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I think it's meth much more than opiates. Opiates can kill you and make you unproductive, but they don't fry your brain and give you psychosis like hardcore simulants do.
The main reason overdoses are up is that fentanyl is really potent and easy to overdose on, but it's also the most popular illegal opiate because it's cheap to make and can be smuggled across the border in large quantities because it's so concentrated. If lower potency opiates (and narcan) could be purchased legally over the counter, fentanyl use and fentanyl deaths would plummet.
Only if we legalized it the right way, which we wouldn't. Look how we legalized marijuana. See how it's celebrated and commercialized now with billboards and brightly lit stores in every shitty small town in America. If we do the same for opioids, usage will go through the roof - as will overdoses.
I would advocate a method where junkies can, under medical supervision, get free opioids in a super boring and lame way that ensures no one will ever do it for fun. That would have the effect of making street dealers unprofitable while reducing the chance of non-junkies getting hooked. Long prison sentences for dealers will do the rest.
But that's exactly why street dealers would still be popular.
And that's why we should arrest the dealers and throw them in prison for decades.
Push/pull works better than just push (prison) or pull (medically-supervised injections) alone.
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Usage would go up, but overdoses would plummet because people could dose accurately.
Why do you assume they would? People are dumb and don't pay attention to what's in their chicken nuggets - suddenly they're going to turn into savvy consumers when it comes to doing complex chemistry calculations to determine correct dosing, and batch testing to ensure that the product isn't being stepped on or cut with fentanyl as it often is currently?
This is what junkies do already -- many of them are good enough at it to survive for many years!
If the junk is government supplied/inspected, the whole point is that is won't be stepped on -- inform them of a dose that is unlikely to kill a zero-tolerance user, and let them figure the rest out themselves. They are quite resourceful -- this way if they OD at least nobody will be able to say it wasn't their 'fault'.
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You don't need the dependent clause. We can just do the math (economics). Many moons ago, at the old old old place, I did an estimate, ignoring any effect of removing criminal penalties, ignoring any effect of branding/marketing/whathaveyou, ignoring any cultural or other developments which could change the elasticities, of how usage of marijuana might change in response to the change in price that was observed. Let's just say that anyone who thinks that usage of drugs is going to go down (or even stay flat) in response to legalization is getting high on their own supply. Marginal Revolution just referred to Portugal. The Bloody Atlantic is almost going after Oregon. It was trendy to think otherwise for a while (I believed it when I was a kid), but like most silly lefty trends, at some point the need to shut out the data and embrace cognitive dissonance becomes too difficult.
The question isn't whether drug use will go down; it's whether ODs will go down. I suspect they would; if you know how much you're getting you're not going to OD because your usual hit is 10x the potency.
Of course if you legalized hard drugs the way pot has been legalized in NY or NJ that might not work, but that's because government can screw anything up. You also can't just decriminalize possession (like Oregon did); you have to legalize production and sales.
This line of thinking is tempting as well, that it's just product uncertainty. There may be some factor, but I'm skeptical that it would be the overwhelming factor that a lot of people think. One could easily talk about two movies from this image. In one movie, fentanyl is primarily about product uncertainty, and that has driven a rise in deaths. In another movie, fentanyl is just way more potent and way more dangerous in general, so of course it's going to be higher. But hell, there are still quite a few prescription opioid deaths there; those are chugging along, even though they don't have the same product uncertainty problem. Instead, they mostly fit into the ordering just fine in terms of inherent danger of the substance, regardless of product uncertainty.
Even alcohol is still chugging along, causing deaths, even though there's basically no product uncertainty there. People still try to cram as much as they can into their bodies, just to see if they can and to see if it feels "super awesome, yo". They still party and try different shit, not actually paying all that much attention to what someone is pouring for them or what pill was handed to them. Certainly not carefully looking up the risk statistics of mixing substances and consulting a dosing chart or whatever. Nah, it's, "GET DAT SHIT IN ME AND LET'S GET SUPER HIGH!"
Maybe I'll try putting it this way... the belief that it's just about product uncertainty smells to me a lot like one of Rob Henderson's luxury beliefs. Sure, you may be a rich upper class person who can manage to make casual cocaine holiday work in your life, so long as there isn't product uncertainty in your cocaine, but for many many other people, life just isn't like that. Intense addiction, the need to try always-increasing quantities, and frankly low intelligence/conscientiousness is just going to lead to deaths mostly in proportion to how inherently dangerous the substances are. Product uncertainty can play a role, but a more minor one.
Finally, even if acute ODs do go down a little, what is the cost in terms of long-term mortality? During alcohol prohibition, the government was literally poisoning alcohol, and yet the health benefits in terms of long-term mortality and such were much more significant than the acute effects of their literal, intentional poisoning.
Overdose deaths will certainly keep "chugging along" even without product uncertainty (or inconsistency). Some number will be suicides, some will be chasing a greater high that tolerance has taken away. But I think the best explanation for the increase in deaths is the uncertainty/inconsistency. (I distinguish the two because an inconsistent but known product could be safe in theory, but as you say addicts aren't going to do the math).
As far as I know though, except simply in absolute amount of substance, fentanyl isn't more dangerous than heroin. Fentanyl's therapeutic index -- its ratio of lethal dose to effective dose -- is 400 compared to morphine's 70. I haven't been able to find heroin's TI (it's not prescribed in the US; I would expect UK data but perhaps they use a different term), but it's likely closer to morphine's. It's possible the euphoric dose is (relative to fatal dose) much higher than that of heroin, or that it has a larger tolerance effect, but I know of no evidence for etiher those conjectures. Instead, it seems it's just that the small absolute amounts of the substance are much harder (for both technical and non-technical reasons) for the illegal pharmaceuticals industry to control. The legitimate pharmaceuticals industry has no such problem; it can produce consistent doses even with the far more potent (100x stronger than fentanyl) carfentanil, though there's worker safety problems there.
I think we agree here, but disagree on how inherently dangerous the substances are. Note that "the need to try always-increasing quantities" is part of the inherent danger; some drugs cause more tolerance than others, and sometimes the (acute) lethal dose changes with tolerance.
I think TI alone isn't the right metric to look at. Wiki would put cocaine and alcohol as similar (15 and 10, respectively), even worse than morphine. Rather than it being only a manufacturing concern, I think there's a significant consumability concern, probably with factors of tolerance/euphoric dose/need-to-try-more as you mention, as well as the culture around consumption. Like, you still have to try pretty darn hard to physically consume enough alcohol before your body starts rejecting it (or build up enough of a tolerance). "I'm already drunk as hell, but I want to push to even higher levels.... oops, now I'm asleep," seems to be somewhat of a limiting factor. "I'm already high as hell, but can you imagine popping one or two more before dozing off?" ...takes about five seconds. And that doesn't even account for mixing drugs. Been drinking half the night, just took a hit of whatever, now you're not thinking straight, just thinking about how desperately your body wants to get suuuuuper high right now. You're probably not going to be rationally counting out your pills or whatever according to a dosing chart (for values of "you" that include far less intelligent/conscientious classes of people than you, particularly).
Alcohol is safer (at least in the short term) for various reasons, like the dose one can survive goes up with tolerance, and the difficulty of getting a fatal dose into you without working at it (though college students regularly manage). But I don't think those kinds of differences exist between the commonly-abused opioids. I'm not saying fentanyl would be as safe as alcohol if the dose was controlled, I'm saying it would probably be at least as safe as heroin. And that the massive increase in OD deaths that coincides with the introduction of fentanyl is primarily due to the inconsistency, not the inherent danger.
Also in the alcohol case, I suspect if instead of the common packaging for serious abusers being bum wine or some sort of standard-proof cheap liquor (which are easily distinguishable from each other), it was whatever the addict could get ranging between 5% and 90% alcohol, plus perhaps some isopropyl alcohol mixed in, and the addict couldn't immediately tell the difference by the taste/burn, we'd have a lot more overdoses.
I maintain that "I can imagine a product being adulterated by bad things" is not sufficient reasoning for population rates. One data point that would have to be explained in the chart I linked is the prevalence of prescription opioid deaths. Why aren't other illegal substances, which are presumably adulterated with rat poison, also off the charts in comparison?
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Most definitely agreed. And now with xylazine, you've got straight methanol or rat poison or something in 1/a few hundred or so? of these bottles of "booze".
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The key thing isn’t the treatment options. Surprisingly opiates are enjoyable and they don’t want to quit and they also don’t want to do it in the environment you describe.
Jailing dealers would do a lot of the heavy work alone. Clearing out the city-center encampments for doing the dope would do a lot. Yes I know you said long prison sentences for dealers but that’s the hard part we have no appetite for right now. Afghanistan solved the dope issue without treatment centers. They just jailed everyone high for a couple months till they were sober.
Also supposedly the Euro countries that did the legalizing thing cleared out the encampments etc. but I don’t see political will in those cities to do that.
Yes, I agree. Clearly strict enforcement is the only real way to solve the opioid problem which is currently killing over 100,000 Americans every year. Every "soft" method has either been ineffective or made the problem worse. But I do think a push/pull might work better than push alone. Giving junkies a way to comply with the law without having to go clean seems like a useful outlet valve for when we do start actually arresting dealers.
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There's something amusingly ironic about Afghanistan, a country the US military helped to ensure produced large amounts of opiates during the occupation, being capable of solving this particular issue.
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Scandinavian way, System shops for drugs? Does it work in Sweden in lowering alcohol use?
Yes. Somewhat.
"In 2016, annual alcohol consumption per capita (for those aged 15 years and older) was 9.2 liters of pure alcohol in Sweden and 7.5 liters in Norway, compared to the European region's average of 10.3 liters."
The monopoly/system shops way of selling alcohol means that there will be no advertising and no discount/bulk buying which would lead to over-consumption.
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The report (or executive summary) also cites meth.
I realize that meth is probably cheaper per hour spent fucked up, but when you have twice as many tweakers as drunks…
I've spoken to bosses of low-skilled labor who actively prefer hiring alcoholics because if they're drunk every night, they go to bed before 10, and get up at 4 too hung over to go back to sleep, and get to work on time because what the fuck else you gonna do in the morning, and then do their work until quitting time because they don't want to be pressured to take overtime- that would cut into their drinking- so on the whole they're a lot better workers than tweakers or potheads. It's possible that low functionality people do better on booze, at least compared to other substances.
The problem with drunks is that they commit violent crimes (particularly domestic ones) in a way which potheads don't - not that they can't hold down jobs. In most of America, also that it is impossible for non-rich people to avoid driving (rich people can afford taxis) so if you are drinking you are probably drink-driving. Stimulants don't make you as bad a driver as depressants like alcohol.
At least, not until the potheads turn psychotic. At that point they're perfectly capable of violence.
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