Quartz: Chronic pain patients are suffering because of the US government’s ongoing War on Drugs

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Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.

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99 Responses

  1. Avatar Oscar Gordon says:

    In the name of saving people from themselves…Report

    • Avatar Morat20 says:

      I always thought it was funny and sad that several of my friends had to jump through more hoops for Ritalin or it’s kin than for Vicodin.

      Oh? You have ADHD? Let’s go ahead and only cover the three times a day medication, not any all-day ones. Then we’ll make you get a prescription every month that has to be picked up by hand, carried by hand, and expires in a week. That sounds like something someone with ADHD could do easily!

      What I meant by that was the hoops for Ritalin were stupid, not that we should decide to add those stupid jumps to yet more drugs.Report

  2. Avatar Jaybird says:

    With the unintended consequence of it being easier for someone to buy heroin on the black market than buying a prescription opiate according to the rules.Report

  3. Avatar notme says:

    No, not the war on drugs. It’s the fault of crooked doctors that took useful drugs like oxycontin and started giving them out via “pill mills” to every drug seeker that would wait in line and lie to them.Report

    • Avatar Oscar Gordon says:

      And how many ‘crooked’ doctors were there? According to the DEA and a quick estimate, I’d say around 300.

      Clearly an epidemic, totally worth making life harder for everyone.Report

      • Avatar Will Truman says:

        It’s not crooked doctors you need to worry about as much as doctors for whom a prescription is the path of least resistance. Because denying them a prescription? That gets a doctor a lot of resistance. Writing a three-month prescription means you don’t even need to see their face again for three months.

        My wife’s safety has been threatened five times. Four involved prescriptions she wouldn’t write.

        That said, a lot of these regulations are actually aimed at drug-seekers trying to work cracks in the system, which is also extremely common.Report

      • Avatar notme says:

        One doc at at pill mill can write quite a few prescriptions. One of my first jobs was at the law firm defending Perdue Pharma from all the BS suits. We couldn’t understand why the DEA didn’t crack down on these docs.Report

  4. Avatar veronica d says:

    It’s almost enough to make one sympathetic to libertarianism.

    Almost.Report

  5. Avatar J_A says:

    What keeps me up at night? The idea that one day buying pseudo-epinephrine would require the same processes as buying Vicodin. I mean, the suffering of cold afflicted patients is irrelevant when we are talking about the War on Drugs

    A year ago I had the worst cold imaginable while touring Scotland. My brother couldn’t understand why I kept mumbling about what was needed for and whether it could be possible for me to get Sudafed since I wasn’t registered with a local GP. Neither did the pharmacy clerk that gave me as much Sudafed as I cared to buy half way through my incoherent explanation about being a tourist.

    In Texas my drivers license gets scanned every time I buy Sudafed, and there is a monthly limit.Report

  6. Avatar Chip Daniels says:

    This is where ideology and theology come up short.

    Most drug laws are based on a moral norm of sobriety and the sanctity of the human body.
    Which is perfectly fine, but bumps up against the utilitarian problem of how to regulate that, and the side effects.

    Its a different sort of ideology that would shrug and say ” Fine, do what you want and accept the consequences”.

    But what is “accepting the consequences”, exactly?
    Do we turn away addicts in need of medical attention? Treat them, regardless of their choices? Carefully step over them as they lie in the doorway and pretend they don’t exist? When they lash out in violent rage, do we feign surprise and make believe we couldn’t have seen it coming?

    The weakness I think is imagining that there is some clean, universal, non-contradictory approach that would somehow “solve” the problem of dysfunctional people, those whose minds and souls are broken.

    As if addiction and mental illness is a unnatural deviation from the human experience, and as if our lives and our pocketbooks can somehow be free of the tax that is exacted by addicts upon us, a tax that’s both metaphorical and literal.Report

    • Avatar Joe Sal says:

      You better have some pretty firm individual consent from all the people (including the addicts, broken minded and broken souled peeps) before you launch into the taxation scheme to ‘solve’ these thinly veiled social prohibition schemes.

      It’s not like there is a long trail of wreckage from what has been tried before.Report

      • Avatar Chip Daniels says:

        There is no “solving” broken people, is my point.

        There is help, there is treatment, but mostly there is coping with, and accepting the cost of them in our lives.Report

        • Avatar Joe Sal says:

          Do they want help, do they want treatment? Hell, do they want you, me or the socialistic state in their life?

          Who decides who and what is broken. Nearly all the parameters to address any of this aren’t social.Report

        • Avatar Kimmi says:

          Sure there’s solving broken people.
          You kill them. Problem solved.
          Maybe that makes new problems.

          Try not to kill all the shmart guys, mkay?Report

      • Avatar pillsy says:

        No one asks for your consent before you get born to, say, a mother who is addicted to opioids.Report

        • Avatar Joe Sal says:

          So what is the solution to that, or is it what it is?Report

          • Avatar pillsy says:

            It is what it is. Consent or no, some people are going to bear costs because pain pills are addictive. Hand out pain pills like candy, and some people will bear costs because they’re in no position to avoid the consequences when those close to them become addicted. Prohibit them, and you get both black markets and you make some people suffer with pain that could otherwise be controlled.

            I’m not sure what sort of solution you would find acceptable, but it seems pretty hard to shift the costs so that only people who’ve consented to them bear them. This is because, for at least one large and important class of people [1], they have no ability or widely acknowledged right to refuse to consent to how they are treated, and who they must maintain relationships with.

            [1] I.e., children.Report

            • Avatar Will Truman says:

              I lean towards @pillsy’s position here. Making it OTC? Well, if Rhode Island wants to try it and see what works, I’d be willing to let them try. But I’m pretty skeptical.

              “Look at all of the damage alcohol does and we don’t prevent people from getting that.”

              “Exactly!”

              There is a balance here between competing concerns.Report

              • Avatar Oscar Gordon says:

                This still essentially assumes that there is some significant population of people who are not addicts to something by virtue of the fear of criminal charges.

                You don’t have to make it necessarily OTC, just start by decriminalizing usage. What evidence suggests is that you will see an uptick in usage, but not much of a correlated uptick in new cases of substance addiction.Report

              • Avatar pillsy says:

                It’s a bit more complicated than that; it seems that people often become addicted to pain pills that they get prescribed by a doctor to deal with real (but temporary) pain. Expanding access to pain pills so that people can take them whenever seems like the kind of thing that could cause an uptick in addiction without there being a deterrent effect from criminalization.

                Of course, if people could just buy more pills cheaply at the drug store when they run out, addiction might be a less severe problem. I’m given to understand that blackmarket pills are not at all cheap.Report

              • Avatar Oscar Gordon says:

                @pillsy @will-truman

                Have either of you ever been addicted to something? I know Will has an addiction to smoking, but Pillsy?

                Me? I’ve never been addicted to anything, and not for lack of trying. Alcohol doesn’t do anything except make me fuzzy headed & loud. Pot makes me sleepy. Opioids just piss me off. I know they do, because I’ve been prescribed them oh so many times, all the way up to IV morphine (you break as many bones as I have, you get a lot of pain meds). I mean, the rush when they kick in is nice, but the decline as it wears off literally makes me angry (my wife calls them Asshole pills). Even morphine does it. I’ve never finished a bottle of pain meds, as I toss them as soon as I can manage the pain with Tylenol & Advil.

                My point here is this: pain meds themselves are not necessarily habit forming. Nor is alcohol, or pot, or any drug. The idea that any drug is instantly or even quickly addictive is a myth. People can, over time and with enough consumption, develop physical dependence. But most people will never consume enough of any given drug to develop that dependence absent a significant underlying psych condition that the drug(s) in question provide relief from.

                We shouldn’t be looking at drug use as a failing of character, as it so often is, but a symptom of a psych condition that needs treatment. Forcing people to acquire drugs from a black or grey market merely prevents the problem from being noticed by medical professionals, as well as putting them in contact with dangerous people, so yes, offer them via Rx or OTC. Use the silly Sudafed tracking to keep an eye on consumption and flag people for treatment if it goes too high.

                But given the ease with which people can still get drugs, the idea that criminal charges are having much of a deterrent effect is pretty much blown. The barrier to access is paper thin. The barriers to treatment are much tougher.Report

              • Avatar Kimmi says:

                ” The idea that any drug is instantly or even quickly addictive is a myth.”

                Oh, you have got to be joking. Plenty of things are quickly addictive (a week to get addicted) — and the withdrawal is a bitch. We’re talking analogues to hormones here, metabolic substitutes that are basically poisons — lots of the real nasty shit that NOBODY wants to take.

                The sort that comes in black boxes, and gets your blood a shiny black tag (Not to be given to others. Probably lethal).

                Needless to say, nobody takes these drugs for fun.Report

              • Avatar pillsy says:

                I was a smoker for many years. I am addicted to coffee to this day.

                I don’t think people are gonna get addicted to Oxy et al. overnight; I do think that some people could become addicted over the course of weeks or months if they take it for its intended purpose of treating pain. This is already something that happens now with prescriptions for pain pills, which is why I think it’s worth considering.

                [1] Am I joking? I can’t even tell anymore.Report

              • Avatar pillsy says:

                OK, but a lot of the things that would mitigate the risk of addiction would fly out the window if this stuff was available OTC.

                Maybe that’s the right public policy trade-off. We accept it with some drugs and not others, and in no particularly principled way, so it’s not particularly implausible. But I see a fair amount of reason to believe that it would be an actual tradeoff.Report

              • Avatar Oscar Gordon says:

                To be honest, I don’t really care if drugs are made Rx/OTC[1], as long as they are at least decriminalized & destigmatized with regard to usage and simple possession.

                Addiction is a health issue, not a criminal issue. Just stop using police to deal with a health concern.

                [1] Although making them Rx/OTC means regulating and taxing the supply.Report

              • Avatar pillsy says:

                I’m fine with that. I just don’t think it necessarily won’t lead to an increase of rates of addiction, and to a certain extent think there’s something a bit wrong with the way, “This may increase rates of addiction,” is treated as a complete deal breaker, instead of just one con to consider along with all the other pros and cons.Report

              • Avatar Oscar Gordon says:

                I am always suspicious of conditions with a high degree of uncertainty being deal breakers, because it tells me that the it’s a “if it saves one life” issue[1], and people who are focused on the uncertain condition aren’t dealing honestly.

                [1] It’s less about the possible con, and more about signalling an attitude regarding the con.Report

              • Avatar pillsy says:

                I hear that, and am driven to distraction how much time and energy is wasted in political arguments to maintaining the ridiculous pretense that we never trade off anything against saving lives. It’s just that we have to constantly pretend that we’re not doing it, so we do it in a particularly haphazard and unprincipled way.

                I think there’s probably a metaphor for drug policy in there somewhere.Report

              • Avatar Oscar Gordon says:

                I think there’s probably a metaphor for drug policy in there somewhere.

                Only one?Report

              • Avatar Will Truman says:

                For all of the failures of alcohol prohibition, it did one thing: Reduced consumption. That’s despite the extraordinary degree to which alcohol is/was weaved into the cultural fabric.

                I don’t have super-strong opinions on whether to put people in jail for opioid use or not. My inclination is against it. But I can also see going too far in that direction turning out badly.

                The barriers to opioids are not paper thin, as indicated by the article in the OP. That’s even for legitimate people. If there weren’t barriers to the illegal market, there wouldn’t be an issue.

                Cigarettes became my addiction due in large part to their availability. Prior to that, it was ephedra. I was never addicted to ephedra, though. I stopped taking it when the FDA took it off the shelf. (Whether I would have started smoking if I’d been able to keep taking ephedra, I don’t know. There is a concern lurking in there, though.)

                Prohibition has one set of dangers. Free access and availability has another. I don’t know where in between those we should be. My main point is that we’re trying to find a balance between the two. OTC strikes me as way too far off to one side, when it comes to opioids.Report

              • Avatar Oscar Gordon says:

                Fine, opioids are by Rx only. Then stop hammering doctors for prescribing them unless the doctor also fails to flag the patients for counseling and treatment.

                Oh, and while we are at it, expand drug treatment.Report

              • Avatar Troublesome Frog says:

                For all of the failures of alcohol prohibition, it did one thing: Reduced consumption. That’s despite the extraordinary degree to which alcohol is/was weaved into the cultural fabric.

                This is true, but there’s one piece of information I’ve always wondered about with respect to that statistic. Given that not everybody’s drive to acquire alcohol is the same, how much of that reduction was among the people causing the problems that spurred prohibition to begin with?

                To take an extreme hypothetical, imagine half of users were casual users who never caused trouble and the other half were addicts who drove drunk, beat people, and drank themselves to death. If prohibition completely eliminated drinking among the first half and didn’t affect the other half at all, you could say that it was a win because it reduced consumption, but it clearly isn’t reducing any of the variables we claimed to care about when we passed the law.

                I don’t have good data handy, but I suspect that the variables they were actually hoping to control weren’t affected nearly as much as they expected.Report

              • Avatar Will Truman says:

                My understanding is that barriers often work on those with the largest consumption. Mark Kleimann has written on this before: Believe it or not, it’s alcoholics that alcohol taxes have the most effect on. Whether that particular barrier is true of other barriers besides cost, I’m not sure. But I wouldn’t be surprised. Nor would I be surprised if fewer problem drinkers developed. (In fact, I’ve read there is some indication that prohibition actually broke some cycles, and that even as alcohol climbed up to normal consumption levels, there were fewer alcoholics.)Report

              • Avatar Oscar Gordon says:

                And how often do such taxes cause alcoholics to seek treatment, and how often do such alcoholics seek untaxed means of getting alcohol?Report

              • Avatar Will Truman says:

                I don’t know the answer to any of those questions. Kleimann would say that the important data point is less consumption overall. Presumably they find a way to cope, or cope with less.

                Cigarette taxes are another example where you can see addicts and/or dependents alterting their behavior. It looks like we’ve reached (well, passed actually) the peak of what that might accomplish, but by most accounts it did accomplished something up to a certain point. I suspect Kleimann would argue that we haven’t reached that point with alcohol, wherever it is.Report

              • Avatar Oscar Gordon says:

                I suspect that what Kleimann sees as a reduction is the people who have some degree of physical dependence, but very little psychological, hence they can reduce or quit with little trouble.

                What I’d be curious to see if he controlled for (and how) was how many who reduced or discontinued use remained sober, and how many merely switched to something else.Report

              • Avatar Will Truman says:

                Substitution is pretty common across the spectrum. Smokers famously start gaining weight when they quit. A lot of drinkers start smoking (or resume smoking or start smoking more). Whether they’re switching from alcohol to something that achieves the same effect? I don’t think alcohol taxes anywhere are sufficient for it to stop being the least expensive way to get plastered.Report

              • Avatar Jaybird says:

                If all we wanted to do was prevent people from abusing opiates, I’ve no doubt that we’d be able to cut back on the number of people who abuse opiates by making it impossible to purchase opiates legally.

                If that was all we wanted to do, of course.Report

              • Avatar Will Truman says:

                I think some people are dissuaded by possible criminal consequences, but I think that secondary to the bigger thing, which is barriers to access.Report

              • Avatar Joe Sal says:

                Do you think socially constructed barriers or individual/self constructed barriers are more effective?Report

              • Avatar Will Truman says:

                I’m not sure what you mean by “individual barriers”?Report

              • Avatar Oscar Gordon says:

                I have an individual barrier, in that I’m not inclined to seek an altered mental state. Drugs hold no appeal to me.

                A person who has gone through AA may have an individual barrier through their desire to stay sober for themselves, or for the sake of a loved one.Report

              • Avatar Will Truman says:

                Okay, in that case, individual barriers are definitely more effective when implemented. My wife never drinks because she looks at her family and avoids it.

                But it’s not either-or. I’m certainly not opposing treatment.Report

              • Avatar dragonfrog says:

                We do prevent people getting access to alcohol though – specfically. people under the age of (somewhere between 16 and 21, depending where one lives).

                You know who doesn’t prevent people, of any age, getting access to the product they sell? Drug gangs.

                This is one of the biggest arguments I can see in favour of legalizing the hard stuff – alcohol, opioids, amphetamines. Our only hope of keeping them out of the hands of kids is having sellers who stand to lose their license if they make underage sales.

                And it’s really my only reservation about legalizing the soft stuff – mostly cannabis and shrooms, maybe MDMA and LSD. If we legalize, it’s going to come with effective measures to keep kids away from them. And kids are not going to stop getting high, they’re just going to change what they get high on. If all we leave accessible to kids is the dangerous stuff, that’s what they’ll end up taking.

                It’s why I didn’t drink a lot in high school – booze was way more complicated to obtain than weed. I’m glad I had access to weed at that time.Report

              • Avatar Will Truman says:

                I am sympathetic to the notion that we should make less dangerous things harder to get a hold of than less dangerous things. It’s one of my banners as far as ecigarettes are concerned! And one of the arguments in favor of liberalizing opioids is that it substitutes for heroin.

                In general, my own experiences don’t come close to lining up with yours. Alcohol was always the easiest thing. All I needed was to know someone who was over 21. Or looked it. Then by the time I was 19 I did look it, and had little difficulty. I had pretty limited access to weed (more access to acid, in fact).

                I wouldn’t go apespit if some state or country somewhere decided to give opioid-OTC a try. I wouldn’t want it to be my state, though.Report

              • Avatar dragonfrog says:

                Where I lived, it wasn’t even 21 to buy alcohol, it was 19.

                And yet – weed, somebody at the school that day would likely have some to sell. At lunch, you go across the street and into the alley, buy from the stock they have right there in their backpack, and you could be stoned in time for your afternoon classes if you felt like it.

                Nobody ran an actual speakeasy out of their locker. If you knew someone with an older sibling generally willing to pull at the liquor store, you had to go home with them, hope their sibling was home, butter them up so they’re specifically willing this time, give them money up front, wait for when it’s convenient for them to go to the store, meet up with them a second time to obtain your bottles. A fairly long turnaround time.Report

              • Avatar Troublesome Frog says:

                I agree with the general points being made here, but it’s also worth noting that alcohol is at a distinct disadvantage in terms of concealability and portability when compared to other drugs. Even carefully packaged in very high proof form, a single serving of alcohol is a lot harder to hide and carry around than a single serving of just about any other drug.Report

              • Avatar J_A says:

                When I was a child (under 10) my grandparents sent me to buy wine in bulk (BYOeB – bring your own empty bottle(s)) at the wine shop up street.

                Latin European children grow up handling alcohol, and partaking a bit of it from a young age. Alcohol is not an exotic, forbidden thing, and, as they grow up, are much less prone to binge drinking and alcohol deaths (not that they don’t exist).

                Teenagers being introduced to moderate alcohol consumption within the family would be a better way than sneaking into alleys, but again we run into the morality message wall. What kind of message am I giving my children if I give them a glass of wine in every family party since they are 12 or 14? Might as well teach my children about contraceptives. It’s better that they wait until they turn 21, and are away in college where they can die of alcohol poisoning pumped up in binge consumption by their frat brothers (or sorority sisters). The end results might be worse, but the message remains unsullied.Report

              • Avatar Kimmi says:

                In NJ, they used to send kids as young as 5 years old to pick up buckets of beer for their parents.Report

              • Avatar Morat20 says:

                There’s also the fact that the way teenagers ‘sneak’ alcohol tends to train them towards binge drinking and over-consumption.

                You’re either drinking it down before your parents/authority figures/whatever find out you’ve got it OR you’re indulging one rare night (someone’s parents are gone) before they get back.

                Either way, you’re basically learning to drink by doing as much as you can in as short of a time as you can.Report

            • Avatar Joe Sal says:

              I am just trying to gauge social control here. If it is what it is, the addict is an addict. Opium whether OTC or black market will make it to the addict. So social prohibitions/access is of little consepuence.Report

    • Avatar pillsy says:

      I wonder (not rhetorically) how much of a crisis we would be dealing with if we just allowed OTC sales of opioids to everyone over 21.Report

      • Avatar Chip Daniels says:

        I honestly don’t know, and am open to finding out.

        But the question is always, “so then what happens?”

        What usually lurks behind proposals is the unspoken image of a world in which we don’t have to deal with addicts; they won’t be sleeping in doorways, they won’t be panhandling on the subways, they won’t be loafing in the park.

        I mean, even look at the comments here, and the article in question; most of the outrage and indignation is about the effects of the Drug War on us, those who legitimately need painkillers, or cold medicines.

        Most proposals, from both right and left, is about how to cleave apart the fortunes of drug addicts and non addicts, to where whatever happens to them, it is out of sight and out of mind.Report

        • Avatar DensityDuck says:

          “so THEN WHAT HAPPENS, HUH?” is usually the viewpoint associated with the reactionary, conservative, Republican viewpoint.Report

          • Avatar Jaybird says:

            “We can’t do the change you’re suggesting because we want to avoid X.”
            “But X is happening now.”
            “But your changes will make X worse.”
            “The last three changes you’ve doubled-down upon made things worse.”
            “But we don’t want more X!”
            “BUT X IS HAPPENING NOW.”

            https://youtu.be/ORFoQHz9EXMReport

            • Avatar DensityDuck says:

              The point is not not-X, the point is to be against X. If X happens anyway, that’s an accident that nobody could have forseen or prevented.Report

              • Avatar Jaybird says:

                I’m not going to pretend that I don’t have any sympathy for the Deontology Over Utilitarianism argument.

                I do have problems when people make appeals to Deontology in their efforts to argue for a particular outcome.

                But that’s me being silly and pedantic.

                I should ask “Why are we doing this?” and if the answer is “well, because people using opiates when they shouldn’t be using opiates goes against the Tao”, well, we could explore the best way for our official government policy to help people flow with, rather than against, the Tao.

                If the answer is “we want to reduce opiate addiction”, then we should start measuring shit and paying attention to our policies that actually reduce opiate addiction.

                What in the hell are we trying to do, here? I don’t even understand what we’re trying to accomplish anymore.Report

              • Avatar Will Truman says:

                It’s a combination of trying to address real problems and trying to Do Something.

                The best things that they’re doing is monitoring prescriptions to prevent doc-shopping. They’re also doing more and more Drug Contracts, in which a patient signs a Drug Contract with a doctor where, as long as they keep following the rules, they will get a fair among of leeway as they try to work through their problem. (Rules include things like “Don’t go to the next county and try to hit them up for drugs.”)

                I look at some of the rules mentioned in the article, and some of them strike me as Doing Something approaches. I could bring it up with my wife and she could instruct me on the many ways that I am wrong, but at the very least they strike me as things that could be addressed through better monitoring. (ie If we had more faith that transferring a prescription wasn’t part of some game, we could certainly let them do that.)Report

              • Avatar Jaybird says:

                The argument always goes the same way though:

                “Here’s some utilitarian reason that we should change our policy.”
                “Here’s a deontological reason that it would be wrong to do that.”
                “Fine, here’s a deontological reason that official government policy is the wrong way to address this particular moral issue.”
                “But that would have a bad outcome!”Report

              • Avatar Will Truman says:

                I think what that reveals is the degree to which we view utilitarianism through a deontological lens, whether we realize it or not.Report

              • Avatar Jaybird says:

                But when you try to engage with that sort of thing at all, it becomes just like the Terminator: It can’t be bargained with. It can’t be reasoned with. It doesn’t feel pity, or remorse, or fear. And it absolutely will not stop… ever, until we are dead.Report

              • Avatar J_A says:

                @jaybird

                You seem to be ignoring that for many people the moral message is the important part (*).

                If you focus on reducing the use of opiates, tracking trends, setting up mechanisms for addicts to access the stuff legally, you are missing the message that opiate usage is intrinsically immoral, and there is no moral difference between having one user and one million users.

                Is why people oppose needle exchanges. Setting up a needle exchange program sends the message that you are willing to tolerate the immorality of drug usage. The additional deaths you could have avoided is a price worth paying to avoid sending mixed messages.

                Think of all the parents opposing Sex-Ed in schools. If they didn’t oppose it, it would mean that they were ok with their daughters engaging in sexual activity. Taking your daughter for a discreet abortion is a price these people are willing to pay.

                (*) you see this more in the USA than in Europe or LatAm, but you actually see it everywhere.Report

              • Avatar Jaybird says:

                The problem is that we’re okay (I think?) with people in pain taking painkillers.

                Which is the ultimate nose of the camel to allow that demon poppy into our society in the first place.Report

              • Avatar DensityDuck says:

                “What in the hell are we trying to do, here?”

                We’re trying to not be bad people.

                If I have “taking drugs is bad” as a philosophy, and I let someone take drugs when I might have stopped them, then I have done something bad, and therefore I’m a bad person.

                And if I stop one person taking drugs, then I’ve done a good thing, and therefore I’m a good person. Whether the means by which I stop that person taking drugs results in five other people taking more drugs than they might have done is irrelevant, for all have sinned and come short of the glory of God. That sinners sin is sad but not a personal tragedy; they started out that way, so if they stay that way it’s not my fault. That I saved even one is the triumph.Report

              • Avatar Oscar Gordon says:

                +100Report

              • Avatar Dark Matter says:

                @densityduck
                @jaybird

                If I have “taking drugs is bad” as a philosophy, and I let someone take drugs when I might have stopped them, then I have done something bad, and therefore I’m a bad person.

                Philosophically, it’s not just “drugs = bad” driving this. We also have “more state power = good” and “state power never has unintended side effects”.

                A large police force can be used for all sorts of things directly expands the power/budget of people who control/influence the gov.

                The drug war is a way to express that ideal, if we didn’t have that we’d have other “needs” which require the expansion of state power.Report

              • Avatar Dark Matter says:

                @jaybird

                What in the hell are we trying to do, here? I don’t even understand what we’re trying to accomplish anymore.

                I think we’re protecting jobs and entrenched interests.

                Lots of gov spending on the drug war means lots of other economic actors are dependant on that spending.Report

              • Avatar Jaybird says:

                At least this makes sense to me. “We’re creating crime where, otherwise, crime wouldn’t exist to pay for cops/guards.”

                Additionally, a person who is a murderer or rapist is demonstrably violent while a person who is addicted to painkillers is likely to be less threatening to the cops/guards.

                Win/win.Report

              • Avatar Dark Matter says:

                @jaybird

                DarkMatter: I think we’re protecting jobs and entrenched interests. Lots of gov spending on the drug war means lots of other economic actors are dependent on that spending.

                Jaybird: At least this makes sense to me. “We’re creating crime where, otherwise, crime wouldn’t exist to pay for cops/guards.”

                Another, maybe better, example is China’s One Child Policy. They’re going to need people in the next generation (so even the direct effects are bad), the indirect effects are also bad (male imbalance, etc), but the state agency which runs this is really powerful (it needed to be in order to force sterilization on unwilling people).

                State agencies & agents have a lot of influence on state policy, they don’t vote for their own termination.Report

              • Avatar Stillwater says:

                What in the hell are we trying to do, here? I don’t even understand what we’re trying to accomplish anymore.

                This.

                All I can come up with is American’s love of punition. It’s a sign of godliness. Or right next to it.Report

              • Avatar DensityDuck says:

                It’s like the way that people think carbon taxes aren’t high enough because there is still carbon emission.Report

              • Avatar Stillwater says:

                No, it’s not like carbon taxes at all. I completely understand a Pigouvian tax on carbon emissions; I have no idea what we’re trying to accomplish with our current drug policies and struggle to figure it out. Upthread, Dark mentioned that it’s about make work for jobs, but I disagree. If anything, it’s make profit for private prison owners. But even that explanation doesn’t make any sense given the scope of the insanity and the human and economic costs incurred.Report

              • Avatar Joe Sal says:

                “We are going to social engineer the fish out of X so we can control it!”

                “yeah but X is not socially controllable”

                “No, no, you don’t understand, we are going to social engineer the fish out of it, really get control of it.”Report

              • Avatar DensityDuck says:

                “Damn, it didn’t work. Must be more cheaters out there than we thought! Double the penalties, triple the compliance requirements!”Report

        • Avatar dragonfrog says:

          I guess. We will I think always have to deal with addicts, it’s just a question of how – by stepping over them in the street, by funding or directly providing their treatment or imprisonment, by supporting them while maintaining boundaries for our protection in our own families and friendships.

          A good number of good friends of mine have at various times stuggled with addictions (to opioids, amphetamines, alcohol, cocaine). As have a number of most of our friends, I’m sure – even if we don’t happen to know which friends or at what times. We have to deal with the addicted, we have to deal with being addicted ourselves sometimes.

          I mean, I don’t want the addicted to be sleeping in doorways or loafing in the park, whether their addiction is to something legal or illegal. And if they do still suffer homelessness for a time, I want their chances of regaining their footing maximized with support rather than the criminalization that (I believe) does much more to harm than help them.Report

      • Avatar Jaybird says:

        Whoa whoa whoa. Ease into this.

        Begin with Marijuana.Report

      • Avatar Morat20 says:

        I wonder what would happen if the FDA took a hammer to Oxycontin, and forced it’s makers to honestly assess it’s dosage and timing instructions.

        I’ve been hearing more and more that Oxy has been driving a lot of the pain pill abuse problems because, to be blunt, it doesn’t work as described. People start self-medicating higher dosages because Oxy doesn’t last the full prescribed length, so the pain creeps back well before they’re due another dose.

        That’s pretty much a recipe for over-use and addiction.Report

        • Avatar Kimmi says:

          A large part of back pain is best fixed by sending people to psychologists, as it’s psychosomatic.

          (Some medications don’t work for terribly long. MOST of them are required to put this on the tin (see steriods!) — and it’s part of usage instructions).Report

    • Avatar InMD says:

      I think you’re right, that there is no perfect solution, but to me that’s why we need to get more comfortable with harm reduction. Part of that is accepting that complete harm elimination isn’t attainable. In my ideal policy framework that means leaving review of medical decision making to licensing boards and the tort system, leaving well enough alone for people who recreationally ingest some substance or another on their own time but lead generally functional lives, and making available public assistance for people with serious addiction problems.

      The downside of that framework is that some people, no matter what’s made available to them, won’t get help. That’s tragic but I think it’s probably the best we can do, and more coercive measures have shown themselves to be worse than the disease. There is no such thing as a panacea.Report

      • Avatar Oscar Gordon says:

        If we are all OK with alcohol being legal, I’m really not sure what the issue with other drugs are? There is a lot of evidence to show that even when legal, most people will experiment a bit with a drug and then stop. For those that keep going, at best they become a highly functioning recreational user (akin to a person who drinks socially, but not much more), and at worse, a full blown addict. But the thing is, the statistics suggest that there isn’t some grand population of people who would become addicts but for the threat of criminal charges. The population that will become addicted to drugs, find a way to become addicted to something. Alcohol, pain meds, illegal drugs – they are all self-medicating in one way or another.

        Hell, think of it as an obvious indicator that a given person needs psychological or psychiatric help, once you get them detoxed.Report

        • Avatar InMD says:

          I have similar suspicions, that the type of debilitating hardcore addiction we’re talking about is more likely to be a symptom of some underlying psychological or socio-economic problem, rather than the cause. Anyone over 21 can freely walk into a store, buy gallons of liquor, and destroy themselves yet the vast majority of people chose not to.Report

  7. Avatar Dark Matter says:

    We get stories like this every few years. The next thing the drug warriors will do is take the licenses of any doctor who gives out “too many” (or “too long”, or whatever) prescriptions, which instantly means really bad things for chronic pain sufferers.Report

  8. Avatar John says:

    In the UK the government regulates and license online pharmacies in order for them to treat patients remotely. We found that doctors treating patients online include processes and checks that regular GP’s do not necessarily follow. The result is a vetting system that makes it almost impossible for patients to abuse opioids. When the data is stored securely online, access and compliance is more manageable and the result is a stronger relationship between patient and doctor. See https://www.whitepharmacy.co.uk for example.Report