That's a lot more powerful formula for starting a drug epidemic, than people buying heroin illegally off the street. At least there's no confusion about "experts" and "science" and "doctors" promoting something as safe and effective.
If people have chronic pain, we need to be more progressive and allow medical marijuana everywhere. (There are also quite a few studies that show that chronic pain is not helped with opioids anyway.) If people are in the hospital or end-of-life/hospice, then give them morphine or whatever they need but we need zero prescribable opioids.
Chronic pain refers to long term pain. Your hernia surgery is short term pain.
No-one credible is suggesting preventing using opioids for short term (such as post operative) pain (although it does seem that Drs in the US prescribe too much for this type of pain).
I have a completely untested theory that the number of deaths would be less with a well regulated legalization of drugs than with an unregulated black market where gangs and organized crime supply the demand for illicit substances.
[0]https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-h...
Because there's still a barrier to access, providing a way around it still provides profit.
Medical marijuana is legal where I live, you can buy it at a regulated service, however there are plenty of people who still buy it on the street or produce more than they are legally able to and sell the excess.
Could you tell me what number "multiple" is and what a "dose" looks like?
Are we talking about raw plant material that is opium, or refined heroin/morphine/codeine? The conflation of the word drugs and plant material seems like the most absurd gorilla in the room.
Off to do some coffee...
"The cost-benefit analysis showed a considerable reduction in costs for medical care and law enforcement; the benefits per day and patient amount to the double of the daily treatment costs in HAT (Frey et al 2000)."
in https://sencanada.ca/content/sen/committee/371/ille/presenta...
Additionally, alcohol kills more people than opiates every year, so I'm not sure that's a good sign for the effects of legalization.
There's one sure way to control an epidemic like this: education. That means educating the populace on just how addictive and dangerous these drugs are, educating law enforcement to treat addicts as people who are sick instead of simply stigmatizing criminality, and educating the medical community so that these drugs aren't handed out so casually, and in cases where they are appropriate, that patients are closely monitored for signs of addiction.
And the latter would benefit greatly from the US restricting drug company advertising and lobbying (this crisis was helped along significantly because of Purdue's marketing of Oxy in the 90s) so that medical decisions are made based on science and not marketing... but we know what the odds are of that happening.
They start with back pain due to a workplace injury, for which a doctor immediately prescribes them a powerful opiod (and perhaps a companion drug to deal with the resultant constipation).
Because it's "medicine", these people don't fully understand the risk of addiction nor do they recognize the signs of addiction and tolerance as they develop. Meanwhile, the doctor shirks their duty by not remaining in constant contact with the patient to manage any dependency should it occur.
These individuals eventually become addicted because the drugs lose efficacy over time (and in the case of Oxy, don't actually work for as long a period of time in the body as claimed, forcing people to up their own dosage). And thus the spiral of addiction begins.
Because of the lack of public awareness and the shame and stigma of addiction, people don't seek out help. Instead they try to manage the problem themselves. Ultimately, once addicted they turn to street drugs because they're a) cheaper, and b) more readily available.
Part of the problem is that, prior to the Oxy epidemic, the reality is doctors were probably under-managing pain, particularly for chronic pain sufferers.
Unfortunately, the reaction (again, in part due to drug company marketing) was to swing the other way and over-prescribe these drugs.
There was a Reddit comment on this subject to the effect of "I don't think of a muffin as breakfast, I think of it as my reward for getting up and going to work instead of hanging myself." And that sentiment is probably coming from a software developer in NYC or SF or whatever, so imagine how things look for everyone else.
What about the Portugese model described in the article (legal for consumption, illegal to commercialize), with some of the funds spent on controlling drug related violence instead being turned towards treatment centers where addicts can get something like Methadone?
There's a kind of despair spiral that kicks in for some addicts. Life isn't going well, so they turn to drugs to ease the pain. Then they get arrested, sent to prison, and get labelled as a felon. Now they can't get a job or have a stable living arrangement and they turn back to drugs to get through the despair.
For these people, we need to break the cycle if we're ever going to help them get clean. Making their lives worse will only further entrap them.
> and legal painkillers are still linked to most opioid overdose deaths.
Your comment:
> People wouldn't overdose if they knew exactly how strong the drugs they injected were
Is your comment a knee jerk reaction to an anti-legalization headline because it doesn't appear to be related to the actual content or points raised in the article.
This is not how tolerance works. The same dose can have vastly different effects depending on how long it was since your last dose, other drugs in your system and your body's natural tolerance that might be diminished by exhaustion or infection.
The dose someone uses to feel baseline today might have them completely dysfunctional in a few days or kill them after a couple of weeks.
And the effects will not be vastly different. Just varied in intensity.
If you've taken any common CNS depressant, such as alcohol, benzodiazepines, psychiatric drugs, drugs that are metabolized by the same pathways as opioids, even blood pressure medication or sedatives including antihistamines, you are going to potentiate the CNS depression from opioids.
> And the effects will not be vastly different. Just varied in intensity.
The scale of intensity of effects from a dose of an opioid varies from: enough to get a patient out of withdrawals to completely stopping breathing.
Titration of dose is the only way to more accurately determine a safe and effective dosing schedule for opioids.
Opiates are highly unpredictable. The exact same 'homogenized' batch can kill you at any time. One dose you can slam half a syringe, next dose a day or two later, you can do 1/4 that amount and die.
No drug has this kind of unpredictable physiological profile, you're spreading nonsense.
I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that.
> I suspect you're confused by stories of relapsing users returning immediately to large doses, but there's nothing unpredictable about that.
That is an inherently unpredictable situation. We cannot predict or measure the subjective and changing tolerance a patient has to opioids.
Further, you absolutely can approximate how long tolerance lasts, but my point was that you can predict that your tolerance is reduced after abstinence, as opposed to the original comment which suggested that all dosing was unpredictable.
I didn't imply that repeated doses are unpredictable.
Regular repeated dosages can be predictable as long as the patient remains stable with regards to infection/health and other drugs they ingest. Initial dosages, dosage increases and returning to a previously safe repeated-dose after cessation are not at all predictable.
This is why I mentioned titration in a previous comment: subjective response to drugs and subjective tolerance cannot be accurately predicted or measured.
This is also why drugs like Subutex are titrated when beginning suboxone treatment: a doctor cannot accurately measure tolerance to determine how much of the drug is needed to keep a person out of withdrawals.
> you absolutely can approximate how long tolerance lasts
Naloxone or naltrexone induced withdrawal rapidly diminishes tolerance faster than it would naturally.
This suggests that there's a function that can accurately output a safe and effective dose of opioids based on the variables of previous dosage and time since cessation. I'm arguing that there is a missing variable that's unable to be measured accurately: each person's subjective tolerance. That subjective tolerance depends on a multitude of factors that cannot be determined clinically.
>The exact same 'homogenized' batch can kill you at any time. One dose you can slam half a syringe, next dose a day or two later, you can do 1/4 that amount and die.
Based on your elaboration, I suspect you agree with me that it is nonsense, and that opioids are far more predictible than it implies.
Still, I believe you are overstating the danger associated with opioid dosing. This subjective tolerance you speak of likely falls within a reasonable narrow normal distribution and is the reason that based on your weight and gender, doctors may estimate a safe effective dose without titration.
Also, I don't believe morphine injections are titrated.
You go tell that to my dead pal Carl Mauk, dead from Fentanyl patch. Proscribed, always changed on-time and never abused. Died getting it changed in the hospital.
A. You missed the word 'homogenized' and B. I've had the mispleasure of watching people die on hospital-proscribed opiates taken at proscription times and amounts. Tolerance can change rapidly. The joys of drug counseling.
I don't think you should be able to purchase heroin at 7/11, but certainly there is something better than total prohibition. If you want to keep killing people, force addicts to buy opiates on the street.