A good book to read regarding this topic is "Death in Mud Lick" by Eric Eyre who was a reporter for a local newspaper in WV during the early discovery phase of the epidemic.

The book details the methods used by the drug companies to pedal these drugs into small communities, the tragic victims, and lastly the refusal of drug suppliers to admit any wrong doing. There's also a slight dose (no pun intended) of WV AG's sheer incompetence on the matter due to donations and gifts by said drug suppliers.

Super depressing book, but great read nonetheless.

*peddle

Fun fact: early opioid deliveries were actually, in fact, almost exclusively done by bicycle!

If they used those penny farthing bicycles I’m sure they needed quite a few painkillers.

Painkiller is a great little short series on them too. does a great job at portraying all of what you mention in a six hour tv format. it can get a little on the nose sometimes but the meat is 100% true

Not to mention creating more homelessness, increasing crime and deteriorating our cities, strengthening Mexican drug cartels, providing business to suppliers in China.

They have objectively made the world a worst place.

I thought the lead guy was bad.

7x as many people in the US die from cigarettes every hour, day, week, month, and year as from all opioids combined.

Cigarettes don’t even require a prescription.

If there is an opioid crisis, there is a 7x larger tobacco crisis, too.

Tobacco companies have paid out countless nine figure sums, smoking in public has gone from universal to mostly illegal, cig taxes have skyrocketed, etc…

Tobacco has been treated as a crisis, and I have no doubt that if cigarettes had been invented by one specific family, that family would be hated.

Weird that you don’t know any of this.

What’s weird is that people still think tobacco smoking is about nicotine being addictive and dangerous, when it is literally everything else in the smoke that makes it extremely addictive and mortally dangerous.

The nicotine is what makes it addictive, but everything else makes it deadly.

This distinction is well known here in Sweden where we have snus, and also lower rates of lung cancer and cigarette use than the rest of Europe by a LOT.

Though at the same time I would wager a larger rate of gum disease and mouth cancer than the rest of Europe by a lot.

Going by a quick skim of the 2022 WHO oral health numbers, Sweden[0] doesn't seem significantly worse off oral-health wise than Germany, Holland, or the UK. In fact it's oral cancer incident rates appear a bit better. Though the UK doesn't have great cancer incident rates, it's periodontal disease rate seem to be significantly lesser than the other three (perhaps due to close monitoring as a result of the "bad British teeth" stereotype).

Sweden male tobacco use percentages are slightly higher than the other three countries, which might be a function of the population additionally using non-cigarette tobacco substitutes perhaps as was mentioned by others.

[0] https://cdn.who.int/media/docs/default-source/country-profil...

Not cancer. Because it's, again, not the nicotine that causes the cancer. Snus does NOT increase cancer risk.

It decreases cavities by a lot (presumably because the bacteria doesn't like the environment anymore), but also destroys your gums. All in all, depending on your dosage it could be a wash or even positive for your oral health.

It's absolutely disgusting, but it's not dangerous :P

It's not known in Australia where you have to have a prescription to buy a vape but can buy cigarettes freely. Apparently they're relaxing the prescription requirement later in the year but still only pharmacies will be allowed to sell them.

That is not true. It is the interaction of nicotine with various monoamine oxidase inhibitors that makes tobacco smoking addictive, to an extent that it could be stated that it is the MAOIs entirely causing the addictive behaviour: the exact same MAOIs are also found in coffee, after all.

Why are nicotine pouches and vapes addictive, then? The answer lies in the flavourings, which themselves have psychoactive properties, likely also through MAO inhibition.

God this Gwern junk will never die. There's tons [0] of evidence that nicotine is addictive on its own.

> Why are nicotine pouches and vapes addictive

It's the nicotine.

[0]: https://duckduckgo.com/?q=nicotine+addictive+site%3Anih.gov&...

I'm not here to argue, but all top 5 links for me are about smoking. I've not heard of people being addicted to nicotine patches for example, especially non-smokers.

I looked into this previously, though it was a while ago so I no longer have the sources to hand. Nicotine is still addictive on it's own but when given to non-smokers in a non-tobacco form it's notably less addictive than smoking. Still addictive but far closer to coffee than cigarettes.

Some of this can be explained by different consumptions methods. For example in lozenges, gum and patches nicotine enters the bloodstream much slower than smoking or vaping so even if you consume the same overall amount the peak is lower slowing adaption. But that couldn't explain it entirely.

Nicotine Addiction: Neurobiology and Mechanism: https://pubmed.ncbi.nlm.nih.gov/32322429/

Neurophysiology of Nicotine Addiction: https://pubmed.ncbi.nlm.nih.gov/22454789/

No, it's because nicotine is an addictive chemical.

https://www.fda.gov/tobacco-products/health-effects-tobacco-...

You will have to supply something to back up such a wild statement. Nicotine has been shown to be extremely addictive all the way from humans down to single neurons in a petri dish, for decades.

Can you please tell me which of these mandatory warning messages you feel fails to convey that cigarette smoke, on the whole, is dangerous?

https://www.fda.gov/tobacco-products/labeling-and-warning-st...

True, but it still shows that lobbyists have a lot of influence. Even if it means hundreds of thousands of death people every year. Same goes for Alcohol. And maybe also specific types of food.

> Over a million Americans have died so far in the opioid epidemic.

Which of those million died from Oxycontin overdoses, which of them died from hepatitis they caught when shooting up pills with a reused drug needle?

That’s a good question. You should do some research. Maybe you can ask the families of the victims?

Don't have to. Virtually none. People die from the street heroin they bought as a substitute for the oxy they couldn't get once the DEA cracked down.

You can see it on every fucking graph, the very week that the DEA did this, if the dates have enough resolution. This is why we don't ask "the families of the victims", because you're irrational with grief and can't process what the problem is.

In America, if I shot you in the leg and you died years later from an infection incurred because of that bullet wound I can and likely would be charged with murder because of the long string of consequence caused by my action.

So I can draw a pretty solid causal line from “my father died in a tent in the woods behind a gas station off of I-95 to the Oxy he was once on.” Maybe the pill itself didn’t directly kill him but it sure lead there.

Perhaps I’m just too emotional here, having literally dealt with the above last month. Can’t think straight?

> if I shot you in the leg and you died years later from an infection incurred because of that bullet wound I can and likely would be charged with murder because of the long string of consequence caused by my action.

Which is a useful convention, because it deters the sort of violence as "shooting people in legs".

The analogy doesn't hold. Drug warriors like yourself murdered the OD junkies. Your policy murders, and somehow you perceive yourself as the overburdened heroes. Prohibition is a bizarre policy, and we don't prosecute beer brewers for drunk driving deaths, no matter how addicted the alcoholic was. You're a bad person. You make the world more miserable than it has to be with nothing more than your evil opinions. And nothing I can say will ever convince you of the truth.

> Perhaps I’m just too emotional here, having literally dealt with the above last month.

You're not just emotional, but irrational. I and others like me could fix the things that make you hurt, but you want more of the same. It is not the sadist who screams "the beatings will continue", it is masochists like yourself who beg for it, telling all involved their morale really will improve.

I can’t respond to any of your comments about policy, because you’ve never elaborated your ideas, and you seem to be assuming a great deal about mine and the other commenters.

1) Real heroin does not exist anymore in real life. All of it is varying cuts of fentanyl and research chemicals.

2) Your original comment asked the question “how many have died from oxy vs hepatitis”, which, along with your comments about heroin, made it clear that your knowledge isn’t up to date. It strains credulity to say that more people died of hepatitis than they did of the opioid they’re injecting into themselves regularly. Do you really think hepatitis is the root cause here? Or is it the proliferation of opioids much stronger than heroin. I’m sure you’ve heard of fentanyl and carfentanil, but there are entire other classes (such as Benzimidazoles) that have been rising to prominence in the last few years that are more dangerous.

3) I’m very anti DEA as well, and agree that prohibition kills. However, this is not simply a case of holding a manufacturer for a substance responsible. It’s what the Sacklers did after learning of the addictive power of these medicines that gives them culpability. It’s like a local bar serving someone even when they’re visibly drunk, which confers criminal responsibility if that drunk person later does something while under the influence. Making opiates == legal, being negligent == not legal. I wish we didn’t have a prohibition, and drugs could be acquired safely, but that doesn’t mean that the ends justify the means, and any drug manufacturer is automatically the good guy.

I just don’t think you’re approaching this subject with the care it deserves. It’s easy to make flippant comments blaming “Drug warriors” (genuinely confused what that even means—does that mean someone who is pro-prohibition?), it’s much harder to interact with the literal decades of research about this topic, and magnitudes harder to actually experience these things yourself. If you’d like a starting point, I found this report to be pretty approachable: https://www.rand.org/pubs/research_reports/RR3117.html. However, I wouldn’t be surprised if posing questions the way you have elicits emotional reactions from those who know people who have died. I lived through the first wave of fentanyl in the US, but I know quite a few who didn’t. Based off what i’ve been able to pick up out of all the vitriol, I think we would likely agree about the policy decisions, but your approach of making simplistic comments and then calling people evil based off of their response seems like an ineffectual strategy. And maybe it isn’t, but then you’d have solved the drug crisis already, right?