

Coincidentally, aside from official prescriptions recreational social interactions are also the primary method of introduction to drugs of all sorts.

> Instead the pressure to consume alcohol comes at a grassroots level.

Lately the trend seems to be slightly decreasing, see : https://ourworldindata.org/grapher/per-capita-alcohol-1890 (of course heavy dependent on the country and the timescale selected)

> Social alcohol consumption is deeply rooted in human culture

This is actually dependent on the culture and not all are the same, interesting paper on the topic (in cultures with higher agricultural interdependency alchool was not used as a tool for social cohesion): https://www.researchgate.net/publication/404116345_On_the_Fu...

>The government should just regulate it, control purity and production and let people access small amounts for recreation/performance. It’s not an evil drug per se

>Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. The result? A shattering drug addiction crisis

>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

>I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though?

I tried to draw upon the main central point of each comment to this point. This discussion felt reasonably solid until this point where I feel like you failed to refute their main point. Your counter-example is still apples and oranges. State run liquor stores don't have the strong financial incentives to push alcohol and they don't downplay the addictive potential of their wares using fake science and they don't have authority figures give their patients official recommendations to take alcohol as a treatment with that fake science and financial motivation. Obviously people can and do still get addicted to all kinds of things without that scheme in place but I feel your initial example is pretty uniquely evil and not something we can learn generalizable lessons from, other than "don't do super evil stuff". Surely if your initial point is strong enough you can still make your case using other more generalizable examples.

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.

Lets not forget that in the US not only opioids get legalized, but they were given to people as a substitute for aspirins. And then retired without mercy. Did you get addicted? Well, you are on your own now, go get some fentanyl under a bridge.

I live in Spain. Alcohol is not tighty regulated here, and is cheap if we compare with nordic countries. But we, overall, have a culture of knowing how to drink, low proof drinks and in low quantities. The worst drinkers here are tourists from northern countries that binge on high grade alcohol because it is cheap. I had never seen someone chugging a liter of beer like it is water, or do that thing with a can of beer where you force the whole can, or that other thing with the funnel and a tube, like you were in a hurry to get drunk. You just drink a beer whenever you want, at slow pace. Spain, overall, consumes a lot of alcohol, but the consumption is so spread among the population that you rarely see adults drunk.

Our neighbor in the south, Morocco, allows for marihuana consumption and selling, and they have way less problems with it than any european country. But they have alcohol tightly forbidden, and it is a big problem there.

I went to Finland, and there were ships going from Finland to Estonia, carrying people just to buy cheaper alcohol there. They went back to Helsinki with shopping bags full of vodka. Makes you wonder how does it look Tallin in drinking statistics. I bet something similar is going on between Sweden and Denmark or Germany, whatever trip is shorter and cheaper.

The point is that a culture of taking drugs needs time to develop.

We raised the drinking age from 16 to 18. The end result is more underage drinking but now illegal, more heavy drinking under 18, a rise in hospitalisations and a rise in problematic alcohol usage of the 18-23 group. The rise correlated strongly with the change in law. Let's see if it drops after a decade or so but I doubt it.
Yes, the swedes take the ferry to Denmark and the danes take the car over the border to Germany.

There has also been a movement to change the culture of drinking in Denmark, and the consumption has generally been going down, although it still remains high among youth. This also goes to show that there are many complex factors at play and that legal status alone cannot explain consumption patterns.

I do believe that prohibition makes it a lot harder to influence the culture around consumption compared to a legalized and regulated market.

> I went to Finland, and there were ships going from Finland to Estonia, carrying people just to buy cheaper alcohol there. They went back to Helsinki with shopping bags full of vodka. Makes you wonder how does it look Tallin in drinking statistics.

They just need to exclude the shops in a 150 m radius from Terminal D in the Tallinn harbor to get accurate statistics, the Finns rarely go beyond that ;)

"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."

There's a US-specific one https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_...

"From 1999 to 2020, nearly 841,000 people died from drug overdoses,[7] with prescription and illicit opioids responsible for 500,000 of those deaths"

Here's a chart showing overdose deaths from all drugs in the US- yes there's definitely a large spike from 'synthetic opioids' at the end there that's probably all illegal fentanyl. But notice the blue line for 'prescription drugs' was very very steady for the entire length of the chart. That's an enormous number of deaths from completely legal, regulated drugs!

https://upload.wikimedia.org/wikipedia/commons/f/fa/US_timel...

> with prescription and illicit opioids responsible for 500,000 of those deaths"

So... it's not saying 500K deaths are from prescription drugs, it's saying 500K deaths are from opioids (some of which were prescription)

Also, in the chart you mentioned, it's not clear if the opioid deaths were from legally produced prescription opioids. Certainly fentanyl is one of the biggest killers, and fentanyl is used in medical settings, but the fentanyl killing people is usually not from legal drug manufacturers.

I wonder what sort of environment and conditions contribute to large populations seeking to use opioids in the first place?

Theory: this is a socioeconomic problem rather than a public health problem. Our systems care too little for people. The easiest solution then is for people to self-medicate.

It's easier to deny people a harmful salve that they feel they need than to provide them the social supports that they deserve.

Exactly. It's more helpful to look at this from the perspective of solving problems that push people toward unhealthy choices than from the perspective of how we can limit the freedom of adults for their own good. A few other thoughts:

1. US tobacco policy is far more liberal than the War on Drugs, yet which of the two is a successful case study in curbing harmful addiction?

2. The recent opioid epidemic is far more complex than "the government tried legalizing opioids and it failed". Whatever policies did exist weren't legalization of opioids, and didn't exist in a vacuum. You can't model that policy without factoring in the wide availability of contaminated street drugs and absence of safer OTC cannabis alternatives. More importantly, the drugs weren't merely available, but actively pushed in a way that should have been legally discouraged.

3. The above analysis completely ignores the most important point raised in the top-level comment: prohibition simply redirects capital from businesses that are regulated to those that are not. Say what you will about Big Pharma, but they usually don't go around hanging mutilated bodies from bridges.

4. Even if drug prohibition were the optimal policy for reducing addiction rates, at some point protecting people from their own choices ceases to be a valid excuse for harming the rest of us. We've punished countless marijuana users who mostly aren't addicts, inflicted terror and destabilization upon our neighbors to the south, and created what at least half of America believes to be an illegal immigration crisis.

5. The claim that drug prohibition even helps the people it's ostensibly supposed to help is extremely dubious. We're subjecting addicts to more dangerous substances than the ones they're actually seeking out, and locking up the ones who survive. Maybe there's a narrow slice of people who really want narcotics but lack the motivation to navigate black markets, but otherwise who is this all for? We're hurting everyone in our confusion just to enrich a cabal of warlords.

100%

Drugs are an alluring and easy avenue for people who have a difficult time fitting into their social expectations and dealing with pressures. Obviously this isn’t where it starts, but treatment is so difficult and the punitive effects are so harsh that it creates a system that’s incredibly difficult to get out of…so why would you?

This isn’t always the case, of course, but my own anecdote:

My best friend in high school got hooked on heroin - not sure exactly what started him on it or why, but I could tell that he knew he didn’t want to be in that place, and that he as genuinely trying to get clean but the resources were limited and often harsh.

He did get clean for a while and applied for a job at Walmart - this kid was stupid smart, we’d do EE and programming projects all the time and I always felt like he was miles ahead of my understanding of technology - but this was what he had available because of his history.

The Walmart drug test popped for the drugs he was using _to get clean_ and they denied his application. Went home, relapsed, got found dead by his mother. It’s awful.

> 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.

That depends on the drug. Both it's addictiveness and its destructiveness. It's likely true for meth. I doubt it's true for weed. It's demonstrably not true for many of the OTC drugs that have been easy to get for hundreds of years without the collapse of society

> 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.

I'm not aware that anyone every tried to do it right.

Like how about you have to do a short course which actually explains to you how a drug works, how to use it correctly, what are potential downsides, what are markers of overuse/wrong use.

And the other main issue with opioids and co: some people really have constant / chronic pain.

Do you know how exhaustive it is to constantly have pain? How annoying it is that you can't just go to bed and sleep?

But also we can't play devils advocate to say "you are not allowed to do drugs to num whatever issue you have" and also "but i don't want to take time and effort of helping you".

Oh i don't want you to kill yourself! But i don't want to spend time tomorrow afternoon either with you.

Our society is very hypcritical in this sense. Honestly i think people just don't want to see homeless people or fentapoeple. Its not about helping, its just about not being disturbed by them.

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.
How many died because they were cut of from the supply that they had been told by doctors did not cause addiction?
This is a tired trope but must be made: society has accepted that drugs can be dangerous but we won't stop people from using them -- leading with alcohol and tobacco. Yes, restrict access to youth and avoid reckless advertising, but still the people's choice.

If the drugs are pure, and health problems that occur with abusing them (overdoses and addiction) are treated as health issues rather than criminal issues, then it's all a solvable problem.

Heroin being illegal didn't stop my brother from dying on it.

WTF.

This is complete nonsense.

Opioids have never been made legal for recreational purpose. They were sold as painkillers by pharma corporations lying about their addictive effects and promoted through marketing campaign targeting doctors to prescribe them.

I has nothing to do with the topic of recreational drugs.

Many opioids, including opiates, used to be OTC. I personally know someone who used to smoke paregoric (camphorated tincture of opium), which was OTC in the US until 1970.

I believe 1970 was also the year when amphetamine (Benzedrine) inhalers stopped being OTC.

Do you think opioids have been illegal for eternity?
They are talking about the current opioid crisis, and they are making the story up.
In low doses most hard drugs that are uppers are pretty decent performance enhancing drugs. It's dumb that society can't get energy drinks and stuff with "low enough you can't realistically abuse them because you'll spend too much time going to piss" amounts of cocaine, amphetamines, etc.
What if they were legal but hard to get? Say, we stop/arresting for possession or use in private, stop giving dealers and producers harsh sentences, but still give them moderate to weak sentences, stop proactively searching for dealers and producers, allow companies to produce with strict KYC, and don't allow retail sale in stores?
In California weed is legal but highly regulated. It's easy to buy weed in the legal market but very difficult to be licensed to sell or grow it.

The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers.

Note that the consumers who choose the illegal market are not in general socially excluded, habitual criminals or broken down addicts. Weed is widespread in almost all parts of society and probably less prevalent along dirt poor, mentally unwell or homeless drug users, who favour fent or meth.

People with jobs and houses choose illegal weed because it's both cheaper and easier to get hold of.

Isn't it illegal in the entire US? The question doesn't seem to be whether you can obtain it legally, but how many laws you'd rather break in the process, and how much trace you'd like to leave behind. I imagine the illegal vendors are less likely to leave a discoverable trace (that could affect your future background checks etc.) than the "legal" vendors, which itself is an incentive to obtain it illegally even when it's cheaper and safer and easier to obtain less-illegally right next door.

Which basically means the US hasn't really tried legalizing it at all.

(Not advocating for any position here, just commenting on the facts.)

  > The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers.
Source for this? I mean consumer buying habits not illegal grow ops in general (which are selling a lot of their product out-of-state).

Even with California taxes an 1/8th of flower is often less than half what I’d typically pay back in 2008 or so, even without adjusting for inflation.

Also, I suspect middle class buying preference in the last decade or so has heavily shifted to gummies/edibles and vape carts which are much sketchier in the black market vs relatively interchangeable flower.

The idea of smoking a literal bowl to get high wouldn’t even be in the first like 5 methods among the people I know. It’s not super appealing in your 30s-40s while living in apartments/not wanting to reek of weed in the office. So buying off the black market just isn’t attractive even if possible cheaper.

California is probably the best example going of how not to "legalize" weed.

However, this also highlights the primary difference between weed and meth, opiates: ease of manufacturing. The only other common drugs that come close are things like mushrooms and fermented beverages, and I'd argue both of those are still riskier.

That’s not a feature of legalization, but convenience: illegal weed is easier to get hold of even in places where cannabis is not legalized at all.
Not every drug is an opioid. We have prohibition laws designed for opioids blindly applied to any (in the western context) nontraditional drug. The German law on drugs is literally called "the painkiller law", for instance.
The Dutch law is literally called the "Opiumwet" or opiate law. [1] It involves (almost) all controlled substances.

1. https://wetten.overheid.nl/BWBR0001941/2026-01-28

Yeah, but we also have the separation of "hard-" and "soft-" drugs
The meaning has drifted, appropriately enough. Betäubungsmittel originally meant painkillers, as you can tell from the word. It's just that now every recreational drug is labeled as such.
You seem to be confusing the words "Schmerzmittel" (analgesic, pain killer) and "Betäubungsmittel" (narcotic). Those two classes of substances are not the same.
"Betäubung" has a similar etymology as "narcotic". Both mean to numb the senses or put to sleep (hence e.g. "narcolepsy"), and in German it's therefore also used for sedatives and anesthetic drugs. In modern use, "narcotic" has also semantically shifted to include any illegal drug, as with "Betäubungsmiddel".

Interestingly, in both cases the semantic shift seems to have been caused by the enactment of laws to control drugs. The legal term these days is probably "controlled substance" in English, but "narcotic" now definitely refers to many drugs that are not medically narcotic.

It can also mean anesthetics, which coincidentally would include cocaine as a strong local anesthetic, but not a narcotic in the pharmacological sense.
The US is also currently rerunning this experiment with gambling/sports betting. Also does not seem to turn out so well...
Look at alcohol. How many lives are negatively affected because of alcohol being freely available? By numbers alone when something is legal there are people who will participate who would otherwise never go near it if it were illegal. We're seeing this with weed right now imo.

Because it's legal, people will try it. And because we live in a country where it is celebrated, encouraged, and every holiday seems to be an excuse for folks to get hammered, A LOT of people will try it. How many would never touch it if it were illegal? How many wouldn't drink and drive and kill themselves? How many innocent people in the other car, completely sober, would still be here? Because remember, booze, or drugs in general, impact more than just the user. Their families, friends, and other random people can be impacted. How many kids grow up with a drunk parent, unable to properly express or process emotions, might not have to grow up unable to maintain healthy friendships because they don't know what they look like, or won't be taken advantage of because they have a caretaker/fixer mentality because that's what they had to do as a kid.

We know making booze illegal doesn't work, and that's not what I'm suggesting here. I'm not even suggesting anything. I'm just saying, the blast radius of booze impacts a lot of people beyond the alcoholic, and statistically, a portion of those lives negatively impacted are the direct result of alcohol being legal. I can speak from firsthand experience the impact of an alcoholic single parent growing up, which would be the reason I look at this topic the way I do. Would I have been given a more healthy and "normal" childhood had booze been illegal? Idk. But some kid out there would have, which might be all that matters.

And yet, as the DEA and other agencies tighten distribution of opioids, deaths continue to increase.
People are being cut off from legitimate pharmaceutical sources and are driven to black market drugs like fentanyl and heroin
There are 193 countries, plus the Holy See.
Map Men: There are NOT 195 countries https://www.youtube.com/watch?v=3nB688xBYdY
As members of the United Nations. That says very little.
Why the down votes? There aren’t 300 countries.
Any exact number of countries is offensive to several groups of people.
Yeah true. I did intentionally not count the Gaza Strip.

If that offends anyone, I’m good with that.

> 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.

It seems like you've already made up your mind what to believe. In particular you've failed to critically analyze the broader context in which overdose deaths went up and I also have to question your suggestion that the war on drugs in the US ever ended.

Sure, marijuana is largely accepted at this point. Most other things you still buy from gangsters on a street corner or via the darknet and will still be arrested for having, frequently losing your job as a side effect.

To overdose deaths, those largely correlate to the Sacklers (ie medical professionals inappropriately pushing product with a veneer of legitimacy) and to fentanyl. The latter is particularly deadly due to the combination of accessibility to amateurs with the inherent difficulty of safely compounding such a potent chemical as part of a clandestine operation.

The prescription pills epidemic was largely over by 2018. And yes, then fentanyl started picking up speed.

> suggestion that the war on drugs in the US ever ended.

It has not happened evenly across the country, but it happened on the Pacific coast. Drug use stopped being punished, with people openly consuming drugs in front of the police. Oregon even made that official.

This is an important point. Drug enforcement operations did not stop, because no large-scale bureaucratic system can stop at once. But they became a futile theater.

Curtailing cocaine/opium traffic was hard, but not impossible. Cocaine had to flow from growers high up in the mountains, through multiple countries and transportation modes. Each step increased the price for the end-consumers. And cocaine/opiates are relatively bulky, so smugglers couldn't just do one high-risk operation, they had to build a robust supply chain.

Fentanyl upended that. It can be cooked in a lab in Mexico just outside of the US border. The precursors aren't particularly expensive either. It's also highly potent, so that one milk jug of pure fentanyl powder can supply a large-ish state in the US for a year. So high-risk high-reward one-off smuggling operations are much more feasible.

We may be able the war on drugs has ended or not on how you define it.

The nancy ragean area levels , i would say yes. Rates are down. https://drugabusestatistics.org/drug-related-crime-statistic...

However, it certainly hasn't gone to 0 and is still quite high.

Your numbers are wrong

We're talking 48 thousand gun fatalities and 40 thousand traffic fatalities (98 thousand total) vs 80 thousand

They're not. In 2023 the overdose deaths were more than 100k. They have gone down a bit since then, for a very grim reason: they killed enough people to affect the statistics.
This is complete rubbish. The peak years of the war on drugs had a variety of hard drugs available on street corners across all major cities.

At best it kept some amount of some drugs less visible in some suburbs and communities, while making it profitable for suppliers to cross those lines.

The main effect of the war on drugs was a level of incarceration outdoing almost any society in human history. The fact that the numbers jailed for victimless and quality of life 'crimes' kept going up is testament to the fact that there was hardly any effective deterrence.

To me this reads as naive because I could get most any drug on many street corners easily any time within the last 30 years once I was old enough to realize what was going on and notice.
I think we're agreeing with each other?