Overeating also kills.
Lack of exercise kills and so on.
Opiods are different, IMO, because they are generally issued by doctors, and they can kill you pretty quickly. Alcohol and tobacco, while dangerous, do give quite a bit of time to change and be saved.
Obviously the govt should do anti-smoking campaigns, but opiods are different.
> Alcohol and tobacco, while dangerous, do give quite a bit of time to change and be saved.
The typical tobacco death is someone in their 70s, whereas the typical alcohol death is someone in their 30s. (The majority of alcohol-related deaths are from suicide, car crashes, and slip-and-fall type injuries.) I doubt the types of deaths we're seeing from heroin are that much different than with alcohol.
True, but alcohol deaths are a much lower percentage of the drinking population than opioid deaths are to opioid users. That makes it more difficult to reduce imo. Alcohol kills indirectly in such a way that aside from efforts to curb drunk driving or drinking altogether there's not much that can be done. Personally I think mandatory breathalyzer ignition locks are probably the best you could do to quickly cut down on alcohol related deaths.
> alcohol deaths are a much lower percentage of the drinking population than opioid deaths are to opioid users
Unlike alcohol and tobacco, a lot of opioid use is illegal, and a lot is prescribed by doctors - this makes for a very different playing field.
If opioids were legally and openly sold, it would likely have a big impact (I'm not saying they should be, BTW).
Regulation would mean quality control, so you'd be much more likely to get what you thought you were buying.
Another example, if choice was available, almost no recreational opioid user would choose fentantyl or some of the random opioid RCs that pop up, instead opting for safer versions.
drunk driving deaths are a tiny fraction of deaths caused by or hastened by alcohol.
About 11,000 people die in drink driving accidents in the US. Compare that to only cirrhosis, which kills over 30,000 people per year. Excessive alcohol causes about 1 in 10 deaths in the 18-64 age group in the US.
I fear that we will overcorrect and make painkillers hard to get for people that are suffering. In some countries, the chronically ill are unable to get access to powerful painkillers and that is a damn shame.
I also think that we need more research into pain-fighting interventions to develop non-opioid painkillers.
With kratom, as long as you don't escalate your dose, tolerance never seems to develop.
I've been on a weak opioid (prescription!) for over 2 years now. The 'good sensations' left after only a couple of weeks of taking it, but it's still as effective on pain now as it was at the start.
I don’t think they are, honestly. They are all dangerous substances that should be controlled or banned. However there’s no appetite to ban tobacco or alcohol. The latter was actually tried in the US and failed miserably. Persecuting opioid users has also been tried and failed miserably for exactly the same reasons.
The question is what lessons do we learn from this? Tobacco and alcohol use are treated as public health issues. That should continue and be extended. This has been shown to work where outright criminalizatuon has been shown to fail.
The same lesson should be applied to opioids. I don’t believe they should be legalised. As in Portugal, non medical sales should still be illegal and treated as just as serious a crime as now, but use should not. Possession of small amounts should be no more criminal that having a few too many cigarettes in your airline baggage, it should be an administrative offence. Doctors should be able to treat, help and support opioid addicts just as much as they help alcoholics without risking being treated as accessories to a crime. Providing clean needles should not be treated as a crime aiding and abetting drug use. Hundreds of thousands of users with no history of violent crime and convicted solely on the grounds of possession should be at home with their families and no more persecuted that smokers or drinkers. Crack down on the dealers and support the users to get them back into society, turn users into allies against the trade by treating them as victims. It’s been shown to work.
What about the percentage of users vs deaths? The numbers speak of something, but it would be unwise to use the numbers as a metric to say that opioids are safer than tobacco and alcohol.
And besides the whole rise of organized crime thing, it was a fabulous success!
Did you know that the customer warranty didn't exist before prohibition? People were generally so drunk that it wasn't considered a viable option to warranty your products because people would break them in their drunkenness.
The author seems to be striving to miss the point.
There's a big difference between dying of cirrhosis, heart disease, diabetes, lung cancer, emphysema, etc in middle age and a 19-year-old kid OD'ing a couple of weeks or months after falling down the addiction spiral.
It's not just the number of deaths, it's the impact to society. Line cooks don't steal kitchen equipment to buy booze and smokes. Opiate addiction upends lives in a way that alcohol and tobacco simply do not.
One cause (some say a or the major cause) of the agricultural revolution was a desire to make alcohol more efficiently. Can we count all the people who are alive because the agricultural revolution on the side of alcohol?
I think the author has nailed the point, spot on. A person's life is valuable, regardless of their age and morbidity (or how they came to acquire a lethal health condition). I've see so many people arguing that "because this afflicts younger people, this is the more important crisis." That's a red herring of the worst sort. Resources should be focused on the problem of the greatest magnitude, with which the most net-social-good can be created. The emotionalism surrounding the "opoid epidemic" is little more than that, emotionalism.
>Every day, 28 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This is one death every 51 minutes. The annual cost of alcohol-related crashes totals more than $44 billion.
Keep in mind any solution, including painkiller cutbacks, is proven to result in increased heroin usage (see: oxycontin reformulation in the early 2000's. By the end if the decade all abusable oxycontin would be gone.)
People are dying because heroin is illegal. Full stop. Fentanyl cut in heroin is a result of a broken approach.
That difference is mainly legal status. Make alcohol and tobacco illegal and you'll see line cooks stealing to buy booze and smokes, organized crime around the industry, and everything we currently have with other illegal drugs. Hell, you don't even have to run this thought experiment yourself, but just read books about prohibition.
Also, what's the difference between a 19-year-old kid OD'ing a couple of weeks or months after falling down the addiction spiral and a 19-year-old kid dying in a car crash from drinking and driving a couple of weeks or months after falling down the addiction spiral (of alcohol)?
The subtitle is "Should they be considered an “epidemic”" and it says in the article "We don’t often call alcohol or tobacco “epidemics,” even as we regularly use that same language for opioids that are linked to a fraction of the deaths from alcohol or tobacco.".
They are basically proposing to re-define epidemic. Traditionally, an epidemic is the rapid spread of something, usually a disease but not necessarily. Alcohol and tobacco have already rapidly spread. There's nowhere else for them to spread.
Feels like people are forgetting that Endemic is the perfect word for this sort of thing...They don't need to redefine epidemic; they need to use a more accurate word.
It boggles me that we still are faced with aggregated statistics to deny there is opioid crisis going on. If nothing else, alcohol and tobacco are also prone to addiction and should be curbed as well.
I've never been a fan of these kinds of articles. They beg the question "Why arent we doing X?". There's a similar article about "Why aren't we stopping gamblers from addictive behavior?" on HN's front page. They seem to share a trend:
They look for legalistic controls over an individuals actions. And both attempt to say that their actions are addictive, therefore we cannot trust their actions, so we have to decide for them. I'm not comfortable with that logic. Nor am I for shoving more drugs underground. Cause that's that high taxation and controls do.
I tend to go on the side of freedom, even if it's "free to be dumb". And people will do destructive things. I don't particularly like this notion of nanny state.
People ought to get used to erring on the side of freedom.
Heroin is being cut with fentanyl because heroin is super fucking illegal for nothing more than political leverage over 1960's blacks in the US.
Err on the side of freedom today, save 500 million in price gouged narcan tomorrow.
You can ban everything you want, lock up dealers and distributors, sue doctors, burn poppies etc all day long. You'll just step on more used syringes until each one of us has some tough fucking conversations with each other in these United States of America.
These articles are written by lobbyists. They just want to open up new fronts in the discussion to hinder any change that might threaten the status quo. It's the same with NRA lobbyists, big tobacco in Africa and Asia, big oil companies and soda companies who use high fructose corn syrup.
> I tend to go on the side of freedom, even if it's "free to be dumb"
The issue is not as simple as you characterize it. Should 'freedom to be dumb' include freedom to drive drunk/while texting?
>And both attempt to say that their actions are addictive, therefore we cannot trust their actions, so we have to decide for them.
You seem to think that these controls exist for the protection of the addicts. They don't. They exist to protect the society and economy from a downward spiral caused by widespread drug addiction - which is what will happen if you remove all controls.
DWI is a broad limitation on the use of any substance that impairs its user while driving. Texting is called "distracted driving" in some states/countries.
The drugs can be made legal, the consequences would still be the same. Except in cases where someone smoked cannabis last week and it still shows up a week later as metabolites, which is only a problem because the substance is illegal in most states still.
> The issue is not as simple as you characterize it. Should 'freedom to be dumb' include freedom to drive drunk/while texting?
But, it is. No law stops drunk driving. It is "illegal", but that's only a threat after the fact. And bringing cell phones is only a recent phenomenon.. How about people who read books while driving, or eating, or a thousand different things?
You only need 1 law for this: distracted driving. Distracted can be from doing things unrelated to driving, or being high, or drunk, sleepy, or whatever.
And I also have issue with "drunk driving". The .08 standard is not based in science. It's from MADD lobbying. And to be honest, if someone drives well at .08, so be it. People have different sensitivities - you should reasonably know if you're not safe.
> You seem to think that these controls exist for the protection of the addicts. They don't. They exist to protect the society and economy from a downward spiral caused by widespread drug addiction - which is what will happen if you remove all controls.
So throwing people in metal cages is a good solution here? Cause that's the cost that the US has accepted when violating these controls. And these laws don't exactly have a good result either.
>So throwing people in metal cages is a good solution here? Cause that's the cost that the US has accepted when violating these controls. And these laws don't exactly have a good result either.
Compared to the Opium Wars where China had to go to war with Britain to prevent civilizational collapse from drug use, yes jailing peddlers of poison seems acceptable.
Given my ignorance on the subject, it was called the Opium wars, but it was more about direct trade routes and rights of sovereignty in China vs British.
It's a lot more complicated than your comment portrays. All I can assume, is that you saw Opium wars, and try to use it as some emotional plea.
Sorry, not buying it.
I would rather have the Portuguese system than the current lock everyone up one. Cause we know it doesn't work. And thats experimental data, not theoretical.
I’ve never heard of a court ordering drug addicts to consume alcohol or tobacco as part of their sentence. In certain states however, courts routinely order addicts into opioid drug replacement therapy programs during sentencing.
We haven't criminalized alcohol or tobacco addiction in the same way we have other drugs, so that's not really a reasonable comparison. Tobacco cessation programs do use tobacco substitutes like gum, patches, etc. though, and there's been some experimentation with providing small doses of alcohol to people recovering from serious alcohol addiction.
Actually, most of the opioid epidemic is perfectly legal, as they are pharmaceutically-manufactured substitutes for the Opiates found in street drugs like heroin. Which brings up my secondary point, doctors don't prescribe tobacco nor alcohol. Nor do doctors receive incentives from pharmaceutical companies for prescribing tobacco and alcohol, but they do receive incentives for prescribing opioids. https://arstechnica.com/tech-policy/2017/10/doj-billionaire-...
That said, are you asserting that society's answer for someone out of control on Opiates is for the state to mandate Opioid use? The addicts I work with all tell me on no uncertain terms that kicking opioids is much harder than kicking opiates.
Living in Berlin and coming from Eastern Europe I would say that people smoke and drink a lot more than US.
It’s quite normal to have a glass of wine with your business lunch in Italy and Portugal. As well as a cigarette allowed restaurants in Czech Republic, and smokers bars here in Berlin.
Almost everyone drinks and smokes at least on the weekend. I was really shocked when I visited SF 2 months ago to discover that having a beer and a cigarette is impossible at any bar I tried ( smoking was forbidden 20 feet from entrance ).
Not sure how does it help reduce the death percentage compared to here ( Europe ) where most people consume moderately.
This doesn't seem to be the right metric. Surely, alcohol and tobacco are more common than opioids. To judge how defensible a certain consumption or action is, surely you need to see to the danger _per instance_. If not, I'm sure there are many other, perfectly normal, things that would en up on top of the list.
Indeed, falling down the stairs probably kills more people annually than opioid overdose does, but you're never going to hear anyone complain about how dangerous they are.
Actually slip, trip and fall accidents are a huge safety focus. Regulations can ensure stairs are designed to make falling less likely to cause serious injuries. Or, of course, as with most things Americans can insist their "freedom" to suffer so that somebody else can make a buck comes first.
Another big cause of household accidents is excessively hot water. Sure the kitchen sink might need the possibility of water hot enough to clean grease off a steel pan, but you don't need that for bathing your baby. So some countries legally require bathroom outlets are thermostatically controlled to a fixed limit, if there's not enough cold pressure to hit the limit, the water shuts off safely rather than char you. Simple mechanical valves can do this, and they're not that expensive - once a country is buying them for everybody.
Why do we spend billions of dollars on airport security when nobody in this country dies from terrorism, yet 66,000 people die every year from guns and cars? Because we're fine with people dying en masse if it doesn't bother our morals or make us afraid.
Also, thanks for flagging this article. Intellectual discussion about critical health and safety issues is clearly off topic.
This article tackles death from hundreds and thousands of individual choices as if it were death by accident which a few regulations could cut in half. Everyone knows smoking kills you quicker, but still 11% of U.S. adults choose to smoke. You want to increase the burden on their already burdened existence? Have a heart. Let people slowly kill themselves in peace.
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[ 3.6 ms ] story [ 158 ms ] threadOpiods are different, IMO, because they are generally issued by doctors, and they can kill you pretty quickly. Alcohol and tobacco, while dangerous, do give quite a bit of time to change and be saved.
Obviously the govt should do anti-smoking campaigns, but opiods are different.
The typical tobacco death is someone in their 70s, whereas the typical alcohol death is someone in their 30s. (The majority of alcohol-related deaths are from suicide, car crashes, and slip-and-fall type injuries.) I doubt the types of deaths we're seeing from heroin are that much different than with alcohol.
Unlike alcohol and tobacco, a lot of opioid use is illegal, and a lot is prescribed by doctors - this makes for a very different playing field.
If opioids were legally and openly sold, it would likely have a big impact (I'm not saying they should be, BTW).
Regulation would mean quality control, so you'd be much more likely to get what you thought you were buying.
Another example, if choice was available, almost no recreational opioid user would choose fentantyl or some of the random opioid RCs that pop up, instead opting for safer versions.
About 11,000 people die in drink driving accidents in the US. Compare that to only cirrhosis, which kills over 30,000 people per year. Excessive alcohol causes about 1 in 10 deaths in the 18-64 age group in the US.
I also think that we need more research into pain-fighting interventions to develop non-opioid painkillers.
We don't need to demonise opioids, we need to carefully control their use.
doesn't the body get used to opiods so x months or weeks later they no longer work as before? If so, seems like a losing game
With kratom, as long as you don't escalate your dose, tolerance never seems to develop.
I've been on a weak opioid (prescription!) for over 2 years now. The 'good sensations' left after only a couple of weeks of taking it, but it's still as effective on pain now as it was at the start.
The question is what lessons do we learn from this? Tobacco and alcohol use are treated as public health issues. That should continue and be extended. This has been shown to work where outright criminalizatuon has been shown to fail.
The same lesson should be applied to opioids. I don’t believe they should be legalised. As in Portugal, non medical sales should still be illegal and treated as just as serious a crime as now, but use should not. Possession of small amounts should be no more criminal that having a few too many cigarettes in your airline baggage, it should be an administrative offence. Doctors should be able to treat, help and support opioid addicts just as much as they help alcoholics without risking being treated as accessories to a crime. Providing clean needles should not be treated as a crime aiding and abetting drug use. Hundreds of thousands of users with no history of violent crime and convicted solely on the grounds of possession should be at home with their families and no more persecuted that smokers or drinkers. Crack down on the dealers and support the users to get them back into society, turn users into allies against the trade by treating them as victims. It’s been shown to work.
Did you know that the customer warranty didn't exist before prohibition? People were generally so drunk that it wasn't considered a viable option to warranty your products because people would break them in their drunkenness.
There's a big difference between dying of cirrhosis, heart disease, diabetes, lung cancer, emphysema, etc in middle age and a 19-year-old kid OD'ing a couple of weeks or months after falling down the addiction spiral.
It's not just the number of deaths, it's the impact to society. Line cooks don't steal kitchen equipment to buy booze and smokes. Opiate addiction upends lives in a way that alcohol and tobacco simply do not.
https://www.cdc.gov/motorvehiclesafety/impaired_driving/impa...
>Every day, 28 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This is one death every 51 minutes. The annual cost of alcohol-related crashes totals more than $44 billion.
Keep in mind any solution, including painkiller cutbacks, is proven to result in increased heroin usage (see: oxycontin reformulation in the early 2000's. By the end if the decade all abusable oxycontin would be gone.)
People are dying because heroin is illegal. Full stop. Fentanyl cut in heroin is a result of a broken approach.
Also, what's the difference between a 19-year-old kid OD'ing a couple of weeks or months after falling down the addiction spiral and a 19-year-old kid dying in a car crash from drinking and driving a couple of weeks or months after falling down the addiction spiral (of alcohol)?
They are basically proposing to re-define epidemic. Traditionally, an epidemic is the rapid spread of something, usually a disease but not necessarily. Alcohol and tobacco have already rapidly spread. There's nowhere else for them to spread.
They look for legalistic controls over an individuals actions. And both attempt to say that their actions are addictive, therefore we cannot trust their actions, so we have to decide for them. I'm not comfortable with that logic. Nor am I for shoving more drugs underground. Cause that's that high taxation and controls do.
I tend to go on the side of freedom, even if it's "free to be dumb". And people will do destructive things. I don't particularly like this notion of nanny state.
Heroin is being cut with fentanyl because heroin is super fucking illegal for nothing more than political leverage over 1960's blacks in the US.
Err on the side of freedom today, save 500 million in price gouged narcan tomorrow.
You can ban everything you want, lock up dealers and distributors, sue doctors, burn poppies etc all day long. You'll just step on more used syringes until each one of us has some tough fucking conversations with each other in these United States of America.
The issue is not as simple as you characterize it. Should 'freedom to be dumb' include freedom to drive drunk/while texting?
>And both attempt to say that their actions are addictive, therefore we cannot trust their actions, so we have to decide for them.
You seem to think that these controls exist for the protection of the addicts. They don't. They exist to protect the society and economy from a downward spiral caused by widespread drug addiction - which is what will happen if you remove all controls.
The drugs can be made legal, the consequences would still be the same. Except in cases where someone smoked cannabis last week and it still shows up a week later as metabolites, which is only a problem because the substance is illegal in most states still.
But, it is. No law stops drunk driving. It is "illegal", but that's only a threat after the fact. And bringing cell phones is only a recent phenomenon.. How about people who read books while driving, or eating, or a thousand different things?
You only need 1 law for this: distracted driving. Distracted can be from doing things unrelated to driving, or being high, or drunk, sleepy, or whatever.
And I also have issue with "drunk driving". The .08 standard is not based in science. It's from MADD lobbying. And to be honest, if someone drives well at .08, so be it. People have different sensitivities - you should reasonably know if you're not safe.
> You seem to think that these controls exist for the protection of the addicts. They don't. They exist to protect the society and economy from a downward spiral caused by widespread drug addiction - which is what will happen if you remove all controls.
So throwing people in metal cages is a good solution here? Cause that's the cost that the US has accepted when violating these controls. And these laws don't exactly have a good result either.
Compared to the Opium Wars where China had to go to war with Britain to prevent civilizational collapse from drug use, yes jailing peddlers of poison seems acceptable.
It's a lot more complicated than your comment portrays. All I can assume, is that you saw Opium wars, and try to use it as some emotional plea.
Sorry, not buying it.
I would rather have the Portuguese system than the current lock everyone up one. Cause we know it doesn't work. And thats experimental data, not theoretical.
That said, are you asserting that society's answer for someone out of control on Opiates is for the state to mandate Opioid use? The addicts I work with all tell me on no uncertain terms that kicking opioids is much harder than kicking opiates.
It’s quite normal to have a glass of wine with your business lunch in Italy and Portugal. As well as a cigarette allowed restaurants in Czech Republic, and smokers bars here in Berlin.
Almost everyone drinks and smokes at least on the weekend. I was really shocked when I visited SF 2 months ago to discover that having a beer and a cigarette is impossible at any bar I tried ( smoking was forbidden 20 feet from entrance ).
Not sure how does it help reduce the death percentage compared to here ( Europe ) where most people consume moderately.
Another big cause of household accidents is excessively hot water. Sure the kitchen sink might need the possibility of water hot enough to clean grease off a steel pan, but you don't need that for bathing your baby. So some countries legally require bathroom outlets are thermostatically controlled to a fixed limit, if there's not enough cold pressure to hit the limit, the water shuts off safely rather than char you. Simple mechanical valves can do this, and they're not that expensive - once a country is buying them for everybody.
Also, thanks for flagging this article. Intellectual discussion about critical health and safety issues is clearly off topic.