[idiotsecant]

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.

[cryzinger]

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.

[keepamovin]

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.

[flomo]

Cocaine and Heroin (and LSD...) were widely available 20-30-40-50 years ago. Maybe this is a "It's the economy, stupid" thing?

[mx7zysuj4xew]

Pretty much. Most Americans live awful miserable lives regardless of being addicted to drugs or not

[jazzyjackson]

Sorry what? What does ego death have to do with healing a back injury?

[AnthonBerg]

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.)

[jazzyjackson]

huh. glad I asked.

[AnthonBerg]

I was quite surprised to find that paper! Thank you for… the audience?, for your consideration? It's quietly somewhat maddening that this is on the books and there's so little mention of it.

Like, psychedelics? I'm not a hippie. I'm not into psychedelics. I'm into neuroinflammation, haha

[keepamovin]

I did say aside from physical ailments

[ghthor]

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.

[bhotka]

how does my spiritual wellness affect the mechanical structure of my lower back?

[asgraham]

Ignoring the spiritual part, emotional state does have a well-known feedback loop with physical state. There’s a (largely incorrect) idea in pop psychology that just as happiness leads to smiling, smiling leads to happiness. It’s not nearly that simple, but there are some more straightforward examples: lots of tense emotional states (anger, anxiety) lead to tense muscles (jaw being the classic example). Relaxing your jaw can lead to a (temporary) relaxation of your emotional tenseness. I’ve never heard of a similar result for the lower back, but it’s not hard to imagine. If nothing else, they must be correlated through sedentary lifestyle.

[ulrikrasmussen]

Functional disorders are a thing, and placebo surgery for osteoarthritis of the knee works just as well as real surgery: https://www.nejm.org/doi/full/10.1056/NEJMoa013259

I have heard psychedelics be described as the most effective placebo of all placebos.

[balamatom]

By directing your attention towards, or away from, physical phenomena that mechanically affect your lower back: overexertion, underexertion, posture, nutrient intake, crowd...

[munificent]

Setting the woo aside, there is a lot of data on disorders like central sensitization syndrome that show our psychological state has a very strong modulating effect on our perception of pain.

[nswango]

I mean tons of back pain is medically unexplained. It's not like physiology has a perfect record here that can be used to dismiss alternative theories.

[TheServitor]

Relieved to learn that my small peen is merely a projection of my energetic spiritual being.

[idiotsecant]

I feel like you missed a turn somewhere.

[hash872]

>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

[Retric]

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.

[vintermann]

> 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).

[applfanboysbgon]

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.

[fc417fc802]

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.

[applfanboysbgon]

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.

[fc417fc802]

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.

[vladms]

> 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...

[itsmek]

>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.

[ulrikrasmussen]

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.

[otherme123]

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.

[consp]

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.

[ulrikrasmussen]

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.

[inejge]

> 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 ;)