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Culture War Roundup for the week of August 14, 2023

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It seems plausible that the absence of affordable housing for the first type of person creates a pipeline whereby they are more likely to become the second type of person.

This seems likely.

But, in my mind, the biggest thing that turns a type 1 down-on-their luck person into a type 2 pants pooper is the wide availability of fentanyl and heroin on the streets today.

Fixing housing affordability issues seems is a hard problem. Fixing housing affordability has never been done by any country (as far as I know).

Meanwhile, there are lots of countries with essentially zero drug use. Taiwan, China, Singapore, and Japan have don't have drugs. And unlike the Prohibition Al Capone memes, these countries also have very few if any gangs. We could reduce drug use by a ton and it wouldn't be that hard. All it would take is a serious effort to criminalize drugs.

And before anyone says "War on Drugs didn't work", we should take a look at the overdose stats. Overdoses deaths in the U.S. are up 1000% since the 1980s. The correct take, IMO, is that the war on drugs did work. We just didn't do it hard enough and gave up too soon.

But, in my mind, the biggest thing that turns a type 1 down-on-their luck person into a type 2 pants pooper is the wide availability of fentanyl and heroin on the streets today.

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.

And before anyone says "War on Drugs didn't work", we should take a look at the overdose stats. Overdoses deaths in the U.S. are up 1000% since the 1980s. The correct take, IMO, is that the war on drugs did work. We just didn't do it hard enough and gave up too soon.

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.

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.

If we do the same for opioids, usage will go through the roof

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.

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.

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.

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.

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).

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