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Is it worst because it's legal?
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I certainly can't come up with a better explanation.

I'm having some red wine now. I'm not having any crack now. Clearly alcohol does more damage to me.

In terms of harm, not addiction. Which should be not news to most I hope? Ethanol is really bad for you, unless you only use a little & externally

I bet we are not hearing the stories about all the healthy and functional heroin users mostly because it's illegal and socially unacceptable. It means public only knows about cases when poor people abuse it too much. Rich guy? You bet public never knows if he does it occasionally or did it a lot then went to rehab and recovered.

Yes, you can also get terminally addicted to ethanol and ruin your life. I've seen people like that. The biggest difference is perhaps that these people don't just destroy their body, ethanol abusers also tend to hurt or murder other people when they are high on the substance.

As opposed to that healthy crack.

I guess this is clickbait based on the fact that there are so many alcohol users that the total alcohol related damage is worse (think car accidents and such).

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I know a lot of people who have recovered from alcohol addiction and are living fairly normal lives.

ALL the people I’ve known that were trying to stop heroin are dead now. A big part of it is fentanyl but they were known to relapse more frequently and harder.

I don’t know anybody who works in recovery who would agree with this statement.

The resources and social stigma is vastly different between the two, and way worse for opiate users. The path for getting addicted in the first place is also very different, lots of opiate addicts got hooked after getting them prescribed to them
>The resources and social stigma is vastly different between the two, and way worse for opiate users.

I think that actually makes the numbers worse. Alcoholism can be masked somewhat because it's socially acceptable to drink. That often delays people seeking treatment for it, sometimes by decades. There's no broadly socially acceptable form of using opiates recreationally.

In terms of resources, it varies significantly but there is Narcan for overdoses and Methadone.

I've known people from wealthy backgrounds, who did several stints in rehabs and did not have to worry about having a job etc... they had all the "resources" in the world and still couldn't stay clean.

This isn't to say it's hopeless, I'm just saying anecdotally that the number of people I know who have been in recovery specifically for heroin and achieved long term sobriety (>2-3 years) is less than the people I knew who are now dead.

Obviously "worse" is a meaningless term unless you specify how it's worse. Maybe they're making a point that alcohol is worse overall for society because of how prevalent it is, but if I was a parent I'd 10000000% rather catch my 16 year old drinking beer than doing opiates of any form.

Theres also the fact that to overindulge on alcohol takes a remarkable volume of beer or an amount of liquor that would take a very concerted effort to down fast without sending back up soon after. I don’t know whether or not its possible to “microdose” on a recreational amount of heroin in the same way as drinking a single beer might do, forgetting potential fentanyl contamination, or if you would just be extremely high immediately with a lack of a built up opioid tolerance.
I mean, it’s definitely possible that an opiate could be produced that’s very low potency and delivered in the form of a drink if it was legal and there was consumer demand for such a thing. But it’s not and there isn’t.

The closest thing I’ve seen to “grabbing a beer” in the form of other recreational drugs is having a pull or two on a weed vape. I’ve had friends who are not in recovery/never had a substance abuse issue who do that. It’s probably better for you in the long run.

> I don’t know whether or not its possible to “microdose” on a recreational amount of heroin

Heroin was for some time used as a cough medicine. Does that qualify?

I think that the report is looking on how each drug affects society as a whole. Heroin is worse than alcohol for most individuals but alcohol is far more widespread so can cause more total harm.
This report needs an adjustment for patterns and prevalence of use. The adjustment would modify the ranking to conform to our expectations of the personal and social impact of drugs. Alcohol and tobacco would still be close to the top.
I think sugar, especially high fructose corn syrup, is even worse than alcohol, tobacco, crack, and heroin.
I know this is a funny and edgy meme to repeat but it's just... Factually wrong. Is it hard to cut out sugar? Sure. Mostly due to its availability and prevalence in processed foods. It has serious consequences in the long term but you can eat sugar regularly all your life in moderation person and not see serious advert effects if your diet is otherwise good. You can't consume Heroin in moderation without consequences and definitely not in the amounts we consume sugar...
How many families die per year hit by someone drunk on that sweet sweet corn syrup? How many people are assaulted physically and sexually? How many traumatized mentally? How many killed in a syrup stupor?

Sure, you can eat yourself to death. That affects you, and those who love you.

Alcohol can affect people who have nothing at all to do with the drinker, as well as affect their families, for generations to come.

I hope that you are trolling because if not you are so clueless that it amazes me someone could be so sheltered from reality, though I’m also happy that you don’t know either, it sucks.

Insulin resistance has been shown to be behind the top causes of mortality in the world: diabetes, heart disease, cancer and even dementias.

The #1 offender causing insulin resistance is sugar, there's no controversy around this.

Long ago I read a similar opinion about tobacco, saying it was harder to get off than heroin.

I asked an ex-junkie friend which was harder. She stared at me and said "Heroin - I reckon!", and I'm pretty sure she'd say the same of alcohol.

Important to point out they are talking about harm to self + harm to others. What's not clear is if they are looking at it from a society perspective or from the individual.

From a society perspective any drug with high prevalence of use should top the chart, because of the scale of harm.

In the case of cocaine I would argue that it can't be separated from alcohol. I don't know any cocaine user that doesn't consume it with alcohol, and most do it for the sole purpose of drinking more alcohol. There's a feedback loop where users get very drunk, take a line to feel better and energized, then drink a shit ton again, only to top it off with cocaine, rinse & repeat.