If (illicit) drugs were legal.

[CharonY]

7 hours ago, MigL said:

Quite a few people are advocating legalization, but NOT the selling/producing aspect of it.
why is that ? There doesn't seem to be a problem with the selling/producing aspect of alcohol ?
Either there is a difference, hence the illegality of selling/producing, or there is not, and people should be able to cook meth and open 'drug' stores like they do distilleries and liquor stores.

It depends on the distribution chain, the common use and dangers of misuse. For some drugs, open distribution could act as an amplifier due to their addictive properties and high relapse. But if we were to use alcohol and its abuse as an acceptable baseline (partially because prohibition was a) not popular and b) difficult to enforce and c) came with associated crime) then one could reasonably also advocate access to certain drugs for recreational use. However, at minimum It should be accompanied by policies that minimize self and other harm. Including ban on its use while operating machinery, use in certain places (similar to smoking ban) as well as educational campaigns on use and danger. For some highly addictive drugs more regulations should be put in place. Note that there is a market for legal distribution of opiates en masse, backed by industry. While fatalities have skyrocketed in recent years, they are still lower than alcohol and tobacco-associated deaths.  In fact, the top three preventable causes of death in the USA are (in order) tobacco smoking, obesity and alcohol. Drug abuse ranks far lower in that scheme (though may have increased in recent years). 

If the question is why folks are more comfortable with alcohol/tobacco, the answer is quite simple. Folks are more used to it. If everyone is smoking or drinking, then there is no stigma in its use and with some precautions (e.g. drunk driving) folks are comfortable around these drugs. It is certainly not because folks did an extensive risk-assessment. However, perception changes over time. Whereas smoking was ubiquitous not too long ago, the numbers of smoker and places you are allowed to smoke have plummeted. Moreover, smoking has now a certain stigma as exposure to second-hand smoke has been shown to be harmful and folks may be admonished for smoking, especially around children.

I believe that to date there is no policy that clearly and irrevocably removes drug abuse. Punishment clearly does not work and legalization has not shown to systematically reduce drug abuse, either (though it does not seem to increase). However, unchecked legal access can produce issues, as the opiate crisis has shown. The latter is fueled to a large degree by the us and abuse of legal painkillers.

However, policies and societal changes and pressures have shown to be effective to regulate abuse (to some degree) and to minimize harm. Examples could include the reduction of tobacco smokers, for example. However, they are unlikely to eradicate them. Thus my view on drug policies is not about combating abuse in itself, unless one has found a means that actually works. Rather, it is about minimizing effects on public health and security. In that regard categorization of drugs plays a secondary role. 

With regard to controlled long-term substance abuse (and let's face it, regular alcohol use falls into a similar category), even for highly addictive substances such as heroin it is not quite straightforward. There are studies that have looked at hidden users for example. The reason is that controlled long-term abusers do not necessarily show up in the usual statistics as they do not self-declare to avoid stigma yet can control their drug use to avoid extreme health effects (like heavy drinkers before the cumulative damage of alcohol becomes apparent).

Take the study on a Scottish group (Shewan & Dalgarno Brit J Health Psych, 2010). While the average use of heroin was 7 years, there were few drug-related incidences. This cohort seems to be better educated, have a more controlled substance abuse and was clearly distinguishable from cohorts in treatment. There is an increasing awareness that dependence is not necessarily just the exposure to a substance, but it also involves the circumstances of the individual. Similarly how some folks can cease drinking, whereas others become addicted.

[MigL]

Thanks CharonY, for elaborating in much detail.
As long as we all understand that legalization does nothing to combat or reduce drug abuse/dependency.
It is about reducing the associated public health costs costs ( as well as a large windfall for governments in taxes, not that that's a bad thing ) and related criminality.

[CharonY]

11 hours ago, MigL said:

As long as we all understand that legalization does nothing to combat or reduce drug abuse/dependency.

While it will not accomplish abolition, it does not mean that it will have no impact on the overall dependency rate. Data is not quite consistent and it will depend on a number of factors (including the drug itself). However, removing stigma and punishment from drug use seems to have increased the rate of folks seeking rehabilitation in many areas. I am not sure if current evidence points to a net change in addicts, as for example decriminalization also increase the rate of honest self-reporting. Nonetheless, there are potential ways where legalization/decrimininalization can influence dependency rates to some degree. 

Edited August 21, 2018 by CharonY

[dimreepr]

2 minutes ago, CharonY said:

While it will not accomplish abolition, it does not mean that it will have no impact on the overall dependency rate. Data is not quite consistent and it will depend on a number of factors (including the drug itself). However, removing stigma and punishment from drug use seems to have increased the rate of folks seeking rehabilitation in many areas. I am not sure if current evidence points to a net change in addicts, as for example legalization also increase the rate of honest self-reporting. Nonetheless, there are potential ways where legalization can influence dependency rates to some degree. 

Indeed and I completely agree, but the intention of this thread was not the users, poor souls that they are, but the innocents that find themselves entrenched by the criminal's power... 

[CharonY]

16 minutes ago, dimreepr said:

Indeed and I completely agree, but the intention of this thread was not the users, poor souls that they are, but the innocents that find themselves entrenched by the criminal's power... 

A) the OP was sufficiently vague to not make it clear what it is about. b) who are the criminals in this scenario? Drug users or drug distributors. If the latter, how about legal distributors who inadvertently promote addiction? c) for either case legalization appears to be associated with reduction in drug-related crimes (other than possession and use itself). However data is limited to draw strong conclusions and as others have noted, will depend on the economic system associated with a given drug.

[Ten oz]

On 8/20/2018 at 9:23 AM, MigL said:

Quite a few people are advocating legalization, but NOT the selling/producing aspect of it.
why is that ? There doesn't seem to be a problem with the selling/producing aspect of alcohol ?
Either there is a difference, hence the illegality of selling/producing, or there is not, and people should be able to cook meth and open 'drug' stores like they do distilleries and liquor stores.

Selling and production would be a separate issue. In the U.S. Alcohol is legal but laws vary state by state. Some states only allow Alcohol to be sold in state ran liquor stores with limited hours and days of operation while other states allow liquor sold nearly anywhere 7 days week around the clock. Taxation varies by location and some counties within states are dry and do not allow alcohol to be sold at all. As for production that too is at the mercy of local govt. Different States, counties, and cities have there own standards and limitations for production. A selling and production conversation would be one about taxes, jurisdiction, licensing, legal definitions, and etc. It is a separate conversation.   

[dimreepr]

9 minutes ago, CharonY said:

A) the OP was sufficiently vague to not make it clear what it is about.

No harm in a good debate.

11 minutes ago, CharonY said:

b) who are the criminals in this scenario? Drug users or drug distributors. If the latter, how about legal distributors who inadvertently promote addiction?

The law includes both, but we both know the moral choice.

[CharonY]

Came across an interesting paper (Allison et al. AjPH 2018).  Have only glimpsed through it but there was an interesting part in which they modeled the effect of restricting legal opiates (i.e. painkillers). Here, they predict that over ten years,  restrictions on pain killers would increase opioid related deaths. Massively, in fact. Why? It is based on the observation that folks cut off from painkillers seek alternative sources of opioids. Especially when they turn to fentanyl the lethality spikes.  In that context legalizing and providing controlled access to safe drugs could indeed save lives.

[koti]

On 24.08.2018 at 2:15 AM, CharonY said:

Came across an interesting paper (Allison et al. AjPH 2018).  Have only glimpsed through it but there was an interesting part in which they modeled the effect of restricting legal opiates (i.e. painkillers). Here, they predict that over ten years,  restrictions on pain killers would increase opioid related deaths. Massively, in fact. Why? It is based on the observation that folks cut off from painkillers seek alternative sources of opioids. Especially when they turn to fentanyl the lethality spikes.  In that context legalizing and providing controlled access to safe drugs could indeed save lives.

I came across the Portsmouth Ohio story today and since I wasn't following the opioid and prescription drug problems in the US I learnt quite a few interesting fact on the opioid epidemic in the US, the numbers are scary:

"In a 2015 report, the U.S. Drug Enforcement Administration stated that "overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels."^[4]:iiiNearly half of all opioid overdose deaths in 2016 involved prescription opioids.^[1] From 1999 to 2008, overdose death rates, sales, and substance abuse treatment admissions related to opioid pain relievers all increased substantially.^[5] By 2015, there were more than 50,000 annual deaths from drug overdose, causing more deaths than either car accidents or guns.^[6]

^"Drug overdoses have since become the leading cause of death of Americans under 50, with two-thirds of those deaths from opioids.^[7] In 2016, the crisis decreased overall life expectancy of Americans for the second consecutive year.^[8] Overall life expectancy fell from 78.7 to 78.6 years. Men were disproportionately more affected due to higher overdose death rates, with life expectancy declining from 76.3 to 76.1 years. Women's life expectancy remained stable at 81.1 years.^[8]

 

[StringJunky]

7 minutes ago, koti said:

I came across the Portsmouth Ohio story today and since I wasn't following the opioid and prescription drug problems in the US I learnt quite a few interesting fact on the opioid epidemic in the US, the numbers are scary:

"In a 2015 report, the U.S. Drug Enforcement Administration stated that "overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels."^[4]:iiiNearly half of all opioid overdose deaths in 2016 involved prescription opioids.^[1] From 1999 to 2008, overdose death rates, sales, and substance abuse treatment admissions related to opioid pain relievers all increased substantially.^[5] By 2015, there were more than 50,000 annual deaths from drug overdose, causing more deaths than either car accidents or guns.^[6]

^"Drug overdoses have since become the leading cause of death of Americans under 50, with two-thirds of those deaths from opioids.^[7] In 2016, the crisis decreased overall life expectancy of Americans for the second consecutive year.^[8] Overall life expectancy fell from 78.7 to 78.6 years. Men were disproportionately more affected due to higher overdose death rates, with life expectancy declining from 76.3 to 76.1 years. Women's life expectancy remained stable at 81.1 years.^[8]

 

I read a few days ago, the US border force stopped a load of drugs on the Mexican border and in there was 12Kg of Fentanyl. A therapeutic dose is 50 micrograms.

[Moontanman]

From the standpoint of a chronic pain victim this is especially disturbing, I am currently in the middle of a pain event that comes close to preventing me from even dressing myself. If I didn't have access to hydrocodone I'm not sure how I would exist. Fortunately for me at least hydrocodone isn't even close to as addictive as oxycodone and if taken with some sense works without any side effects other than sleeplessness. 

 

This is a weird thing from my standpoint, oxycontin almost killed me 20 years ago, I can't imagine wanting to take opiates recreationally, maybe cannabis is the answer but in my state it remains illegal but in states where it is legal overdose deaths from opiates are said to be in a steep decline...    

[koti]

51 minutes ago, Moontanman said:

From the standpoint of a chronic pain victim this is especially disturbing, I am currently in the middle of a pain event that comes close to preventing me from even dressing myself. If I didn't have access to hydrocodone I'm not sure how I would exist. Fortunately for me at least hydrocodone isn't even close to as addictive as oxycodone and if taken with some sense works without any side effects other than sleeplessness. 

 

This is a weird thing from my standpoint, oxycontin almost killed me 20 years ago, I can't imagine wanting to take opiates recreationally, maybe cannabis is the answer but in my state it remains illegal but in states where it is legal overdose deaths from opiates are said to be in a steep decline...    

Why dont you try pot Moon, the worst than can happen to you is it wont help you and you’ll clean the fridge out. I feel for you man, I had 5 months of horrible neurological pain prior to my spine surgery, it was undbearable. I rhink it was Sun Tzu who said something along the lines of „If you know you can’t defeat your enemy try to befriend him” Be cleverer than the pain...

[Moontanman]

8 minutes ago, koti said:

Why dont you try pot Moon, the worst than can happen to you is it wont help you and you’ll clean the fridge out. I feel for you man, I had 5 months of horrible neurological pain prior to my spine surgery, it was undbearable. I rhink it was Sun Tzu who said something along the lines of „If you know you can’t defeat your enemy try to befriend him” Be cleverer than the pain...

Well pot is illegal and expensive where I live, If I tested positive for pot I'd lose my hydrocodone and be expelled from the local medical collective... I have tried it and it does work just too expensive and I'm too pretty to go to jail...

Edited August 27, 2018 by Moontanman

[koti]

5 minutes ago, Moontanman said:

Well pot is illegal and expensive where I live, If I tested positive for pot I'd lose my hydrocodone and be expelled from the local medical collective... I have tried it and it does work just too expensive and I'm too pretty to go to jail...

I hear you. Whats the local medical collective thing?

[CharonY]

1 hour ago, Moontanman said:

From the standpoint of a chronic pain victim this is especially disturbing, I am currently in the middle of a pain event that comes close to preventing me from even dressing myself.

A while back I cam across a metastudy looking at efficacy of different pain management options. IIRC at least for chronic pain there are alternative options that were shown to be equally ore even more effective in bringing down pain than opioids.

For acute pain IV administration of e.g. acetaminophen in combination of opioids was shown to reduce pain while also cutting down on the required (opioid) dosages for relief.

Cannabis on the other hand has shown at best limited potential for treatment of acute pain.

Edited August 27, 2018 by CharonY

[Moontanman]

2 minutes ago, koti said:

I hear you. Whats the local medical collective thing?

 The local hospital has expanded and has all the doctors and medical test facilities in out country and a couple of surrounding ones under one bureaucracy. Capitalist communism is what I call it...   

1 minute ago, CharonY said:

A while back I cam across a metastudy looking at efficacy of different pain management options. IIRC at least for chronic pain there are alternative options that were shown to be equally ore even more effective in bringing down pain than opioids.

For acute pain IV administration of e.g. acetaminophen in combination of opioids was shown to reduce pain while also cutting down on the required (opioid) dosages for relief.

Cannabis on the other hand has shown at best limited potential for treatment of acute pain.

Cannabis is worthless for acute pain in my experience but i have chronic pain that can last for days even weeks with no let up, mostly nerve damage in my case..  

[CharonY]

2 minutes ago, Moontanman said:

Cannabis is worthless for acute pain in my experience but i have chronic pain that can last for days even weeks with no let up, mostly nerve damage in my case..  

From memory: outside of cancer and palliative treatment, a combination of therapy and some analgesics (but no opioids) were more effective in bringing down pain. The reason why opioids were preferred is really that it works faster in the short term. The tricky bit is that there is lingering pain which makes it more likely that folks go for a second dosage. Therapy on the other hand takes more time and may not be available to everyone. 

[Moontanman]

7 minutes ago, CharonY said:

From memory: outside of cancer and palliative treatment, a combination of therapy and some analgesics (but no opioids) were more effective in bringing down pain. The reason why opioids were preferred is really that it works faster in the short term. The tricky bit is that there is lingering pain which makes it more likely that folks go for a second dosage. Therapy on the other hand takes more time and may not be available to everyone. 

I've been through therapy so far no joy, in fact what they did made it much worse, I'm not sure they really know why I have such pain in my hands and arms. This has been going on for 20 years now, it's connected with my job at DuPont and exposure to extreme heat and repetitive motion. 

Edited August 27, 2018 by Moontanman

[CharonY]

1 hour ago, koti said:

"In a 2015 report, the U.S. Drug Enforcement Administration stated that "overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels."^[4]:iiiNearly half of all opioid overdose deaths in 2016 involved prescription opioids.^[1] From 1999 to 2008, overdose death rates, sales, and substance abuse treatment admissions related to opioid pain relievers all increased substantially.^[5] By 2015, there were more than 50,000 annual deaths from drug overdose, causing more deaths than either car accidents or guns.^[6]

The death rates are staggering and a huge issue. However, just to add perspective: smoking has been linked to 480,000 deaths per year in the USA annually with 40,000 related to second-hand smoke alone. Now since that statistic, the number of smokers have reduced but even accounting for that we are looking at 450,000-465,000 deaths a year.

[koti]

2 minutes ago, CharonY said:

The death rates are staggering and a huge issue. However, just to add perspective: smoking has been linked to 480,000 deaths per year in the USA annually with 40,000 related to second-hand smoke alone. Now since that statistic, the number of smokers have reduced but even accounting for that we are looking at 450,000-465,000 deaths a year.

 I would assume the reasonable and logical direction would be to make nicotine illegal not legalise opioids.

 

[CharonY]

17 minutes ago, Moontanman said:

I've been through therapy so far no joy, in fact what they did made it much worse, I'm not sure they really know why I have such pain in my hands and arms. This has been going on for 20 years now, it's connected with my job at DuPont and exposure to extreme heat and repetitive motion. 

There are options for neurophatic pain, but unfortunately I have the feeling (but no real expertise) that there are vast differences how medical professional approach the issue. And unfortunately it seems to be one of the cases where the treatment has to be very tailored to be effective (and often still remains insufficient). There are broad classes of other drugs being shown to be effective in trials, but the usually there is a large spread in terms of efficacy.

3 minutes ago, koti said:

 I would assume the reasonable and logical direction would be to make nicotine illegal not legalise opioids.

 

That is the point: opioids are legalized. Painkillers are a huge industry and it is a pathway to get many folks hooked. But now that a sizable proportion of folks are addicted, cutting off supply without replacement options will increase deaths. Also, at least as tobacco user you are not in trouble if you seek help. With opiates that is not so clear.

Edited August 27, 2018 by CharonY

[dimreepr]

There is no drug that can alleviate all the pain all of the time. Kinda where addiction kicks in. 

[koti]

Seems there is some light ahead:

https://medicalxpress.com/news/2018-08-scientists-big-non-addictive-painkiller.html

[CharonY]

On 8/29/2018 at 1:02 PM, koti said:

Seems there is some light ahead:

https://medicalxpress.com/news/2018-08-scientists-big-non-addictive-painkiller.html

The approach of this one is quite interesting, though one should keep in mind that non-opiate analgesics have already been shown to be effective against chronic pain, but are not as often prescribed, often because they need longer to kick in.

In the end, it is not simply the availability of alternatives that is an issue, but rather the overall approach in pain management therapies. Many centers have been switching models, but many physicians still overprescribe opiates.

[Moontanman]

1 hour ago, CharonY said:

The approach of this one is quite interesting, though one should keep in mind that non-opiate analgesics have already been shown to be effective against chronic pain, but are not as often prescribed, often because they need longer to kick in.

In the end, it is not simply the availability of alternatives that is an issue, but rather the overall approach in pain management therapies. Many centers have been switching models, but many physicians still overprescribe opiates.

Maybe some chronic pain, chronic pain is not a single thing. I've been dealing with this for more than 20 years, if there is something I haven't hung my hat on only to be dissipointed I do not know what it could be...

The lack of respect I get, even from physicians, is overwhelming. A couple years ago I developed a bone infection in my lower jaw, it swelled up over several days to the point of looking like I had a baseball emerging from my face.  The pain was impossible to deal with but because I am a chronic pain patent it took me two weeks of agony before I was finally hospitalised. I came very close to ending my suffering in a very final way after days of switching from being unconscious to log hours of being crazy crying and totally unable to to take care of myself. All because I am a chronic pain patient.

Doctors have cut on me without even a local because I am a chronic pain patient.

I suffered for three months with a face wound from surgery that wouldn't heal because the doc thought I was putting on to get drugs then they discovered they had left several inches of tubing in my face that was causing me to not heal and be in extreme pain all because I was a chronic pain patient and therefore could not be trusted to report my situation accurately. 

I am currently having problems getting lawyers to give me the time of day on this issue because... I am a chronic pain patient and not any more than a junky. Yes it makes me angry beyond description but even that is just my chronic pain scam, according to the docs, as I try to get more drugs. 

I have never sought out drugs and I have stopped taking anything stronger than the occasional hydrocodone which are all prescribed to me by a doctor that monitors me very closely to make sure I am not taking drugs to get high yet my pain remains and often overwhelms me in my day to day life.   

Edited August 30, 2018 by Moontanman